Category: Nursing

Rough Draft Qualitative Research Critique and Ethical Considerations

Quantitative Research Critique

Quantitative Study

“Chun-Hung, L., Jui-Hsiu, T., Shihn-Sheng, W., Yang-Pei, C., Yen-Hsia m W., Jian-Shing, L. & For-Wey, L. (2014). Quantitative comorbidity risk assessment of dementia in Taiwan: A population-based cohort study.
Medicine
, 97(15), e0298. doi: 10.1097/MD.0000000000010298”

Background of Study

The article contends that although dementia is acknowledged to be a burdensome ailment among elderly patients, management efforts have been hindered by limited knowledge on the multiple risk-factors for dementia. This is a source of concern since medical personnel can simply focus on controlling the risk factors to effectively manage dementia. The need for this information is further enhanced by the awareness that elderly persons suffer from age-based declines that make them prone to chronic ailments. Based on this knowledge, there is a need to develop a good understanding of the specific comorbidities for dementia among elderly persons with the intervention of presenting a simple, rapid and appropriate predictive tool. To facilitate the efforts, regression analysis fitted with Bayesian inference approach is discussed as a good tool for comparing multiple variables as is the present case. In this respect, the article quantitatively explores the comorbidities linked with dementia. Rough Draft Qualitative Research Critique and Ethical Considerations.

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Methods of Study

The research applied a quantitative approach that used a population-based cohort design. In this case, 4,749 dementia patients were recruited into the study. These participants had been diagnosed with the dementia between 2000 and 2009, based on the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic criteria (ICD-9-CM 290, 294.1–294.2, A210, A213, or A222). They were older than 64 years in 2000. Another inclusion criteria was that the participants had to have inpatient files for dementia. All the participants were recruited from the Taiwan National Health Insurance Research Database. Once the participants’ data was collected, it was subjected to a logistical regression model that applied Bayesian supervised learning inference. The model intended to assess the quantifiable effects of six comorbidity risk factors and socio-demographic features for dementia in elderly persons as identified in the Taiwan national longitudinal population-based database. The six comorbidity risk factors included senile cataract, diabetes mellitus, hearing loss, severe head injury, vascular disease, and depression. Rough Draft Qualitative Research Critique and Ethical Considerations. Other than the six comorbidity risk factors, analysis was also conducted for socio-demographic factors that included gender, age, monthly income and urban residence.

The research methodology is appropriate. That is because it allowed the study to access a large sample who were then recruited for the research. This implies that the right data could be collected and subjected to statistical analysis before interpretation. In essence, the methodology allowed for a true assessment of the factors that could influence depression parameters among elderly patients. In addition, the comprehensive exhibition of the research methodology expedites research replication efforts. Also, there is an indication that researcher bias was minimized by using data collected from a previous national survey so that the researcher did not need to prepare new data collection tools and only had to ‘copy and paste’ data that was already available. The only notable shortcoming that can be discerned in the methodology is that the authors do not mention if an independent third-party was approached to conduct verification and accuracy checks Rough Draft Qualitative Research Critique and Ethical Considerations. A second shortcoming is that there is no mention about the software that was applied for data analysis. This makes it difficult to verify the results in terms of truthfulness. The mentioned shortcomings are an indication that there were opportunities for bias in the research.

Results of Study

The study recruited 4,749 participants who met the inclusion criteria. Statistical analysis results from the model indicated that advanced age, female gender, urban residence and low income are socio-demographic risk factors for dementia among elderly persons. In addition, the results indicated that the odds of dementia had a direct correlation with the comorbidity and socio-demographic risk factors. This implies that one factor had lower odds ratio when compared to two or more factors with the odds increased with every increase in the number of factors that are present.

These results are valuable to nursing practitioners since they present evidence that support efforts to profile dementia. They show a clear correlation between the dementia and factors under review so that nurses will have evidence to support advice offered to patients with a plurality of factors, particularly when the advice is in relation to dementia management. Although the study does not make suggestions for future studies, it identifies limitations present in the current study. Addressing the mentioned limitations is an opportunity for future research. Rough Draft Qualitative Research Critique and Ethical Considerations.

Ethical Considerations

There is evidence to show that the research was carried out following ethical considerations. In fact, the study mentions that approval for the research was sought and received from all affiliated institutions. In addition, it mentions that although the requirement for informed consent was waived despite the research involving human subjects, seeking informed consent was unnecessary. That is because the data used was collected from a database and had been de-identified. The approval from the affiliated institutions shows that they were convinced that the research would not harm the participants and sufficient measures had been put in place for their protection. The four measures show that the research was conducted in an ethical manner.

Conclusion

The research sought to develop a good understanding of the specific comorbidities for dementia among elderly persons with the intervention of presenting a simple, rapid and appropriate predictive tool. This is based on the understanding that although dementia is acknowledged to be a burdensome ailment among elderly patients, management efforts have been hindered by limited knowledge on the multiple risk-factors for dementia. To facilitate the efforts, a quantitative approach was applied to include regression analysis fitted with Bayesian inference approach is discussed as a good tool for comparing multiple variables as is the present case. The participants had been diagnosed with the dementia between 2000 and 2009, and were recruited from the Taiwan National Health Insurance Research Database. In addition, they were older than 64 years in 2000 and had inpatient files for dementia. The model intended to assess the quantitative effects of six comorbidity risk factors and socio-demographic features for dementia in elderly persons to include senile cataract, diabetes mellitus, hearing loss, severe head injury, vascular disease, depression, gender, age, monthly income and urban residence. 4,749 participants who met the inclusion criteria were recruited Rough Draft Qualitative Research Critique and Ethical Considerations. The statistical analysis revealed that advanced age, female gender, urban residence and low income are socio-demographic risk factors for dementia. It also showed that odds of dementia had a direct correlation with the comorbidity and socio-demographic risk factors. These results are valuable to nursing practitioners since they present evidence that support efforts to profile dementia. They show a clear correlation between the dementia and factors under review so that nurses will have evidence to support advice offered to patients with a plurality of factors, particularly when the advice is in relation to dementia management.

 

Qualitative Research Critique

Qualitative Study

“McDermott, O., Orrell, M. & Ridder, H. M. (2014). The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists.
Aging & Mental Health
, 18(6), 706-716. doi: 10.1080/13607863.2013.875124” Rough Draft Qualitative Research Critique and Ethical Considerations

Background of Study:

I originally began this study on ways that pets could have a positive impact on the treatment of symptoms for the those that suffered from Alzheimer’s and Dementia, however discovered there was little known research even though I have witnessed the positive outcomes a fur baby can inflict on those suffering from such a brutal disease.  There was, however more to be said about how music therapy can positively impact the lives of these individuals.

The research study was conducted with the goal of identifying the value of using music-based interventions to treat dementia. The authors identified that music-based interventions are beneficial for managing dementia, particularly its psychological complications. Of interest is the fact that music features that include dancing, singing and listening are easily accessible and have presented positive results for home care of dementia patients since music can be enjoyed in its own right and as a social activity. In addition, it is noted that the cognitive functions related to music do not deteriorate for dementia patients. Despite this awareness, it is noted that previous studies on the value of music-based interventions in dementia management is that they do not provide a good link between theoretical frameworks and the applied model. The implication is that there is a need to contextualize research outcomes by developing a model for music use in dementia management. Based on this awareness, the present research approached dementia as a process of cognitive decline that worsens over time so that music is presented as an intervention that influences the process. Still, it concedes that experiences with music influences specific psychosocial fixed and tractable factors so that a study of the impact of music on dementia should evaluate the psychosocial factors with a focus on the how and why for the model. Rough Draft Qualitative Research Critique and Ethical Considerations As such, three goals are presented to include exploring the meaning and value of music for dementia patients, investigating how music is perceived for treating moderate to severe dementia, and exploring the link between dementia and psychosocial factors to guide the development of a theoretical model.

Method of Study:

The study applied a qualitative methodology that involved using interviews and focus group discussions as tools for collecting primary data. In fact, the two tools were managed by the lead researcher and presented to four group of participants. The first group of participants are dementia patient living in care homes as well as their family members. The second group of participants are staff at the care homes. The third group of participants are dementia patients visiting day hospitals. The final group of participants are music therapists. The study participants were recruited from two National Health Service care homes where the lead research was engaged as a music therapist. The two homes consented to be part of the research study. 69 residents in the two homes were persons with dementia, of which the first home had 45 dementia patients while the second home had 24 dementia patients. The dementia patients were approached for recruitment in the study with invitation letters sent to invite them and their family members. The participants were then subjected to individual interviews that included the family members for the patients who had cognitive impairment and unclear speech that could easily be misinterpreted. The focus group discussions were held for the four groups of participants within the two care homes. During the course of the study, music therapists with a minimum of four years’ experience were recruited from post graduate music therapy programs and asked to use an active model that entail the patients exploring musical instruments and voice-use during the therapy. The use of the active model was tailored for each patient based on individual needs as well as each the music therapist’s capabilities and experiences. The interviews and focus group discussions divided the participants into two groups. The first group was the dementia patient who were asked what music meant to them, what they thought about music therapy and if it was important to them. The second group comprised of family members, care home staff and music therapists who were asked the changes they observed in the patients following the use of music therapy, and how they knew whether music was meaningful for the patient. The primary data collection phase terminated when no new emerging themes could be identified in the interviews and focus group discussions. The focus group discussions and interviews were audio recorded before being subjected to thematic analysis. Rough Draft Qualitative Research Critique and Ethical Considerations.

Results of Study

The research approached 44 families that met the inclusion criteria of which 19 sent a reply. 15 of these families consented to participate in the study by attending the focus group discussions and interviews. Overall, 53 study participants were recruited to include 12 dementia patients who were residents in one of the two care homes, 4 dementia patients who visited day hospitals, 15 family carers, 14 care home staff, and 8 music therapists. These participants were divided into 17 interviews and 6 focus group discussions conducted at times convenient for the participants. The collected primary data was subjected to thematic analysis. The first theme used 61 transcription cards to note that music was a readily available medium that caused mental stimulation and an emotionally meaningful experience whether used for the immediate or short-term engagement. The second theme used 48 transcription cards to note that music relied on personal and cultural identity to facilitate memory retention, particularly when the lyrics are linked to personal history. The third theme used 40 transcription cards to show that music therapy is a novel experience that can build and sustain relationships while maintaining music connectedness. The fourth theme used 30 transcription cards to identify effects of music on the mood that included short-term mood improvement. The fifth theme used 21 transcription cards to note that music had an effect on the care home environment. The final theme used 34 transcription cards to note that music therapy improved communication. The article concluded that music therapy is more effective in dementia management when supported by personal music history, especially when the music and interpersonal connectedness is sustained to maintain the quality of life.

Ethical Considerations

The article presents details on the ethics procedure applied during the study. It first notes that ethical approval was sought from the National Research Ethics Service Committee for London East. Prior to inclusion in the study, informed consent was sought from all the participants to include the patients, family members, music therapists, and facility personnel. In this respect, the participants were protected during the course of the study with care taken to ensure that the research procedure was not harmful Rough Draft Qualitative Research Critique and Ethical Considerations.

Conclusion

The study applied a qualitative approach that relied on focus group discussion and interviews to collect primary data from selected participants. The intention was to identify the value of using music-based interventions to treat dementia. It concedes that although music therapy is acknowledged as effective, no acceptable theoretical model has been presented to explain the relationship. As such, the collected data was subjected to thematic analysis, which concluded that music therapy is more effective in dementia management when supported by personal music history, especially when the music and interpersonal connectedness is sustained to maintain the quality of life.

Alternative Therapies for Patients with Alzheimer’s and Dementia

As a nurse currently working on a Neuro floor, the devastation to family and loved ones trying to understand, as well as care for a their loved one that has been diagnosed with Dementia or Alzhiemers is most often times heartbreaking.   Nurses who are caring for this patient population are at the forefront and witness the devastation this disease brings to the family and their loved ones.  Often times treatment and or care for these patients results in using medications and, at times, restraints in order to keep the patient safe from harming themselves or others.  As a witness to so many tears cried, and questions asked, there is a definite need in finding ways to bring comfort and a sense of humanity back to this population of patients to have what every individual deserves, and that is to be able to leave this world with compassion and integrity. Rough Draft Qualitative Research Critique and Ethical Considerations.

The efforts of the NIA, (National Institute of Aging) is relentless as they continue to research the causes of this sad disease and hopes that by 2025 Prevent and Effectively Treat Alzheimer’s Disease.  The goals are to optimize quality of care and efficiency, reach out to more support to the families effected by Alzheimer’s and Dementia, increase public awareness, as well as be able to track the progress of the individuals who are suffering from this sad and crippling disease (nia.nih.gov)

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Proposed question for this research assignment:

Can the use of alternative therapies, such as pets therapy have a more positive outcome with patients that have been diagnosed with Alzheimer’s and Dementia.

Setting includes:   hospital, long term care facilities, and in their own home with family members.

Age and demographics:  Both male and female patients ranging from ages 65 and older, even though signs and symptoms can present at an earlier age. Rough Draft Qualitative Research Critique and Ethical Considerations.

Outcome is that the use of alternative methods such as pet therapy will show a positive impact on the quality of life for patients and families that live with the disease of Alzheimer’s and Dementia and leads to a better quality of life, even if only for brief moments of time.

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. It is the most common cause of dementia in older adults. While dementia is more common as people grow older, it is not a normal part of aging. Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people (nia.nih.gov).  Unfortunately, this disease can not be pre-diagnosed and once symptoms begin to show there seems to be little that can be done to minimize the impact it has on not only the patient but their families.

 

About Paws for People. (n.d.). Retrieved from
http://hai.tufts.edu/paws/about-paws-for-people/

Abstract:   Tufts Institute for Human-Animal Interaction is located at Tufts University in Medford Massachusetts.  The program Paws for People was first developed in 1998 by Dr. Gary Patronek of Tufts Center for Animals and Public Policy and started with only 10 volunteers.  Since then, with the ongoing support from the Tufts Center for Animals and Public Policy, Paw for People has grown and consists of over 100 animal/handler teams, who visit a variety of programs including elder care facilities, hospice centers, at-risk youth, adult and adolescent mental health care, hospitals, public schools, libraries, and others.  Continuing on with educational and research aspects of the human-animal bond has developed a strong and thriving program and has brought much interest from many to research more on the positive outcomes a pet can have on elderly patients with Alzheimer’s as well as those with other social and medical conditions.

 

Alzheimer’s Disease Fact Sheet. (n.d.). Retrieved from
https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet

Abstract:   The only way that Alzheimer’s disease can be diagnosed is only after death, by linking clinical measures with an examination of brain tissue in an autopsy which treating and caring for this population of patients is even more complicated.  Other ways the medical professionals may be able to determine if a patient is suffering from this disease is to ask the person and a family member or friends questions that pertains to their overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality.  Issue tests that consist of recalling simple information, problem solving, and language. The use of certain medical tests, such as lab work or urine samples as well as performing brain scans such as CTs, MRIs or PET scans to rule out other possibilities for the presenting symptoms. Rough Draft Qualitative Research Critique and Ethical Considerations.

 

How Caregivers Can Use Pet Therapy to Care for Their Loved One. (2013, December 20). Retrieved from http://blog.alz.org/how-caregivers-can-use-pet-therapy-to-care-for-their-loved-one/

Abstract:  Pet therapy began in the 1860s, but unfortunately studies only began to be taken seriously was in 1980s. While the medical community is still waiting for scientific data that shows pet therapy can have long-term or behavioral change benefits, even famous nurse Florence Nightingale recognized that animals provided a level of social support in the institutional care of the mentally ill over 150 years ago. In an effort to prove the therapeutic benefits of pet therapy, the National Institutes of Health has funded grants to study scientific evidence-based research in therapeutic effects of not only children but of the elderly that suffer from Alzheimer’s and Dementia.

 

https://www.brightfocus.org/alzheimers/article/alzheimers-disease-magic-pets ntia.

Abstract:  There was a study conducted in 2002 on an Alzheimer’s special care unit, where researchers set out to determine the effects of a resident dog and a visiting dog and how they impacted the behavior of the patients.  Resident’s behavior during the day and during the evening were evaluated during the week before the dog was placed on the unit, and then for four weeks following the dog’s arrival. Even though there was little or no significant behavior changes that happened on the evening shift, there was a significant change in the behavior of those patients during the day shift. Rough Draft Qualitative Research Critique and Ethical Considerations.

 

Authors, N. (n.d.). Nonpharmacologic Interventions for Agitation and Aggression in Dementia – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27099894

Abstract: Even though there have been several different trials done to determine effective nonpharmacologic interventions for agitation/aggression in dementia, which is an important topic, it has been found through evidence base is weak because of the different types of comparisons, measurement issues, and other methodological limitations. When there was sufficient evidence to draw conclusions about the effectiveness of interventions in a group, agitation/aggression outcomes were most often similar to those of control groups. Further research is needed to assist providers and caregivers in finding effective interventions for agitation/aggression in dementia.

Churchill M , et al. (n.d.).  – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10218187

Abstract:  The use of a therapy doge can improve socialization skills in persons with Alzheimer’s.  Exposure to therapy dogs and cats can decrease the amount of agitation in persons that are institutionalized and suffer from Alzheimer’s disease, even during the period of agitation known as sundown syndrome. Use of therapy animals can be used along with other calming interventions Rough Draft Qualitative Research Critique and Ethical Considerations.

 

Rough Draft Qualitative Research Critique and Ethical Considerations instructions 

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

In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource ”Research Critique Guidelines” for suggested headings and content for your paper.

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 Turnitin Rough Draft Qualitative Research Critique and Ethical Considerations

Historical Review of Epidemiology

Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

John Graunt

James Lind

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Edward Jenner

Ignaz Semmelweis

John Snow

Choose three of the individuals from your research. In a 1,000-1,250 word paper, describe the epidemiological advancements that were influenced by these individuals. Include the following:

Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.

Discuss how the individuals influenced or advanced epidemiological methods and the process they used to describe and control disease. Discuss how their contributions helped to inform the definition of epidemiology. Consider whether they used qualitative, quantitative, or both types of data collection methods, and the approach they used to test their hypotheses Historical Review of Epidemiology.

Discuss how similar epidemiological methods have been used to understand one current public health issue (not one for each individual). Discuss the key research studies used to understand the risk factors associated with the problem or disease. Two potential examples include lung cancer (Doll and Hill, 1950) or cardiovascular disease and the Framingham Heart Study (Drawber, Meadors, & Moore, 1950; Kannel, 2000).

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 success. Please make sure you use public health and nursing articles

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

Case 3:
Volume 1, Case #5: The Sleepy Woman with Anxiety Case study 

 

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office. Sleepy Woman with Anxiety Case Study

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnosis for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s 
Prescriber’s Guide
and consider medications you might select for this patient.

Review the posttest for the case study.

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Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Sleepy Woman with Anxiety Case Study. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on
Submit
!

 

Post
 a Response to the Following:

 

1-Provide
the Case Study number
in the subject line of the Discussion.

 

2-
List Three Questions
you might ask the patient if he or she were in your office. Provide a rationale for
WHY
you might ask these questions.

 

3
-Identify
people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation.

 

4-
Include Specific Questions
you might ask these people and
WHY
.

 

5-
Explain
what
Physical Exams and Diagnostic Tests
would be appropriate for the patient and
HOW
the results would be used.

 

5-
List Three Differential Diagnoses
for the patient.

 

6- Identify the
ONE
that you think is most likely and
Explain Why
.

7-List
TWO
Pharmacologic agents and their dosing that would be appropriate for the patient’s
Sleep/Wake Therapy
based on pharmacokinetics and pharmacodynamics.

8-From a mechanism of action perspective,
Provide a Rationale for Why
you might choose
ONE
agent over the other.

 

9-If your assigned case includes
“check points”
(i.e., follow-up data at week 4, 8, 12, etc.), indicate any
Therapeutic Changes
that you might make based on the data provided.

 

10-
Explain “Lessons Learned”
from this case study, including
HOW
you might apply this case to
your own practice
when providing care to patients with similar clinical presentations.

Read
 a selection of your colleagues’ responses.

 

 

Learning Resources

Note:
 To access this week’s required library resources, please click on the link to the Course Readings List, found in the 
Course Materials
 section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

 

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
(4th ed.). New York, NY: Cambridge University Press.

 

To access the following chapters, click on the
Essential Psychopharmacology, 4th ed
tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b).
The prescriber’s guide
(5th ed.). New York, NY: Cambridge University Press.

 

To access information on the following medications, click on
The Prescriber’s Guide, 5th ed
tab on the Stahl Online website and select the appropriate medication.

 

Review the following medications:

For insomnia

alprazolam

amitriptyline

amoxapine

clomipramine

clonazepam

desipramine

diazepam

doxepin

flunitrazepam

flurazepam

hydroxyzine

imipramine

lorazepam

nortriptyline

ramelteon

temazepam

trazodone

triazolam

trimipramine

zaleplon

zolpidem

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

 

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines.
British Journal of Psychiatry
, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16

 

To prepare for this Discussion:

CASESTUDY-5

47

PATIENT FILE

The Case: The sleepy woman with anxiety

The Question: How can you be anxious and narcoleptic at the same time?

The Dilemma: Finding an effective regimen for recurrent, treatment

resistant anxious depression while juggling complex treatments for sleep

disorders

Pretest Self Assessment Question (answer at the end of the case)

Which of the following are approved treatments for treatment resistant

depression?

A. Deep brain stimulation

B. Transcranial magnetic stimulation

C. Vagal nerve stimulation

D. Aripiprazole (Abilify)

E. Quetiapine (Seroquel)

F. MAO inhibitors

Patient Intake

• 44-year-old woman with a chief complaint of anxiety

Psychiatric History

• The patient had onset of anxiety and depression at about age 15, which

she began self-medicating with alcohol

• After graduating from high school, she began college and was about to

leave for study abroad when she experienced a panic attack for which

she was treated in the emergency room

• She was then hospitalized and treated for alcohol abuse at age 18,

and has remained sober ever since, although she does admit to some

possible alprazolam (Xanax) abuse in 1999 as well as one overdose

with alprazolam

• Her history also includes multiple hospitalizations for major depression

– Age 19 (approximately one year after her release from the hospital

for alcohol abuse) because she became suicidal

– Age 24 due to recurrence of depression

– Age 26 with an overdose following a divorce and recurrence of

depression

– Age 27 due to recurrence of depression

– Age 29 after two miscarriages, with a possible postpartum element

and some discontinuation of her medications at that time to try to

get pregnant

– Age 30 when she received electroconvulsive therapy (ECT): 7

sessions as an inpatient and 23 as an outpatient

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All rights reserved. Not for commercial use or unauthorized distribution.

48

PATIENT FILE

• Details of medication history unclear from available information and

from patient’s memory, but has received numerous psychotropic drugs

including antidepressants, antipsychotics, and mood stabilizers, all

with poor results

• She was much better for several years following her ECT treatment, but

had severe memory impairment

• She had a recurrence of her depression one year ago severe enough

to become totally disabled, necessitating resignation from a job as an

offi ce worker that she had enjoyed

• She continues to be disabled from depression and has a great deal

of anxiety, subjectively more disturbed by her anxiety than by her

depression

Social and Personal History

• Married since 1996 (second marriage); no children from either

marriage

• Non smoker

• Husband an architect, supportive

• Little contact with her family of origin

• Few friends or outside interests

Medical History

• Narcolepsy

• Restless legs syndrome

• Nighttime urinary incontinence possibly related to highly sedating

medications

• BMI 26

• BP 120/78

• Normal fasting glucose and triglycerides

Family History

• Grandmother: depression and who has received ECT with good

results

Current Medications

• Bupropion (Wellbutrin XL) 450 mg/day (thinks it is helpful as she

worsens if she tries to taper)

• Ziprasidone (Geodon, Zeldox) 60 mg in the morning and 180 mg at

night (unsure if this is helpful)

• Lamotrigine (Lamictal) 200 mg in the morning and 150 mg at night

(thinks it is helpful for her mood)

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All rights reserved. Not for commercial use or unauthorized distribution.

49

PATIENT FILE

• Gabapentin (Neurontin) 300 mg in the morning, 600 mg at noon,

and 900 mg at night; occasional 100 mg as needed for breakthrough

anxiety (experiences intolerable return of anxiety at much lower doses)

• Pramipexole (Mirapex) 1 mg/night for restless legs syndrome (unclear

whether helpful)

• Methylphenidate extended-release (Concerta) 54 mg/day for daytime

sleepiness (thinks it is helpful)

• Sodium oxybate (Xyrem) 9 mg in one dose at night for narcolepsy and

daytime sleepiness (not taken in recommended split dose)

• DDAVP (the peptide Desmopressin) 0.4 mg/night for bedwetting

Based on just what you have been told so far about this patient’s history

and current symptoms, would you consider her to fall within the bipolar

spectrum?

• Yes

• No

Would you continue her “mood stabilizing” medications?

• Yes, continue both ziprasidone (Geodon) and lamotrigine (Lamictal)

• Continue ziprasidone but discontinue lamotrigine

• Continue lamotrigine (Lamictal) but discontinue ziprasidone (Geodon)

• No, discontinue both ziprasidone (Geodon) and lamotrigine (Lamictal)

Attending Physician’s Mental Notes: Initial Psychiatric

Evaluation

• Nothing unexpected on mental status examination which showed

depression and anxiety

• Because she has had numerous recurrences, this makes her illness

appear to be somewhat unstable; however, she has not shown any

overt signs of bipolarity

• The best diagnosis for this patient may be severe generalized anxiety

with major depressive recurrent unipolar disorder

• Nevertheless, tactics that are useful for bipolar mood disorders may

be useful in this patient

• Continuing ziprasidone (Geodon) and lamotrigine (Lamictal) may help

mitigate the risk of a future relapse

• Thus, these medications were continued at the time of the initial

evaluation

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50

PATIENT FILE

Further Investigation:

Is there anything else you would especially like to know about this

patient?

• What about details concerning the diagnosis of narcolepsy and of

restless legs syndrome, the treatments given and the responses to

those treatments?

– During the past year as her depression has recurred and worsened,

she has developed excessive daytime sleepiness

– She had an overnight sleep polysomnogram done in another city

that supposedly showed sleep onset REM (rapid eye movement)

periods, but you do not have a copy of the report and do not know

if it was done while taking any medications, or after the withdrawal

of any medications

– During the past year she has also complained of restless legs

worse in the evening when trying to fall asleep

– Because of her diagnosis of narcolepsy, she was prescribed

methyphenidate extended release (Concerta) which helps a bit for

her daytime sleepiness, but because she was still sleepy, sodium

oxybate (Xyrem) was added without further improvement of

daytime alertness although she gets to sleep right away and also

sleeps well through the night now

– In fact, she sleeps too well through the night now, and has

bed wetting, for which she has been prescribed DDAVP

(Desmopressin), but it is not very helpful

– Because of her diagnosis of restless legs syndrome, she is

prescribed pramipexole (Mirapex), with equivocal results

Based on what you know so far about this patient’s history, current.

symptoms, and treatment responses, are you convinced her daytime

sleepiness and nighttime restlessness are adequately diagnosed and

treated?

• Yes

• No

Would you continue her 4 sleep disorder medications?

• Yes, continue all 4 (methylphenidate (Concerta), sodium oxybate

(Xyrem), DDAVP (Desmopressin) and pramipexole (Mirapex))

• No, stop one or more of these

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51

PATIENT FILE

Attending Physician’s Mental Notes: Initial Psychiatric

Evaluation, Continued

• The patient’s complaint of excessive daytime sleepiness can be

diffi cult to assess given all the medications she is taking, especially

sodium oxybate (Xyrem) and gabapentin (Neurontin), which can cause

excessive daytime sleepiness

• It can also be diffi cult to determine whether her sleepiness represents

narcolepsy or really represents “hypersomnia” as an associated

symptom of depression

• It can be similarly diffi cult to determine whether her restless legs

represent restless legs syndrome or really represent psychomotor

agitation as an associated symptom of anxiety or whether restless

legs represent a side effect of bupropion (Wellbutrin) rather than

restless legs syndrome

• It is even possible that her sleep disorder treatments are interfering

with her treatments for depression and anxiety

• Thus, her sodium oxybate (Xyrem) was tapered, and then her DDAVP

(Desmopressin) discontinued, and her pramipexole (Mirapex) was

also tapered over the next month following her initial assessment

Case Outcome: First and Second Interim Followup Visits,

Weeks 2 and 4

• The patient experienced some initial insomnia and restless sleep

as sodium oxybate (Xyrem) was withdrawn, but this resolved in

several days, as did her incontinence; her daytime sleepiness actually

improved somewhat but she continued to have problems falling asleep

some nights

• Next, her pramipexole (Mirapex) was tapered without worsening of

restless legs, or of insomnia, or mood

• Finally, her daytime gabapentin (Neurontin) was tapered to half

dose with improvement in daytime sleepiness, but this was only

intermittently tolerated, because of re-emergence of anxiety; however,

higher gabapentin (Neurontin) doses caused daytime sleepiness

• She continued to have depression; also, her anxiety continued to

wax and wane day and night, with some relief by additional doses of

gabapentin (Neurontin), but, unsatisfactory overall results; if anxiety

and agitation occur at night, she also has insomnia

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52

PATIENT FILE

Considering her former response and side effects with ECT treatment,

would you consider using an alternative non-drug treatment method for

her refractory symptoms?

• Yes, consider ECT

• Yes, consider VNS

• Yes, consider TMS

• Yes, consider DBS

Attending Physician’s Mental Notes: Second Interim Followup,

Week 4

• The patient’s prior response to ECT suggests that it, or a similar

treatment, may be benefi cial

• She is hesitant to try ECT again because of the memory loss she

sustained, but may benefi t from another alternative treatment strategy

• Vagal nerve stimulation (VNS) (approved for treatment-resistant

depression and available at the time of this evaluation)

– VNS involves surgical implant of a stimulation device in the upper

left side of the chest (intended as a permanent implant, though it

can be removed)

– The pulse generator can be programmed to deliver electrical

impulses to the vagus nerve at various durations, frequencies, and

currents

– Stimulation typically lasts 30 seconds and occurs every fi ve

minutes

– After an initial wave of enthusiasm for this treatment, use of VNS

for depression has waned due to disappointing results, high

costs and some complications, include the hassle of having the

stimulator and electrode removed

• Transcranial magnetic stimulation (TMS) (approved for treatmentresistant depression)

– Generally done on an outpatient basis

– Electromagnetic coil is placed against the scalp near the forehead

and turned off and on repeatedly for 30 to 50 minutes per treatment

– Typical treatment duration is fi ve daily treatments a week for four to

six weeks

– Insurance coverage is variable for a course of this treatment which

costs several thousand dollars

– TMS has been best studied in patients who have failed a single

antidepressant, and not for more complicated cases, or in cases

with prior good or bad responses to ECT, so it is diffi cult to predict

the chances of success for this patient

• Deep brain stimulation (DBS) (in trials for treatment-resistant

depression)

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53

PATIENT FILE

– Involves two surgical procedures, one to implant electrodes in the

brain and a second to implant a neurostimulator in the chest

– Stimulation is generally constant but can be temporarily turned off

by holding a magnetic device over the area of the chest where the

neurostimulator is located

– DBS is an experimental procedure available at only a few medical

centers with research protocols that may cover some or all of the

costs

– Risks and benefi ts of DBS remain unknown in treatment resistant

depression, so DBS is reserved for patients who have failed many

treatments, such as this patient

• After discussion of these options, the patient asked to defer action on

them so she could research VNS, TMS and DBS, and in the meantime,

she asked to try some other medications

Would you continue her methylphenidate extended release (Concerta)

for daytime sleepiness?

• Yes

• No

Attending Physician’s Mental Notes: Second Interim Followup,

Week 4, Continued

• On one hand, methylphenidate extended release (Concerta) seems

to be helpful for her daytime sleepiness and one could even consider

raising the dose to try to alleviate her depression

• On the other hand, this could risk making her anxiety worse and, to

the extent that daytime sleepiness is related to sedating medications’

side effects, it may be better to adjust those

• For now, the patient is not willing to stop the stimulant, and after a

discussion of risks and benefi ts, methylphenidate was continued

• Spoke with husband who is supportive and denies any marital confl ict

Would you consider adding any of the following medications to her

regimen?

• Lithium (to boost mood and mitigate risk of cycling)

• Monoamine oxidase inhibitor (MAOI) (to boost mood)

• Mirtazapine (Remeron) (to boost mood and possibly treat anxiety)

• Quetiapine (Seroquel) (to boost mood and possibly treat anxiety)

• Aripiprazole (Abilify) (to boost mood)

• None of these

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54

PATIENT FILE

Attending Physician’s Mental Notes: Second Interim Followup,

Week 4, Continued Sleepy Woman with Anxiety Case Study

• Lithium

– Could help to boost her mood and mitigate risk of future relapse

– If added it may not be necessary to give her a full dose as she is

already on other mood stabilizing medications

• MAOI

– May help boost mood, as this has been effective for patients with

anxious depression

– However, this could also be activating for some patients and cause

problems with sleep and anxiety

– If added, an MAOI would require discontinuation of bupropion

– Transdermal selegiline (Emsam) does not require dietary restriction

and may be a preferable formulation

• Mirtazapine (Remeron)

– May boost mood and also potentially treat anxiety

• Quetiapine (Seroquel)

– May boost mood (approved for depressed phase of bipolar disorder

and as adjunct for unipolar depression)

– May also be helpful for anxiety (anecdotal reports as adjunct)

– If added, it may require careful dosing to avoid daytime sedation

• Aripiprazole (Abilify) Sleepy Woman with Anxiety Case Study

– May boost mood (approved as adjunct for unipolar depression)

– Can be activating and cause problems with anxiety

• The patient was encouraged to switch from bupropion (Wellbutrin)

to mirtazapine (Remeron), but instead opted for aripiprazole (Abilify)

augmentation of her current medications (bupropion, lamotrigine,

gabapentin, methylphenidate), while discontinuing ziprasidone.

Case Outcome: Multiple Interim Followups to Week 24

• Aripiprazole (Abilify) titration from 2 mg to 5 mg while ziprasidone

(Geodon) was discontinued showed no real changes good or bad for

the fi rst month (week 12)

• Aripiprazole was then increased to 10 mg, with slight improvement

(week 16)

• After a second month at 10 mg of aripiprazole, no further

improvement in depression and anxiety and overall results not

satisfactory (week 20)

• The patient was switched from aripiprazole to quetiapine (Seroquel),

which was not associated with improvement of mood or anxiety, and

made her sleepiness worse (by week 24)

• The patient was offered a trial of mirtazapine (Remeron) again, and

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55 Sleepy Woman with Anxiety Case Study

PATIENT FILE

due to the results with quetiapine, was not willing to take it (at week

24)

• She was offered an MAOI, but said she would rather consider VNS,

TMS or another round of ECT (at week 24)

• Insurance approved VNS, and the patient became essentially

asymptomatic for more than 4 years

Case Debrief

• The patient has a 25-year history of recurrent anxiety and depression

that appears unipolar in nature and has been somewhat responsive to

antidepressants and very responsive to ECT in the past

• Her current relapse is causing her disability and is not fully responsive

to the 8 medications she was taking on initial referral (bupropion,

lamotrigine, ziprasidone, gabapentin, sodium oxybate, DDAVP,

methylphenidate and pramipexole)

• It seems possible that her sleep symptoms are more related to her

anxious depression rather than to additional diagnoses of narcolepsy

and restless legs syndrome and, in any event, her treatments for these

sleep disorders did not improve her symptoms; discontinuation of

several sleep medications (sodium oxybate, pramipaxole and DDAVP)

if anything improved her symptoms; other clinicians may have opted

to continue these medications

• Following simplifi cation of her medication regimen from 8 medications

to 5, she failed to respond to augmentation with aripiprazole or with

quetiapine

• Possibly because of her prior response to ECT (and a fi rst degree

relative also responded to ECT), she was an excellent candidate for

VNS

Take-Home Points

• It can be diffi cult to determine whether insomnia with anxiety

and psychomotor agitation at night, with simultaneous excessive

sleepiness during the day while having poor sleep at night in a patient

taking sedating medications, are due to a sleep disorder, to an anxiety

disorder, to a depressive disorder or to side effects of medications

• Simplifying medication regimen from 8 medications to 5 may help

determine whether some of the symptoms are due to medications and

whether all medications are necessary

• The ultimate proof that her symptoms of daytime sleepiness and night

time agitation are linked to her anxiety/mood disorder rather than to

sleep disorders was that these symptoms abated when her depression

and anxiety abated with effective treatment by VNS

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56

PATIENT FILE

Performance in Practice: Confessions of a

Psychopharmacologist

• What could have been done better here?

– Did it take too long to get to the VNS recommendation?

– Should she have been pushed harder to try mirtazapine or an

MAOI rather than augmentation with two additional, three total,

atypical antipsychotics?

– Did it take too long to clarify the sleep issues?

– Should we have tried harder to get a copy of the written results of

the polysomnogram?

• Possible actions for improvement in practice

– Make sure that augmentation with atypical antipsychotics is not

the only option offered, or the only option offered early, since these

drugs are expensive and can have notable side effects

– Despite less robust comparative data, agents such as mirtazapine

and MAOIs, and also VNS and ECT, can be considered earlier in the

treatment algorithm

– Get husband more involved as patient is at high risk for long term

depression, and he is her major support system

– Consider psychotherapy earlier rather than after VNS and assess

whether the patient is a good candidate for interpersonal or

cognitive behavioral approaches

Tips and Pearls

• Treatment with pregabalin (Lyrica), approved for anxiety in Europe

but not in the US, rather than gabapentin (Neurontin), not approved

anywhere for anxiety, may be less sedating if more expensive

• If the patient requires an MAO inhibitor, best to stop the bupropion

and the methylphenidate, but lamotrigrine and gabapentin can be

continued. For heroic cases unresponsive to an MAO inhibitor,

stimulants such as methylphenidate can sometimes be cautiously

added to an MAO inhibitor by experts monitoring cardiovascular status

who are sophisticated about weighing risks and benefi ts

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57

PATIENT FILE

Two-Minute Tute: A brief lesson and psychopharmacology

tutorial (tute) with relevant background material for this case

– Classifi cation and testing for narcolepsy, hypersomnia and

restless legs syndrome

– Overlap of symptoms in sleep disorders with psychiatric

disorders

International Classifi cation Of Sleep Disorders

Diagnostic Criteria Of Narcolepsy

• Patient complains of excessive sleepiness or sudden muscle

weakness

• Recurrent daytime naps or lapses into sleep almost daily for at

least 3 months

• Possible sleep-onset REM (rapid eye movement) periods,

hypnagogic hallucinations, and sleep paralysis

• With cataplexy

• Sudden bilateral loss of postural muscle tone in association

with intense emotion

• Hypersomnia not better explained by another disorder

• Should be confi rmed by PSG (polysomnogram) followed by

MSLT (multiple sleep latency test, see below) which should show

a mean sleep latency of 8 minutes and two more sleep-onset

REM periods (SOREMPs) following normal sleep

• May be confi rmed by orexin levels in the cerebrospinal fl uid

(CSF) <110 pg/ml or, 1/3 of mean normal control levels Narcolepsy is estimated to occur in 0.03–0.16% of the general population, with its development mostly beginning in the teens. Narcoleptic sleep attacks usually occur for 10–20 minutes and, on awakening, the patient can be refreshed for 2–3 hours before feeling the need to sleep again. Although sleep attacks occur most often in a monotonous situation, they can also occur when a person is actively conversing or eating. Symptoms of narcolepsy may include frightening hypnogogic hallucinations and sleep paralysis, which are usually coincident with SOREMPs. Not everyone with narcolepsy will have cataplexy but it is a unique feature of this disorder. An attack normally lasts a few seconds to minutes, during which the person is conscious. Some people have only minimal muscle involvement, while others can have “full-body” attacks; however, the respiratory and ocular muscles are never involved. Excessive sleepiness is the main symptom to continue with age, and it may worsen alongside the development of periodic limb movements and obstructive sleep apnea. In addition, sleep may be disrupted and include frequent awakenings (International Classifi cation of Sleep Disorders, revised, 2001). Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 58 PATIENT FILE Multiple Sleep Latency Test (MSLT) • Dark comfortable room at an ambient temperature • Smoking, stimulants and vigorous physical activity avoided during the day, only light breakfast and lunch given • Instructions are to – “Lie quietly in comfy position, keep eyes closed, try to fall asleep” • Five nap opportunities as 2 hour intervals – initial nap opportunity 1.5–3 hours after termination of usual sleep • Between naps patient out of bed and awake • Sleep onset determined by time from “lights out” to fi rst epoch of any sleep stage • To assess occurrence of REM sleep the test continues for 15 minutes from fi rst sleep epoch • Session terminated if sleep does not occur after 20 minutes The Multiple Sleep Latency Test is carried out in sleep laboratories often after a night of PSG and a week fi lling in a sleep diary. Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 59 PATIENT FILE The Epworth Sleepiness Scale (ESS) is a self-rating tool to enable patients and physicians to easily investigate problems with excessive sleepiness. For the most part it can be used both for looking at a day as a whole or for various times throughout a person’s wake time to chart their circadian changes. As a self-rating tool, it is of course subjective and may not correlate well with objective test measures. For the general population the average score on the ESS may be approximately 9 where as scores over 11 indicate excessive sleepiness. Interestingly those with insomnia may have scores lower than the general population, lending further weight to the theory that insomnia is a disorder of the arousal mechanisms that, as well as keeping someone awake at night, can leave someone in a state of hyperarousal during the day. Likelihood of falling asleep or dozing off when: Sitting and reading 0123 Watching television 0123 Sitting inactive in a public place – theater, meeting 0123 As a car passenger for an hour without a break 0123 Lying down to rest in the afternoon 0123 Sitting and talking to someone 0123 Sitting quietly after lunch without alcohol 0123 Stopped for a few minutes while driving a car 0123 Total Score Chance of Dozing: The Epworth Sleepiness Scale (ESS) Likelihood scale – rate each from 0–3 and total score 0 – would never doze 2 – moderate chance of dozing 1 – slight chance of dozing 3 – high chance of dozing Score over 11 indicates abnormal sleepiness Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 60 PATIENT FILE Cardinal diagnostic features of RLS (restless legs syndrome) 1 Urge to move limbs usually associated with paresthesias or dysesthesias 2 Symptoms start or become worse with rest 3 At least partial relief with physical activity 4 Worsening of symptoms in the evening or at night Patients with RLS experience an urge to move their legs to rid themselves of unpleasant sensations (prickling, tingling, burning or tickling; numbness; “pins and needles’’ or cramp-like sensations). This movement typically relieves the sensations, which can occur at any time but are most disruptive when one is trying to fall asleep. Primary hypersomnia Differential Diagnosis • Substance-induced hypersomnia Drug of abuse Medication use Exposure to a toxin • Psychiatric disorder Major depressive disorder Depressed phase of bipolar disorder • Sleep deprivation Symptoms reversed with increased sleep • Post-traumatic hypersomnia Head trauma CNS injury • Delay- or advance-phase sleep syndrome Circadian rhythm is shifted Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 61 PATIENT FILE Differential diagnosis in patients with hypersomnia disorders can be diffi cult, but is important in choosing the best treatment. The diagnosis of primary hypersomnia is reserved for those patients in whom no other factor can be considered causal to the symptom of sleepiness. Diagnostic measures in narcolepsy and hypersomnia (data from Bassetti et al 2003) ESS = Epworth Sleepiness Scale MSLT = Multiple Sleep Latency Test Lat = latency SOREMP = Sleep onset REM Periods CSF = Cerebrospinal Fluid ESS MSLT Lat. (min) MSLT # SOREMP CSF Hypocretin pg/ml Narcolepsy with Cataplexy 18 3.38 3.5 96.5 Narcolepsy without Cataplexy 19 2.75 2.5 277.3 Primary Hypersomnia 17 6 0 226.8 Hypersomnia in Psychiatric Disorders 18 7.83 0 278 Major Depressive Disorder Attention Defi cit Hyperactivity Disorder Narcolepsy Obstructive Sleep Apnea Shift-Work Sleep Disorder Mood +++ – – + – Sleepiness + + +++ +++ +++ Fatigue ++ + ++ ++ ++ Concentration ++ +++ ++ ++ ++ Overlap of symptoms in sleep and psychiatric disorders Many of the symptoms seen in sleep disorders are common in psychiatric disorders and vice versa. This chart compares the frequency of different symptoms among common sleep and psychiatric disorders, which is useful in making a differential diagnosis. The degree of symptom overlap among many disorders emphasizes the need to be able to recognize and treat a patient’s individual symptoms, rather than use a single treatment strategy for all symptoms of a disorder. Disorder Symptom +++ Most Common ++ Common + Average – None Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 62 PATIENT FILE Posttest Self Assessment Question: Answer Which of the following are approved treatments for treatment resistant depression? A. Deep brain stimulation (in trials for treatment-resistant depression but not approved) – Involves two surgical procedures, one to implant electrodes in the brain and a second to implant a neurostimulator in the chest – Stimulation is generally constant but can be temporarily turned off by holding a magnetic device over the area of the chest where the neurostimulator is located – This is an experimental procedure available at only a few medical centers with research protocols that may cover some or all of the costs – Risks and benefi ts remain unknown so this is reserved for patients who have failed many treatments B. Transcranial magnetic stimulation (approved for treatment-resistant depression) – Generally done on an outpatient basis – Electromagnetic coil is placed against the scalp near the forehead and turned off and on repeatedly for 30 to 50 minutes per treatment Sleepy Woman with Anxiety Case Study – Typical treatment duration is fi ve daily treatments a week for four to six weeks – Insurance coverage is variable for a course of this treatment which costs several thousand dollars – TMS has been best studied in patients who have failed a single antidepressant, and not necessarily indicated for more complicated cases, or for cases with multiple antidepressant failures or failure of ECT C. Vagal nerve stimulation (approved for treatment-resistant depression) – Involves surgical implant of a stimulation device in the upper left side of the chest (intended as a permanent implant, though it can be removed) – The pulse generator can be programmed to deliver electrical impulses to the vagus nerve at various durations, frequencies, and currents – Stimulation typically lasts 30 seconds and occurs every fi ve minutes – Studied in patients with more treatment failures than those patients studied with TMS, aripiprazole, or quetiapine – After an initial wave of enthusiasm for this treatment, use of VNS for depression has waned due to disappointing results, high Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 63 PATIENT FILE costs and some complications, include the hassle of having the stimulator and electrode removed D. Aripiprazole (Abilify)(approved for treatment resistant depression) – Studied in patients with major depression who did not have an adequate response to one SSRI (Serotonin Selective Reuptake inhibitor) or one SNRI (Serotonin Norepinephrine Reuptake Inhibitor) antidepressant – Not known how well it works in patients with failures to more antidepressant treatments E. Quetiapine (Seroquel)(approved for treatment resistant depression) – Also studied in patients with major depression who did not have an adequate response to one antidepressant – Also not known how well it works in patients with failures to more antidepressants F. MAO inhibitors (not approved for treatment resistant depression) – Although almost always used for treatment resistant depression and almost never used fi rst line, is currently only approved for fi rst line use and not for treatment resistant depression • Clinical practice and numerous anecdotes suggest that some patients who do not respond to one or more antidepressants, including ECT, may respond to MAO inhibitors, but no controlled studies. Activating for some patients and may cause problems with sleep and anxiety Answer: B, C, D and E References 1. Stahl SM, Antidepressants, in Stahl’s Essential Psychopharmacology, 3rd edition, Cambridge University Press, New York, 2008, pp 511–666 2. Stahl SM, Disorders of Sleep and Wakefulness and their Treatment, in Stahl’s Essential Psychopharmacology, Cambridge University Press, New York, 2008, pp 815–862 3. Stahl SM, Aripiprazole, in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 45–50 4. Stahl SM, Quetiapine, in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 459–64 5. Stahl SM, Gabapentin, in Stahl’s Essential Psychopharmacology The Prescriber’s Guide, 3rd edition, Cambridge University Press, New York, 2009, pp 221–225 6. Silberstein S, Marmura M, Stahl SM (Ed), Pramipexole, in Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution. 64 PATIENT FILE Neuropharmacology: The Prescriber’s Guide, Cambridge University Press 2010, pp 262–265 7. Stahl SM, Diagnosis and Treatment of Sleep Wake Disorders, NEI Press, Carlsbad, California, 2007 8. Stahl SM, Sleep: Excessive Sleepiness, NEI Press, Carlsbad, California, 2005 9. Marangell LB, Martinez M, Jurdi RA et al. Neurostimulation Therapies. Acta Psychiatrica Scandinavica 2007; 116: 174–181 10. Bassetti C, Gugger M, Bischof M et al. The narcoleptic borderland: a multimodal diagnostic approach including cerebrospinal fl uid levels of hypocretin-1 (orexinA). Sleep Medicine 2003; 4: 7–12 Sleepy Woman with Anxiety Case Study Downloaded from http://stahlonline.cambridge.org by IP 100.111.251.218 on Thu Dec 26 13:02:55 UTC 2019 Stahl Online © 2019 Cambridge University Press. All rights reserved. Not for commercial use or unauthorized distribution.

Assignment 1: Early Onset Schizophrenia

Schizophrenia is a severe debilitating psychotic disorder associated with high disability, morbidity and mortality rates. Patients with schizophrenia manifest altered perceptions of reality (hallucinations), fixed false beliefs (delusions), disorganized thought process, abnormal motor behaviors, and negative symptoms. Early onset schizophrenia is a rare chronic form associated with   neuro-developmental problems in early life such as; delayed linguistic capabilities, speech, motor coordination, and psychosocial development (American Psychiatric Association., 2013). Schizophrenia is managed through antipsychotics, psychosocial therapy, and psycho-educational interventions.

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Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia

Antipsychotic medications are mainly used for management of early onset schizophrenia. The choice of acute management and maintenance medication in children and adolescents should be made carefully because of their physical growth, brain development, sexual development, and high vulnerability to fast weight gain. Also children have increased sensitivity to other side-effects of antipsychotic medication, high risk of 
treatment
resistance, co morbidities of disorders. Second-generation antipsychotic are used for first line treatments of early onset schizophrenia due to their low risk of causing extra pyramidal effects and tardive dyskinesia Assignment 1: Early Onset Schizophrenia. The FDA approved atypical antipsychotics for children include risperidone, aripiprazole, olanzapine, lurasidone, quetiapine and paliperidone (McClellan & Stock, 2013). Children and adolescents are more sensitive to medication effects therefore; low doses are given when initiating the treatment and gradually titrated upwards. The choice is based on the side-effect profile. Despite their safety and efficacy, they are associated with weight gain and severe metabolic problems, and neurological side effects.  In adults conventional are used for first line treatment of schizophrenia. They include haloperidol and perphenazine .Second generation antipsychotic may also be considered in case of non response to the conventional antipsychotic (John , James., 2015). All antipsychotics have side effects, therefore dietary, lifestyle counseling and monitoring of adverse effects are crucial when on initiation of treatment.

In adults, various psychosocial interventions like cognitive-behavioral therapies, training in social skills, cognitive remediation, and family therapy have proved helpful in reducing schizophrenic symptoms, improving occupational functioning and relapse prevention. In children and adolescents, multimodal care in terms of family interventions in the care, social skills training, and supportive environment is vital. Psycho-education for the child and their family is vital especially for long-term compliance with medication. Supportive psychotherapy encourages reality and monitoring signs of relapse (Stafford, Mayo-Wilson, Loucas, James, Hollis, Birchwood etal.,2015). Children and adolescents exhibit cognitive impairment, and more negative symptoms compared to adults who have more delusions and hallucinations. This makes family interventions more effective compared to cognitive behavior therapy used for adults (John, James., 2015)).

Legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia and
the role of PMHNP in addressing the issue

The purpose of antipsychotic therapy is to do good to the patient and avoid harm. Thus the PMHN seeks to help the patients get well through administration of antipsychotics. Schizophrenia adversely affects the cognitive functioning making a person unable to consent to treatment and more so a child who is not of legal age to consent. This posses the ethical and moral issue of forced treatment Assignment 1: Early Onset Schizophrenia .The PMHN have the responsibility of involving the family members or the guardian in medication planning and allowing them to provide consent before initiation of treatment. Use of a bio-psychosocial model of holistic care that involves client and family education and shared decision-making in the treatment plan helps in resolving the moral and ethical issue of forced treatment in children. This requires that the PMHN continually engage client and family members in transparent sharing of information on treatment decisions (Mahone, Maphis, & Snow., 2016)

References

American Psychiatric Association.(2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing
.

John Lally, James H. MacCabe. (2015).Antipsychotic medication in schizophrenia: a review, 
British Medical Bulletin
, Volume 114, Issue 1, 1 June 2015, Pages 169–179, 
https://doi.org/10.1093/bmb/ldv017

Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016). Effective Strategies for Nurses Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery. 
Issues in Mental Health Nursing
, 
37
(5), 372–379.
http://doi.org/10.3109/01612840.2016.1157228

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia.
Journal of the American Academy of Child & Adolescent Psychiatry
, 52(9), 976–990. Retrieved from
http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

Stafford, M. R., Mayo-Wilson, E., Loucas, C. E., James, A., Hollis, C., Birchwood, M., & Kendall, T. (2015). Efficacy and Safety of Pharmacological and Psychological Interventions for the Treatment of Psychosis and Schizophrenia in Children, Adolescents and Young Adults: A Systematic Review and Meta-Analysis. 
PLoS ONE
, 
10
(2), e0117166. http://doi.org/10.1371/journal.pone.0117166 Assignment 1: Early Onset Schizophrenia

 

Assignment 1: Early Onset Schizophrenia

Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.

In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.

 

Learning Objectives

Students will:

Compare evidence-based treatment plans for adults versus children and adolescents diagnosed with schizophrenia Assignment 1: Early Onset Schizophrenia

Analyze legal and ethical issues surrounding the forceful administration of medication to children diagnosed with schizophrenia

Analyze the role of the PMHNP in addressing issues related to the forceful administration of medication to children diagnosed with schizophrenia

 

To Prepare for this Assignment:

Review the Learning Resources concerning early-onset schizophrenia.

 

The Assignment (2 pages):

Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.

Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.

Note:
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements. All papers submitted must use this formatting. Assignment 1: Early Onset Schizophrenia

 

Introduction

One of the most chronic and severe mental disorders that affects about one percent of the population in the Unites States, is Schizophrenia. Schizophrenia is one mental disorder that impacts the way one thinks, behaves and feels about themselves and others around them. Considering schizophrenia is a chronic mental disorder it comes with many signs and symptoms, effects, risk factors, possible causes, and theories as to why someone may possess this horrible illness.

Schizophrenia is a psychological disorder as it affects the human mind and feelings. “A psychological disorder, also known as a mental disorder, is a pattern of behavioral or psychological symptoms that impact multiple life areas and create distress for the person experiencing these symptoms.” (Cherry, 2018)

Diagnostic criteria for Schizophrenia

Some of the following symptoms need to be resent for at least 6 months to be diagnosed with schizophrenia:

Hallucinations

Delusions

Negative symptoms

Cognitive issues/disorganized thinking

Reasons I chose this topic

Personal experience with my mother being diagnosed with the mental disorder

I want to know more about how the mental illness develops and changes the human mind

Epidemiology

Annually the number of new cases is about 1.5 per 10,000 people

Typical age for onset is adolescence Assignment 1: Early Onset Schizophrenia

Childhood and late-life onset are rare

More men than women are diagnosed

Ages 18-25 for men

Ages 25-35 for women

Urban areas are more affected than rural

Discussion

Detailed description of the disorder

Signs and symptoms of the disorder are consistent with hallucinations, voices, false beliefs and paranoia.

The epidemiology of schizophrenia is the following:

Season of Birth

Birth complications

Parental age

Infections and the Immune system

Autoimmune diseases

Ethnicity

Cannabis use

Urban residence

Subtypes of the disorder are the following:

Paranoid Schizophrenia

Disorganized Schizophrenia

Catatonic Schizophrenia

Undifferentiated Schizophrenia

Residual Schizophrenia

There are three spectrum disorders of schizophrenia which are the following:

Schizoaffective disorder

Schizophreniform disorder

Schizotypal personality disorder

Natural History of Schizophrenia

With treatment, the disorder is always going to be a lifelong disorder requiring treatment

Even with treatment, people with schizophrenia have issues taking their medications as some are not aware of them having the illness

Without treatment for the disorder there are about 30% of patients that can manage schizophrenia without any antipsychotic meds. Women tend to do better in managing without medication more than men.

Methods used to diagnose, evaluate and manage the disorder

The initial diagnoses of schizophrenia are not as simple as a blood test. It is based on an interview with the patient asking certain questions to maintain the aspect of diagnosing.

Ongoing management for schizophrenia is constantly seeing the therapist and getting treatment based on how the meds are working or not working.

Risk Factors

Gene and environment

Brain chemistry and the structure of the brain

Other causative factors Assignment 1: Early Onset Schizophrenia

Family history

Immune system issues

Complications during pregnancy

Drug use

Nervous system structures and/or pathways involved is the CNS – central nervous system.

Neurotransmitters and receptor systems involved in the pathology of the disorder “Changes in the neurotransmitter release pathways in schizophrenia may be important in the pathology of the illness, and recent findings suggest that abnormalities in the Wnt pathway, which controls transcription selectivity in cells, may be involved.” (B., 2002)

Current treatment options

When treating schizophrenia, it is more complicated than giving a pill and calling it day. There is so much more to the process and finding the proper regimen as each case and patient are different. People with schizophrenia can and do take medication but the issues with this is, they decide they are better and stop taking the medication, causing relapse. Treating schizophrenia will consist of a treatment with medication, psychosocial, and/or support therapies. To be stable with this mental illness requires the patient to comply with the treatment plan.

Future areas of research

Better treatment is expanding making it easier for patients to function with the disorder. Assignment 1: Early Onset Schizophrenia

Conclusion

After sorting through all the research, I have complied foe my final, I am realizing there’s much more to schizophrenia than what one person experiences. What I mean, my mother has been diagnosed with schizophrenia, she is able to live daily life and care for herself by cooking, cleaning, and function as a normal human being based on society’s expectations. Schizophrenia is a whole other world with sub mental categories that fall under it. Paranoid schizophrenia is one of the sub categories. So, never judge a book by its cover they say, also with people as you never know what horrible mental illness they are fighting to survive in life.

 

References

B., D. (2002, march 1). Understanding the Pathology of Schizophrenia: recent advances from the study of the molecular architecture of postmortem CNS tissue.
Postgraduate Medical Journal, 78
(917), 142-148.

Barse, M. (2017, July 23).
Some Schizophrenia Patients can Cope Without Medication
. Retrieved from ScienceNordic: http://sciencenordic.com/some-schizophrenia-patients-can-cope-without-medication

Cherry, K. ( 2018, March 05).
Psychological Disorder and Diagnosis
. Retrieved from VeryWell Mind : https://www.verywellmind.com/what-is-a-psychological-disorder-2795767 Assignment 1: Early Onset Schizophrenia

Dina Cagliostro, P. (2018, February 14).
5 Schizophrenia Subtypes
. Retrieved from PSYCOM: https://www.psycom.net/schizophrenia-5-subtypes

Elements Behavioral Health. (2017, January 03).
Schizophrenia: Symptoms, Signs, and Treatment
. Retrieved from Elements Behaviroal Health : https://www.elementsbehavioralhealth.com/addiction-resources/mental-health-resources/schizophrenia-symptoms-signs-treatment/

Erick Messias, M. P., Chuan-Yu Chen, P., & William W. Eaton, P. (2007, September ). Epidemiology of Schizophrenia: Review of Findings and Myths.
Psychiatric Clinic North America, 30
(3), 323-338.

Living with Schizophrenia . (n.d.).
How is Schizophrenia Diagnosed?
Retrieved from Living with Schizophrenia : https://www.livingwithschizophreniauk.org/advice-sheets/how-is-schizophrenia-diagnosed/ Assignment 1: Early Onset Schizophrenia

NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker

Assignment: The Nurse Leader as Knowledge Worker

The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, 
The Landmarks of Tomorrow
 (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker.

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

Review the concepts of informatics as presented in the Resources.

Reflect on the role of a nurse leader as a knowledge worker.

Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

Explain the concept of a knowledge worker.

Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

Develop a simple infographic to help explain these concepts.NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker.

Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses.

 

How to make infographics PowerPoint website

https://24slides.com/presentbetter/how-make-infographic-powerpoint/

Our inpatient psychiatric unit has identified the existence of a high rate of medication administration errors. The errors include the giving of wrong dosages to several patients leading to complications. The error has led to an increase in patient mortality rate and a reduction in the quality of patient experiences. Nursing informatics can be applied to determine the main source of this problem. Recently, my institution has measures put in place to ensure the safety of our patient. We recently transition from paper documentation to Electronic medical records (EMR) documentation. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker.

Our IT department has recently installed desktop computers in each medication room, each computer has a scanner used to scan patient wristbands before administering medication. We currently use the MEDITECH EMR in our psychiatric hospital. During admission each patient is given a wristband with a barcode on it. In addition to using the barcode scanner, our staff are trained to use the five rights of medication administration. These measures put in place has significantly reduced medication errors in our facility. Barcode medication administration (BCMA) is recommended for the prevention of MAEs because it allows nurses to verify the five rights of medication administration (i.e., patient, drug, time, route, and dose). Observational studies on BCMA technology reported a decrease in the incidence of MAEs, the implementation of a BCMA system for patients with serious psychiatric issues was associated with an 90% relative reduction of MAEs. Aside administering medication, our facility uses MEDTECH software to collect other data such as patient lab work, vital signs and, documentation of patient assessment during and at the end of each shift.

Below is a scenario in my week 1  discussion post showing the application of nursing informatics to improve clinical reasoning and judgment in nursing

Paper documentation has posed serious health consequences on the life of patient in most psychiatric facilities. A patient was once given the wrong medication meant for another patient during the paper documentation process, but luckily for that patient just about the time of discharge, the nurse decided to take a look at the medication when providing medication teaching to the patient. If the nurse had not taken a look at the medication it could have pose a serious health problem for the patient. Additionally, the error could have led to legal proceedings for the facility. Since the implementation of the MEDITECH software, these errors have greatly reduced.

The implementation of EMR have promoted patient safety in the healthcare industry. The ANA and other healthcare organizations are encouraging hospitals and other healthcare facilities to implement EHR. Reimbursement agencies like Center for Medicaid and Medicare are giving incentives to healthcare facilities that use EHR for documentation and clinical procedures. The use of nursing informatics has enabled healthcare institutions to collect patient data and input it in software making it possible for the healthcare team to view these data electronically, these helps the team to collectively make informed decision regarding the patients, thus promoting patient involvement in their care. With EMR patient are able to view their electronic health records and make informed decisions about their care. These promote compliance and autonomy. Additionally, the use of EHR records in healthcare institutions have proven to reduce medication error, thus promoting patient safety, provide quality care and safety outcomes. (McGonigle & Mastrian, 2017). NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker.

 

References

Laureate Education (Producer). (2018).
Health Informatics and Population Health: Trends in Population Health
[Video file]. Baltimore, MD: Author.

 

Lin J, Lin K, Jiang W, & Lee T. (2007). An exploration of nursing informatics competency and satisfaction related to network education. 
Journal of Nursing Research (Taiwan Nurses Association)
, 
15
(1), 54–66. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=106105042&site=ehost-live&scope=site NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker

 

Sweeney, J. (2017). Healthcare informatics.
Online Journal of Nursing Informatics, 21
(1).

Note:
You will access this article from the Walden Library databases.

 

McGonigle, D., & Mastrian, K. G. (2017). 
Nursing informatics and the foundation of knowledge
. (4
th
ed.) Burlington, MA: Jones & Bartlett Learning.

 

Kelly, S. (2016). The patient misidentification crisis. Health Management Technology, 12-13.

Hoffmeister, L., & Schebella, G. (2014). Use of identification wristbands among patients receiving inpatients treatment in a teaching hospital. Rev Lat Emfermagen, 23 (1), 36-43.

Laureate Education (Producer). (2018).
Health Informatics and Population Health: Trends in Population Health
(Video file). Baltimore, MD: Author.

 

 

 

Assignment: The Nurse Leader as Knowledge Worker

The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, 
The Landmarks of Tomorrow
(1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar? NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

Review the concepts of informatics as presented in the Resources.

Reflect on the role of a nurse leader as a knowledge worker.

Consider how knowledge may be informed by data that is collected/accessed. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker

The Assignment:

Explain the concept of a knowledge worker.

Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

Develop a simple infographic to help explain these concepts.NOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.

Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker

 

How to make infographics PowerPoint website

https://24slides.com/presentbetter/how-make-infographic-powerpoint/

Our inpatient psychiatric unit has identified the existence of a high rate of medication administration errors. The errors include the giving of wrong dosages to several patients leading to complications. The error has led to an increase in patient mortality rate and a reduction in the quality of patient experiences. Nursing informatics can be applied to determine the main source of this problem. Recently, my institution has measures put in place to ensure the safety of our patient. We recently transition from paper documentation to Electronic medical records (EMR) documentation.

Our IT department has recently installed desktop computers in each medication room, each computer has a scanner used to scan patient wristbands before administering medication. We currently use the MEDITECH EMR in our psychiatric hospital. During admission each patient is given a wristband with a barcode on it. In addition to using the barcode scanner, our staff are trained to use the five rights of medication administration. These measures put in place has significantly reduced medication errors in our facility. Barcode medication administration (BCMA) is recommended for the prevention of MAEs because it allows nurses to verify the five rights of medication administration (i.e., patient, drug, time, route, and dose) NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker. Observational studies on BCMA technology reported a decrease in the incidence of MAEs, the implementation of a BCMA system for patients with serious psychiatric issues was associated with an 90% relative reduction of MAEs. Aside administering medication, our facility uses MEDTECH software to collect other data such as patient lab work, vital signs and, documentation of patient assessment during and at the end of each shift.

Below is a scenario in my week 1  discussion post showing the application of nursing informatics to improve clinical reasoning and judgment in nursing

Paper documentation has posed serious health consequences on the life of patient in most psychiatric facilities. A patient was once given the wrong medication meant for another patient during the paper documentation process, but luckily for that patient just about the time of discharge, the nurse decided to take a look at the medication when providing medication teaching to the patient. If the nurse had not taken a look at the medication it could have pose a serious health problem for the patient NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker. Additionally, the error could have led to legal proceedings for the facility. Since the implementation of the MEDITECH software, these errors have greatly reduced.

The implementation of EMR have promoted patient safety in the healthcare industry. The ANA and other healthcare organizations are encouraging hospitals and other healthcare facilities to implement EHR. Reimbursement agencies like Center for Medicaid and Medicare are giving incentives to healthcare facilities that use EHR for documentation and clinical procedures. The use of nursing informatics has enabled healthcare institutions to collect patient data and input it in software making it possible for the healthcare team to view these data electronically, these helps the team to collectively make informed decision regarding the patients, thus promoting patient involvement in their care. With EMR patient are able to view their electronic health records and make informed decisions about their care. These promote compliance and autonomy. Additionally, the use of EHR records in healthcare institutions have proven to reduce medication error, thus promoting patient safety, provide quality care and safety outcomes. (McGonigle & Mastrian, 2017).

References

Laureate Education (Producer). (2018).
Health Informatics and Population Health: Trends in Population Health
[Video file]. Baltimore, MD: Author.

 

Lin J, Lin K, Jiang W, & Lee T. (2007). An exploration of nursing informatics competency and satisfaction related to network education. 
Journal of Nursing Research (Taiwan Nurses Association)
, 
15
(1), 54–66. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=106105042&site=ehost-live&scope=site

 

Sweeney, J. (2017). Healthcare informatics.
Online Journal of Nursing Informatics, 21
(1).

Note:
You will access this article from the Walden Library databases. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker

 

McGonigle, D., & Mastrian, K. G. (2017). 
Nursing informatics and the foundation of knowledge
. (4
th
ed.) Burlington, MA: Jones & Bartlett Learning.

 

Kelly, S. (2016). The patient misidentification crisis. Health Management Technology, 12-13.

Hoffmeister, L., & Schebella, G. (2014). Use of identification wristbands among patients receiving inpatients treatment in a teaching hospital. Rev Lat Emfermagen, 23 (1), 36-43.

Laureate Education (Producer). (2018).
Health Informatics and Population Health: Trends in Population Health
(Video file). Baltimore, MD: Author. NURS_6051 informatics week 2 Assignment: The Nurse Leader as Knowledge Worker.

Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

Name:

Institution:

CONCEPT OF KNOWLEDGE WORKER

‘Knowledge worker’ introduced by Peter Drucker in 1959.

Are highly skilled and knowledgeable professions.

ORDER A PLAGIARISM-FREE PAPER HERE

Right complement of knowledge, experience and skills.

‘Knowledge worker’ is a term that was first coined by Peter Drucker in 1959 to refer to highly skilled persons who require specialized knowledge to fulfil their professional responsibilities. This was in response to the increasing specialization and awareness that certain professional roles required specific skills. This implies that knowledge workers must have the right complement of knowledge, experience and skills that differentiates them from other professions and makes them the best persons to complete the tasks unique to them (Drucker, 1959). Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. For instance, nurses are knowledge workers since they are high level professionals who acquire theoretical and analytical knowledge from formal training, and apply that knowledge to offer nursing services and develop medical products, with other professions incapable of competing with nurses in…

Assignment: The Nurse Leader as Knowledge Worker

The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book, 
The Landmarks of Tomorrow
 (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

Review the concepts of informatics as presented in the Resources.

Reflect on the role of a nurse leader as a knowledge worker.

Consider how knowledge may be informed by data that is collected/accessed.

The Assignment:

Explain the concept of a knowledge worker.

Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

Develop a simple infographic to help explain these concepts. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignmentNOTE: For guidance on infographics, including how to create one in PowerPoint, see “How to Make an Infographic in PowerPoint” presented in the Resources.

Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

 

How to make infographics PowerPoint website

https://24slides.com/presentbetter/how-make-infographic-powerpoint/

Our inpatient psychiatric unit has identified the existence of a high rate of medication administration errors. The errors include the giving of wrong dosages to several patients leading to complications. The error has led to an increase in patient mortality rate and a reduction in the quality of patient experiences. Nursing informatics can be applied to determine the main source of this problem. Recently, my institution has measures put in place to ensure the safety of our patient. We recently transition from paper documentation to Electronic medical records (EMR) documentation. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment.

Our IT department has recently installed desktop computers in each medication room, each computer has a scanner used to scan patient wristbands before administering medication. We currently use the MEDITECH EMR in our psychiatric hospital. During admission each patient is given a wristband with a barcode on it. In addition to using the barcode scanner, our staff are trained to use the five rights of medication administration. These measures put in place has significantly reduced medication errors in our facility. Barcode medication administration (BCMA) is recommended for the prevention of MAEs because it allows nurses to verify the five rights of medication administration (i.e., patient, drug, time, route, and dose). Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. Observational studies on BCMA technology reported a decrease in the incidence of MAEs, the implementation of a BCMA system for patients with serious psychiatric issues was associated with an 90% relative reduction of MAEs. Aside administering medication, our facility uses MEDTECH software to collect other data such as patient lab work, vital signs and, documentation of patient assessment during and at the end of each shift.

Below is a scenario in my week 1  discussion post showing the application of nursing informatics to improve clinical reasoning and judgment in nursing

Paper documentation has posed serious health consequences on the life of patient in most psychiatric facilities. A patient was once given the wrong medication meant for another patient during the paper documentation process, but luckily for that patient just about the time of discharge, the nurse decided to take a look at the medication when providing medication teaching to the patient. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. If the nurse had not taken a look at the medication it could have pose a serious health problem for the patient. Additionally, the error could have led to legal proceedings for the facility. Since the implementation of the MEDITECH software, these errors have greatly reduced.

The implementation of EMR have promoted patient safety in the healthcare industry. The ANA and other healthcare organizations are encouraging hospitals and other healthcare facilities to implement EHR. Reimbursement agencies like Center for Medicaid and Medicare are giving incentives to healthcare facilities that use EHR for documentation and clinical procedures. The use of nursing informatics has enabled healthcare institutions to collect patient data and input it in software making it possible for the healthcare team to view these data electronically, these helps the team to collectively make informed decision regarding the patients, thus promoting patient involvement in their care. With EMR patient are able to view their electronic health records and make informed decisions about their care. These promote compliance and autonomy. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. Additionally, the use of EHR records in healthcare institutions have proven to reduce medication error, thus promoting patient safety, provide quality care and safety outcomes. (McGonigle & Mastrian, 2017).

 

References

Laureate Education (Producer). (2018).
Health Informatics and Population Health: Trends in Population Health
[Video file]. Baltimore, MD: Author. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment.

 

Lin J, Lin K, Jiang W, & Lee T. (2007). An exploration of nursing informatics competency and satisfaction related to network education. 
Journal of Nursing Research (Taiwan Nurses Association)
, 
15
(1), 54–66. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=106105042&site=ehost-live&scope=site

 

Sweeney, J. (2017). Healthcare informatics.
Online Journal of Nursing Informatics, 21
(1).

Note:
You will access this article from the Walden Library databases.

 

McGonigle, D., & Mastrian, K. G. (2017). 
Nursing informatics and the foundation of knowledge
. (4
th
ed.) Burlington, MA: Jones & Bartlett Learning.

 

Kelly, S. (2016). The patient misidentification crisis. Health Management Technology, 12-13.

Hoffmeister, L., & Schebella, G. (2014). Use of identification wristbands among patients receiving inpatients treatment in a teaching hospital. Rev Lat Emfermagen, 23 (1), 36-43. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

Laureate Education (Producer). (2018).
Health Informatics and Population Health: Trends in Population Health
(Video file). Baltimore, MD: Author.

 

NURSE LEADER AS KNOWLEDGE WORKER

Name:

ORDER A PLAGIARISM-FREE PAPER HERE

Institution:

CONCEPT OF KNOWLEDGE WORKER

‘Knowledge worker’ introduced by Peter Drucker in 1959.

Are highly skilled and knowledgeable professions.

Right complement of knowledge, experience and skills.

‘Knowledge worker’ is a term that was first coined by Peter Drucker in 1959 to refer to highly skilled persons who require specialized knowledge to fulfil their professional responsibilities. This was in response to the increasing specialization and awareness that certain professional roles required specific skills. This implies that knowledge workers must have the right complement of knowledge, experience and skills that differentiates them from other professions and makes them the best persons to complete the tasks unique to them (Drucker, 1959). For instance, nurses are knowledge workers since they are high level professionals who acquire theoretical and analytical knowledge from formal training, and apply that knowledge to offer nursing services and develop medical products, with other professions incapable of competing with nurses in completing the full complement of nursing tasks.

CONCEPT OF KNOWLEDGE
WORKER cont’d

Knowledge workers are all professions requiring formal training.

Are policed through routine checks by professional bodies.

Knowledge and skills authenticated through certification.

Practice errors can have catastrophic consequences.

Rely on thoughts and intellectual abilities.

Perform complex tasks.

Receive higher compensations.

The term knowledge worker is applicable to all professions that require formal training to transmit a specialized complement of knowledge and skills that are authenticated through certification. In fact, it is not uncommon for knowledge workers to be policed by professional bodies that routinely authenticate their competence to practice and issue finitely timed practice licenses since any errors in work performance could have catastrophic implications. The policing is particularly targeted at incompetent professionals who are weeded out (Yoder-Wise, 2013). For instance, state nursing boards routinely verify the certification and capacity to practice of all nurses before allowing them to practice since any errors in the performance of professional nursing tasks could be fatal for patients and even the nurses or other stakeholders. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment.  Through the routine checks, the nursing boards can identify incompetent nurses who would then be denied practice licenses and stopped from endangering their lives and the lives of others. Another unique feature of knowledge workers is the reliance on thoughts and intellectual abilities that allow them to address complex tasks within their practice areas. Also, knowledge workers typically receive higher compensations that reflect the complex nature of their work and their relative independence within the work process (Drucker, 1959). Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment.

 

NURSE LEADER AS KNOWLEDGE WORKER

Nurses are knowledge workers.

It is a specialized profession

Applies high level skills and knowledge acquired through formal training

Perform complex professional tasks

Adhere to professional practice standards

Enjoy a high level of independence and autonomy with minimal supervision

Policed by nursing boards

Receive high salaries

The term knowledge worker appropriately identifies nurse personnel. That is because this is a specialized profession that applies high level skills and knowledge acquired through formal training. The professional tasks that nurses complete involve the application of the knowledge and skills they acquired to address the health care needs of their patients. Also, they are required to adhere to professional practice standards, enjoy a high level of independence and autonomy with minimal supervision, are policed by nursing boards, and receive high salaries that reflect the complexity of their professional tasks (Drucker, 1959; Yoder-Wise, 2013). Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

 

NURSE LEADER AS KNOWLEDGE WORKER CONT’D.

Nursing is reinforced by emerging technologies

Acquire technical skills

uTechnology improved information management capacity and clinical knowledge

uIntegrated knowledge management

uInnovative thought processes

uExtend traditional boundaries of professional nursing practice

uEmbrace transformative possibilities and redesign nursing processes

Nurses identity as knowledge workers is reinforced by the emergence of technologies requiring them to acquire technical skills to improve health care outcomes. These emerging technologies have improved the information management capacity and clinical knowledge of nurses, allowing them to generate new understandings about the nursing profession (Nagle, Sermeus & Junger, 2017). This is especially seen in information technologies that are leveraged with other tools and technologies to present electronic health records that has transformed nursing practice, especially medical information management to conform with HIPAA requirements. It is also seen in integrated knowledge management where innovative thought processes are encouraged to expand nursing and solve existing and anticipated practice problem. As knowledge workers, nurses are boldly extending the traditional boundaries of their professional practice even as they embrace transformative possibilities and redesign nursing processes (McGonigle & Mastrian, 2017). Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

 

u
NURSE LEADER AS KNOWLEDGE WORKER CONT’D.

uNurses rely on thoughts and intellectual abilities to address complex tasks

uUse informatics to manage information and large data

uApply technical computer skills

Nurses reliance on thoughts and intellectual abilities to address complex tasks within their practice areas is seen in their increasing focus on improving health care through reducing costs, increasing quality and improving access (Lin et al., 2007). This highlights the position that informatics plays as an increasingly important branch of nursing. In this case, informatics requires that nurses acquire and apply technical skills that focus on the use of computers to help in making sense of large data. Also, it allows nurses to match technologies to nursing care units and service lines to allow for efficient and effective health care. For that matter, informatics allows nurses to act as knowledge workers through conceptualizing and managing data to guide the delivery of nursing care that improves the odds for a positive outcome. The implication is that nurses are supported by information technologies that collect and make sense of large data, requiring them to apply specialized skills to identify reliable methods for analyzing the data and presenting logical conclusions that inform practice. Informatics is a reasonable progression that highlights the identity of nurses as knowledge workers (McGonigle & Mastrian, 2017).

 

u
NURSE LEADER AS KNOWLEDGE WORKER CONT’D.

Four informatics skills highlight the identity of nurses as knowledge workers. The four skills are data gathering, information use, knowledge use, and knowledge building. The first skill is data gathering that involves collecting and summarizing information that is relevant to nursing care, such as outcomes reported for different nursing interventions. The second skill is information use that interprets the collected data to gain insight into their implications for nursing practice and relevance to other health care stakeholders. The third skill is knowledge use that correlates the information to other information (literature) to aggregate information and identify trends that inform professional nursing practice. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. The final skill is knowledge building that turns the collected information into meaningful practice that could include changes in practice standards and policies (Bowerman & van Wart, 2015).

 

u
NURSE LEADER AS KNOWLEDGE WORKER CONT’D.

The position of nurses as knowledge workers requires that they display combination of four characteristics. Firstly, they should display the theoretical and practical knowledge and skills that acquired from formal nursing education. The formal training is conducted in an environment that allows them to acquire information even as their skill and knowledge levels are tested to ensure that only competent learners graduate and are able to practice. Secondly, they should display information management capacity that includes accessing and applying information from large databases with a focus in pointing out key information. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. This characteristic requires nurses to apply relevant judgement and analytical reasoning to condense important information. Thirdly, they should display communication skills that allows them to transmit and receive information from other health care stakeholders. This includes speaking, writing, reading and discussing. Fourthly, they should be motivated to remain relevant through continuously improving their professional skills and knowledge, accepting challenges, being innovative, and preserving the spirit of enquiry (Finkelman, 2016).

u
SCENARIO: MEDICATION ADMINISTRATION ERROR

uMedication administration errors occurs among 56% of nurses.

uPresented as:

uDocumentation errors

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uTechnique errors

uTime errors

uCaused by

uNurse proficiency

uInterruptions at time of administration

uPatients’ age

uAddressed through

uImproving medication administration proficiency

uLeveraging technology in informatics

The scenario discusses medication administration errors are a concern among nurse personnel. In fact, approximately 56% of nurses reported such errors in patient encounters. The errors are presented as documentation, technique and time errors. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment. The variables associated with the errors are nurse proficiency (working experience, skill levels and education level), interruptions at time of administration, and the patients’ age (Feleke, Mulatu & Yesmaw, 2015). The position of nurses as knowledge workers offers them an opportunity to address the errors, through improving proficiency in medication administration and leveraging technology through informatics. Improving proficiency ensures that nurses are competent enough to administer medication without making errors (Lin et al., 2007). Informatics allows nurses to identify the sources of errors and implement deliberate strategies to address this errors without the practice standards and protocols (Nagle, Sermeus & Junger, 2017). Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment.

u
References

uBowerman, K. & van Wart, M. (2015).
The business of leadership: an introduction
. New York, NY: Routledge.

uDrucker, P. (1959).
The landmarks of tomorrow
. New York, NY: HarperCollins Publishers.

uFinkelman, A. (2016).
Leadership and management for nurses: core competencies for quality care
(3rd ed.). London: Pearson Education.

uLin, J., Lin, K., Jiang, W. & Lee, T. (2007). An exploration of nursing informatics competency and satisfaction related to network education.
Journal of Nursing Research
, 15(1), 54-65.

uMcGonugle, D. & Mastrian, K. (2017).
Nursing informatics and the foundation of knowledge
(4th ed.). Burlington, MA: Jones & Bartlett Learning. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

uNagle, L., Sermeus, W. & Junger, A. (2017). Evolving role of the nursing informatics specialist.
Forecasting Informatics Competencies for Nurses in the Future of Connected Health,
212-221. doi:10.3233/978-1-61499-738-2-212

uYoder-Wise, P. (2013).
Leading and managing in nursing
(5th ed.). Amsterdam: Elsevier Health Sciences. Nurse Leader as Knowledge Worker – NURS 6051 informatics week 2 assignment

u

Population & Community Health Promotion Essay

What are specific actions that health professionals can take regardless of their practice area and site to promote population and community health?

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Population and Community Health Promotion

Specific actions that health professionals can take regardless of their practice area and site to promote population and community health

Planning and implementation Health education programs

Health education is a major approach for implementation of disease prevention and health promotion programs.  Health professionals can plan and implement health education programs to offer education to populations and communities on how they can become responsible for their development and protection of their health all their lives.  According to Kabasakal and Kublay (2017), health education, which provides structured learning opportunities, partly includes communication approaches projected at promoting health literacy practices, like the increase in the levels of knowledge along with the advancement of life skills to assist improve community and individual health. Population & Community Health Promotion Essay.

Health care education can be offered through sharing of information, as well as motivating and encouraging trust and certain skills, which are influential in bringing improvement to the health of people. Kabasakal and Kublay (2017) state that if health care professionals working in institutions that offer primary health care have the necessary skills, experience and knowledge to promote health, they can inform communities by counselling them about appropriate lifestyle behaviors that promote health.

Getting involved assessment of community needs and health planning  

Community health planning starts with health professional diagnoses. Health professionals design goals aimed at resolving potential or existing health concerns.  Population & Community Health Promotion Essay Recognition of potential or specific health issues with premeditated action to attain anticipated outcomes offers the data and framework for community needs assessment.  As Edelman, et al (2017) indicate, community involvement in health planning enables effectual assignment of priorities. As recipients of health services, community members endeavor for services that are high-quality and reasonably priced. Residents intend to attain suitable benefits for the concerns and needs of the populations. Health planning highlights the promotion and protection of population health and thus the definition of problems, actions, and solutions occur at the group level.

Planned change is as a result of efforts by groups and individuals and entails fundamental changes in behavior. Individuals function as agents of their personal health conditions and community health goals usually relay on dynamic decisions to alter their lifestyles. Endeavors to impact and reinforce transformations in community health behavior is the emphasis of effectual risk reduction programs. According to Edelman et al (2017), promotion of community health via risk reduction programs entails community members become more responsible of their personal health, becoming more active in the adoption of healthy lifestyles, and monitoring resources within the community to accomplish healthy behaviors. Population & Community Health Promotion Essay.

Advocating for social change

Health professionals can advocate for policies that can improve social conditions which influence the health of disadvantaged and poor populations.   Economically and socially disadvantaged populations have a less likelihood of being in good health, less likelihood to access quality healthcare services and a high likelihood of dying prematurely compared to economically and socially advantaged populations. According to Williams et al (2018), economically and socially disadvantaged populations are greatly affected by public policy and can thus gain from policies intended at improving social conditions that influence health. Nurses, physicians, and other health professionals can advocate for the proper social policies to promote fairness, justice and health parity and adequately, addresses social determinants of health.

Health professionals have an influential voice and can s articulate on the health effects of social challenges to inspire wider policy responses and impact what goes onto the local agenda. As Andermann (2016) alleges, health professionals can participate in activism through supporting political parties and social movements that lobby for affordable childcare, progressive taxation, basic income, along with other measures to lessen health disparities. they can undertake locally pertinent research and utilize data on social determinants intercede in their personal context in a better way and produce evidence as a pedal for advocacy. Population & Community Health Promotion Essay. Williams et al (2018) claim that the appropriate policies and right interventions can interpose the cycle of disadvantage, poor health, and poverty. Evidence-based, effectual policies can result in healthier communities and tackle inability to access material and social resources that act as the source of health inequities.

References

Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals.
Canadian Medical Association Journal
, 188(17-18): E474-E483.

Edelman, C., Mandle, C., & Kudzma, E. (2017).
Health Promotion Throughout Life Span – E-Book
.  New York:  Elsevier Health Sciences.

Kabasakal, E., & Kublay, G. (2017). Health Education and Health Promotion Skills of Health Care Professionals Working in Family Health Centers.
International Journal of Medical Research   & Health Sciences,
6(3): 22-28.

Williams, S., Phillips, J., & Koyama, K. (2018). Nurse Advocacy: Adopting a Health in All Policies Approach.
The Online Journal of Issues in Nursing
, 23(3): 1. Population & Community Health Promotion Essay

NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

Evidence-Based Decision Making-Handwashing To Reduce HAIs

Name

Institution

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Course Name

Date

Description Of Healthcare Organization

A regional-based hospital of a 400 bed capacity

The hospital serves an estimated population of 200,000 people

The healthcare workforce majorly comprises of nurses

NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

Healthcare staffs are dedicated and passionate

The organization has embraced a culture of multidisciplinary collaboration

For the purpose of this EBP project, the healthcare organization of choice is regional-based hospital of a 400 bed capacity which serves an estimated population of 200,000 people (children, elderly and adults). The hospital’s healthcare workforce primarily comprises of nurses although there are other healthcare providers such as physicians, dieticians, cardiologists, nurse practitioners and specialists. The nurses are passionate and dedicated and guided by professional values and ethics which increase their likelihood to be engaged in EBP research. The hospital has a library with a wide-range of resources to research from.

 

Problem Description

üHAIs comprise 30% of the hospitals diagnoses among hospitalized patients

üHigh incidences of HAIs are as a result of poor hand hygiene practices

üPatients experience prolonged admissions and poor health outcomes

üHigh incidences of HAIs  impact negatively on the hospitals financial performance

üIt also has a negative impact on rates of patient satisfaction, staff satisfaction and patient health outcomes

Hospital Acquired Infections were noted to contribute to 30% of diagnoses among patients who were hospitalized. The high incidences were attributed to poor hand hygiene practices and lack of hygiene protocols. As a result, most patients faced prolonged admissions with additional medical costs and poor health outcomes. These effects proved to impact negatively on the hospital’s financial performance and reputation. It also lowered the …

 

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

Reflect on the four peer-reviewed articles you critically appraised in Module 4.

Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment:
 (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

Add a lessons learned section that includes the following:

A summary of the critical appraisal of the peer-reviewed articles you previously submitted

An explanation about what you learned from completing the evaluation table (1 slide)

An explanation about what you learned from completing the levels of evidence table (1 slide)

An explanation about what you learned from completing the outcomes synthesis table (1 slide)

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Topic: Preventing Healthcare-Associated Infection ( HAIs) in my workplace

Below are 4 journals to support a change in practice in my workplace

 

Article 1- Ford, C., & Park, L. J. (2018) –Level 7

Article 2- Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017)-Level 2

Article 3 – Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018)-Level  4

Article 4- Halm, M., & Sandau, K. (2018)-Level 1

 

 

Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. 
British Journal of Nursing
, 
27
(20), 1164–1166.
https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2018.27.20.1164

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
BMC Infectious Diseases
, 
17
, 1–9.
https://doi-org.ezp.waldenulibrary.org/10.1186/s12879-016-2157-z

 

 

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
Nurse Education Today
, 
63
, 112–118.
https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2018.01.022

https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S0260691718300492?via%3Dihub

 

 

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
American Journal of Critical Care
, 
27
(4), 334–337. https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2018727

 

 

Below are the research databases I used to conduct my research

 

Walden University Library. (n.d.-b). Evidence -based practice research: CINAHL Search help.

Retrieved September 6, 2019, from

https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

 

Library of Congress. (n.d.). Search /browse help-Boolean Operators and nesting

Retrieved September 19, 2018, from,

https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchKeyword.html

 

Walden Library. (n.d.) PubMed: Getting Started. Retrieved September  19, 2019 from,
https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pubmed/?otool=mnwullib

 

Evidence-Based Decision Making-Handwashing To Reduce HAIs

Name

Institution

Course Name

Date

Description Of Healthcare Organization

A regional-based hospital of a 400 bed capacity

The hospital serves an estimated population of 200,000 people

The healthcare workforce majorly comprises of nurses

Healthcare staffs are dedicated and passionate

The organization has embraced a culture of multidisciplinary collaboration

For the purpose of this EBP project, the healthcare organization of choice is regional-based hospital of a 400 bed capacity which serves an estimated population of 200,000 people (children, elderly and adults). The hospital’s healthcare workforce primarily comprises of nurses although there are other healthcare providers such as physicians, dieticians, cardiologists, nurse practitioners and specialists. The nurses are passionate and dedicated and guided by professional values and ethics which increase their likelihood to be engaged in EBP research. The hospital has a library with a wide-range of resources to research from.

 

Problem Description

üHAIs comprise 30% of the hospitals diagnoses among hospitalized patients

üHigh incidences of HAIs are as a result of poor hand hygiene practices

üPatients experience prolonged admissions and poor health outcomes

üHigh incidences of HAIs  impact negatively on the hospitals financial performance NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

üIt also has a negative impact on rates of patient satisfaction, staff satisfaction and patient health outcomes

Hospital Acquired Infections were noted to contribute to 30% of diagnoses among patients who were hospitalized. The high incidences were attributed to poor hand hygiene practices and lack of hygiene protocols. As a result, most patients faced prolonged admissions with additional medical costs and poor health outcomes. These effects proved to impact negatively on the hospital’s financial performance and reputation. It also lowered the staff and patient satisfaction rates.

 

Proposed Evidence-based Idea

üThe hospital has selected handwashing with soap and water to reduce HAIs

üA proposed alternative is the use of alcohol-based handrubs

üHandwashing promotes hand hygiene

üIt also reduces  the acquisition rates of pathogens on the hands

üHandwashing will help  to prevent and reduce the incidences of HAIs

The organization has decided on handwashing using soap and water to reduce the rates and incidences of HAIs. An alternative that has also demonstrated efficacy is the use of alcohol-based handrubs. Handwashing has proven to promote hand hygiene by reducing the rates of acquiring pathogens on hands thus reducing and preventing the rates and incidences of HAIs in the organization. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

 

Plan For Knowledge Transfer

üStakeholders’ knowledge on hand hygiene using a survey will be assessed

üThe survey results will be reviewed to identify information gaps

üTraining plans will be planned based on the identified knowledge and information gaps

üTraining will be  modified to  address organizational and patient needs

üAn actual training  will be conducted and feedback obtained

üAn infection control committee will be implemented to oversee the implementation process

The first step when planning for knowledge transfer will be to assess for the needs in training by assessing stakeholders’ knowledge on hand hygiene and hand washing and how it prevents HAIs through a short survey. The findings will help to identify potential information and knowledge gaps and help to facilitate plans for training. The training will be modified to address patients and organizational needs to achieve specific goals. The implementation of the knowledge shared and adoption of a hygiene protocol will be overseen by an infection control committee that will thereafter be established. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

 

Measurable Outcomes

üIncident reports from the inpatient setting of patients diagnosed with HAIs

üPatient’s length of stay in hospital

üThe hospital’s financial performance

üMortality and morbidity rates

üPatient experience of care

After implementing the proposed intervention, expected outcomes should be able to be measured by the infection control committee. As a result, it will be able to establish whether the organization has achieved its goals or not.  The most relevant measurable outcomes are: incident reports of inpatients diagnosed with HAIs, patients’ experience of care, morbidity and mortality rates, financial performance and length of patient’s stay in hospital. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

 

Lessons Learned: Critical Appraisal Summary Of Peer-reviewed Articles

üFour peer-reviewed articles were appraised

üThe articles were published between the years 2017-2018

üAll articles supported handwashing with soap and water to prevent HAIs

üThe articles had different study designs

üThe articles evidence levels ranged from Level I–Level VII

All the articles that were appraised supported the hand hygiene practice of washing hands using soap and water to prevent HAIs. These articles were published between the years 2017-2018 and had totally different study designs with  evidence levels ranging from  level I-level VII. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

 

Lessons Learned: Evaluation Table

üThe conceptual framework used was not explained in all articles

üBased on every researcher’s objectives and aims, various study designs were used

üData collection methods involved the use of semi-structured surveys and interviews

üStudy populations in each article were different and included nurses, general practitioners

üThe study setting was determined by  the objective, design and data collection method of a study

üData analysis was done using framework analysis, statistical analysis and thematic analysis.

The conceptual framework used was not explained in all articles. Based on every researcher’s objectives and aims, various study designs were used. Data collection methods involved the use of semi-structured surveys and interviews. Study populations in each article were different and included nurses, general practitioners. The study setting was determined by the objective, design and data collection method of a study. Lastly, data analysis was done using framework analysis, statistical analysis and thematic analysis. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

 

Lessons Learned: Outcome Synthesis Table

üThe participants in each of the studies varied in terms of professional background

üThe characteristics of study participants was determined by a study’s objective and purpose

üThe outcomes included participants directly and indirectly involved and expected change

üHealthcare providers should embrace hand hygiene practices to reduce/prevent HAIs

üNurses should be educated on hand hygiene practices to promote patient safety

The participants in each of the studies varied in terms of professional background. The characteristics of study participants were determined by a study’s objective and purpose. The outcomes included participants directly and indirectly involved and expected change. Healthcare providers should embrace hand hygiene practices to reduce/prevent HAIs. Nurses should be educated on hand hygiene practices to promote patient safety. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

 

Lessons Learned: Levels Of Evidence Table

üThe methodological quality determined the level of evidence assigned to each study

üThe evidence level given to each study informed the recommended grade and strength

üThe highest evidence level was Level I

üThe lowest evidence level was level VII

ü All the studies were  reliable, valid and the results were generally applicable  to large population settings

The methodological quality determined the level of evidence assigned to each study. The evidence level given to each study informed the recommended grade and strength .The highest evidence level was Level I and the lowest evidence level was level VII.  All the studies were reliable, valid and the results were generally applicable to large population settings.

 

References

üFord, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. 
British Journal of Nursing, 27
(20), 1164–1166.

üHovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
BMC Infectious Diseases, 17
, 1–9.

üHalm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
American Journal of Critical Care, 27
(4), 334–337.

üKingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
Nurse Education Today, 63
, 112–118. NURS_6052_week_9 Assignment: EBP, Part 5: Recommending an EBP Change

N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay

N502 Assignment 1

Introduction

This paper will reflect on my leadership styles, professional goals, role concept, and prospective action plan. I have been working as a registered nurse since 1997 and as a nurse anesthetist since 2001. During my practice, my desire to expand my nursing knowledge and competency and be an advanced nurse practitioner has grown.  My purpose is to serve the patients of my community and the surrounding region. In addition, to serve other underserved, rural regions and states via telemedicine. In addition, I want to become a respected, dedicated and compassionate nurse anesthetist practitioner. N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay. I also want to become a competent leader who inspires, motivates, mentors and acts as a role model for my juniors while in practice. I am also interested in helping patients with anxiety or have problems in understanding, due to language barriers or low level of education, what the recommended procedures require and the rationale behind prescription of such procedures.

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Becoming a specialist as a nurse practitioner will enable me to get the highest knowledge base and most competent level of skill possible, which will enable me to differentiate myself as a nurse anesthetist practitioner with the ability to “add value” to the profession through learning and research. By furthering my education, I seek to achieve my personal potential using my experience and training so far, within the most challenging and afterward satisfying role. N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay.

Professional Background

I became and started practicing as a registered nurse in 1997 after completing my diploma in nursing. In 1999, I obtained my bachelor of science in nursing (
BSN
) and in 2001 I obtained my MS with a concentration in nurse anesthesia. In addition, in 2009 I obtained a nurse legal consulting certificate. I also participate in professional development courses and maintain continuing education as per the professional requirements and as for my passion.

I began my nursing career in 1997 in a telemetry unit after I obtained my diploma in nursing. Afterwards, I transferred to critical care/surgical ICU where my duties included assessment of patients’ conditions and progress; treatment administration and monitoring doses; provision of constant support to patients during recovery; delivering regular updates to physicians, patients and their families; responding to medical emergencies and notifying appropriate physicians; completing all required paperwork during patient’s transition; and developing and implementing effective care plans for the patients (Woo et al, 2017). In addition, from 2001 I have worked as a nurse anesthetist in various settings and states. N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay. During my practice as a nurse anesthetist, I worked in collaboration with surgeons, obstetricians, doctors, anesthesiologists, podiatrists, and other healthcare practitioners to ensure safe and effective administration of anesthesia. Some of my duties included provision of pain management, providing stabilization services, and managing patient recovery (Woo et al, 2017).

My decision to go back to graduate school and obtain my NP degree and finally become an advanced nurse practitioner has evolved over the years, and my focus is on the adult population. As an NP, I will be able to assess, diagnose, and even provide treatment to the patients within specialized healthcare, and in this case adult population.  I also plan to enroll in advanced pain management fellowship (Advanced Pain Management Certificate Program) to equip me with the required skills to meet the pain management needs of my patients. After completing the pain management fellowship, I N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay

 

Personal and Professional Goals

Personal Goals

To advance my education in order to gain knowledge and skills necessary to attain my educational personal goals of graduating with a degree in anesthetic nurse practitioner

To become a transformational nurse leader during my practice. Transformational leadership style is characterized by the ability to inspire and motivate staff and improve care through innovation.

To continue my education by pursuing a Doctorate in Nursing Practice (DNP) in order to improve patient care through knowledge advancement. As a DNP prepared nurse, I will be able to effectively implement evidence developed by researchers into daily patient care. Therefore, I plan to engage in extensive research as a DNP prepared nurse N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay.

Professional Goals

To seek employment as a full-time advanced nurse practitioner in my area of study (anesthetist). The rationale for this goal is that it will enable me to gain experience, skills, and competency that will enable me to continue growing.

To become an educator or a preceptor for other nurse practitioner students. Being a mentor for new nurse practitioners and other experienced NPs is important since the success of all is on the success of each. When mentoring other practitioners, I will foster a nurturing environment and give other practitioners the necessary resources to enable them handle situations and challenges they may encounter during their practice.

To increase my overall understanding of nursing and have an opportunity to research issues touching my community in order to improve their health. Advanced nursing will provide me with the professional latitude to make the diagnosis, prescriptions, and management of patient care while emphasizing on prevention and education during the patients’ lifespan.

Empirical Application of the Role Concept

The roles I am likely to encounter in my graduate school include role stress, role stressors, and role transition. Role stress will occur due to the increased role performance demand as I juggle between the education demand, work duties as a registered nurse, personal and family obligations (Barnes, 2015). These many duties can cause stress and burn out during my study. N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay. In order to integrate my study more effectively into my already busy life, I plan to pursue my MS for NP online. I will also create schedule for my activities, plan my course in advance and always set time to attend the assignment and classes. I also plan o take regular breaks from some duties such as family activities in order to maintain a healthy work-education-life balance.

Role stressors involve an increase in factors that produce role stress. In my case, the factors will include financial obligations and academic demands. For financial obligations, I plan to apply for the available scholarships from professional nursing associations, Federal and state governments, and institutions of higher learning (Lathrop & Hodnicki, 2014) N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay.

The last concept applicable to me, is role transition where I will be transitioning from a nurse to an advanced nurse practitioner in my area of study.  According to Barnes (2015), transitioning from an RN to a nurse practitioner is normally a major career role transition that can be stressful. However, due to my wide experience as a nurse anesthetist which was important in developing competency and acquiring skills in the area, I believe my role transition will be relatively easy. In addition, I believe that structured orientation and mentorship as a transit into an NP will ensure faster and easy transition.

Conclusion

My professional goal and passion have always been to obtain an NP degree and become an advanced nurse practitioner. I plan to advance as an anesthetist nurse practitioner focusing on the adult population. My personal goals include advancing my education, to pursue Doctorate in Nursing Practice and to become a transformational leader in my practice. My professional goals include seeking employment as a full-time advanced nurse practitioner, becoming an educator or preceptor, and becoming a researcher to improve care. During my transition to an NP, there is a likelihood of encountering role stress, role stressors, and role transition. N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay.

 

References

Barnes H. (2015). Exploring the Factors that Influence Nurse Practitioner Role Transition.
J Nurse Pract
. 11(2), 178–183.

Lathrop, B & Hodnicki, D. (2014). The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse.
OJIN: The Online Journal of Issues in Nursing
. 19(2).

Woo B, Lee J & Tam W. (2017). The impact of the advanced practice nursing role on the quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review.
Hum Resour Health
. 15(63). N502 Nursing Assignment 1 – leadership styles, professional goals, role concept, and prospective action plan Essay

Critical Appraisal Tools Worksheet Template

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

Evaluation Table

ORDER A PLAGIARISM-FREE PAPER HERE

Use this document to complete the
evaluation table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Full
citation
of selected article

Article #1

Article #2

Article #3

Article #4

 

 

 

 

Conceptual Framework

Describe the theoretical basis for the study

 

 

 

 

 

Design/Method
Describe the design

and how the study

was carried out

 

 

 

 

 

Sample/Setting

The number and

characteristics of

patients,

attrition rate, etc.

 

 

 

 

 

 

 

 

Major Variables Studied

List and define dependent and independent variables

 

 

Measurement

Identify primary statistics used to answer clinical questions

Data Analysis

Statistical or

qualitative

findings

Findings and Recommendations

General findings and recommendations of the research

Appraisal

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of

use in your practice?

ORDER A PLAGIARISM-FREE PAPER HERE

General Notes/Comments

 

 

 

 

 

 

 

Levels of Evidence Table

 

Use this document to complete the
levels of evidence table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Author
and
year
of selected article

Article #1

Article #2

Article #3

Article #4

 

 

 

 

Study Design

Theoretical basis for the study

 

 

 

 

 

Sample/Setting

The number and

characteristics of

patients

Evidence Level *

(I, II, or III)

 

 

 

Outcomes

 

 

 

General Notes/Comments

 

 

 

 

 

 

 

* Evidence Levels:

 

Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

 

Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

 

Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

 

Outcomes Synthesis Table

 

Use this document to complete the
outcomes synthesis table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Author
and
year
of selected article

Article #1

Article #2

Article #3

Article #4

 

 

 

 

Sample/Setting

The number and

characteristics of

patients

Outcomes

 

 

 

 

Key Findings

 

Appraisal and Study Quality

 

General Notes/Comments

 

 

 

 

 

 

 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template (1)

Critical Appraisal Tools Worksheet Template

Introduction

           
This paper systematically and carefully examines four studies to determine their relevance, value and trustworthiness in addressing the issue of HAIs to influence good health outcomes in clinical settings. It includes a literature evaluation table, a level of evidence table and an outcomes synthesis table. For nurses to  safeguard  public health  and provide high quality services, valid and reliable information is needed on what is likely or not likely to harm  patients and the approaches to care  that represent good value.

Evaluation Table

 

Use this document to complete the
evaluation table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

Full
citation
of selected article

Article #1

Article #2

Article #3

Article #4

Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. 
British Journal of Nursing, 27
(20), 1164–1166.

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
BMC Infectious Diseases, 17
, 1–9

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
Nurse Education Today, 63
, 112–118.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
American Journal of Critical Care, 27
(4), 334–337.

Conceptual Framework

Describe the theoretical basis for the study

 

Not provided

Not provided

Not provided

Not provided

Design/Method
Describe the design

and how the study

was carried out

Design-
Clinical practice guidelines

Method-
clinical guidelines based on the review of literature of hand hygiene and handwashing by NICE, WHO and other studies.

Design-
Randomized control trial

Method-
1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).On a weekly basis self-reported data of GTI and RTI symptoms were collected through emails. The multilevel binary regression model was used to analyze data.

Design-
Observational cross-sectional design

Method-
a questionnaire was administered electronically to 872 medical and nursing students in a university and outcome data analysed using relevant software.

Design-
Systematic review

Method-
a comprehensive search was conducted in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene.

Sample/Setting

The number and

characteristics of

patients,

attrition rate, etc.

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting.

 

1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).

323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines.

3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.

Major Variables Studied

List and define dependent and independent variables

Dependent variable
-none

Independent variable
-none

 

Dependent variable
-RTI and GTI symptoms

Independent variable
-alcohol hand rubs, water and soap

 

Dependent variable
s-body fluid exposure, patient surrounding

Independent variable
– alcohol hand rubs, use of soap and water NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

 

Dependent variable
-dermatitis

Independent variable
-alcohol-based handrubs and handwashing

 

Measurement

Identify primary statistics used to answer clinical questions

Guidelines provided by NICE and the WHO on hand hygiene and handwashing.

Weekly prevalence of RTI and GTI symptoms

Compliance with WHO hand hygiene model, compliance with hand hygiene practices after contact with the surrounding of a patient or exposure to body fluids.

Incidence and prevalence of dermatitis/contact dermatitis

Data Analysis

Statistical or

qualitative

findings

Decontamination of the hands through handwashing using soap and water is the most effective and easy way to prevent the spread of infections in the clinical setting.

 

Within 16 months of the trial, 238 people who used alcohol-based handrubs, 297 who used soap and water and 230 who used nothing provided their reports. An increase in RTI and GTI exposure was reported in both the intervention and control groups. Among those who used soap and water, the prevalence of GTI reduced to 24% as compared to the control group. Alcohol rubs did not affect the prevalence of the symptoms.

 

 

 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

Of the 872 participants, 323 responded. Nursing students complied more with the WHO “my five moments for hand hygiene” model as compared to medical students. Compliance with hand hygiene was high after being exposed to body fluids (MS 91%. NS 99.5%) and low after contact with a patient’s environment (MS-57.5%, NS-61.5%). Both disciplines had a positive attitude towards hand rubbing. 45% of MS and 16% of NS were not aware of the clinical contraindications to using ABHR. 36% of MS and 9% of NS did not know when to use ABHR and when to use soap and water. 22% NS and 46% MS routinely used ABHR for decontamination.
 

3 relevant studies were retrieved. ABHRs were not linked to reduced skin hydration, allergic reactions and disruption of the skin barrier. Skin tolerance of ABHRs was high with reports from healthcare providers on less irritation of the skin and less dryness in comparison to the use of lotions, creams or handwashing.

 

 

 

Findings and Recommendations

General findings and recommendations of the research

Washing hands with soap and water is the best decontamination method in preventing HAIs.

Handwashing with soap and water safeguarded the participants from GTI and RTI. In clinical settings, it should be adopted as an infection control measure to prevent/reduce the incidence and prevalence of HAIs.

 

 

 

 

Gaps in knowledge on hand hygiene and handwashing are a potential barrier to deficits in hand hygiene practice and use of ABHRs. In clinical settings, leadership should identify potential knowledge gaps, frequently review hand hygiene policies and address them as required.

Evidence on how ABHRs influence contact dermatitis and the effectiveness of antiseptic hand hygiene protocols in preventing dermatitis was level II and III. Lipid-emulsifying alcohols or agents disrupt the skin barrier and cause a lot of skin irritation thus should be avoided.

Appraisal

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of

use in your practice?

Adds to clinical knowledge on how to prevent the transfer of pathogens in healthcare settings through handwashing and hand hygiene. It has no risks associated with implementation in clinical practice and is highly feasible in my practice.

The study adds to the nursing knowledge on how to prevent RTI and GTI infections in the clinical setting.

A major strength is that since a wide study sample was used, the results can be applied to wide population settings. However, since the data collected on RTI and GTI symptoms were based on electronic self-reporting; varied reports might include biased data which affects the validity and reliability of the results. The research is however feasible in my practice.

The research adds to nursing knowledge on the potential barriers in observing hand hygiene practices in clinical settings. Its major limitation is that since it had a self-reporting design, the likelihood of potential biases is high. However, the huge random study sample increases the validity, reliability and applicability of the results. The study is highly feasible in my practice.

The study adds to the nursing knowledge on health worker perceptions that influence compliance with hand hygiene practices and its influence on the rates of HAIs. Since it is a systematic review that included only 3 articles, the reliability and applicability of its findings is not entirely guaranteed. A major strength of the study is that it recommends the use of ABHRs to reduce bacterial count since it causes less irritation to the skin.

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

General Notes/Comments

Will be included in the EBP project since it matches the scope and proposed EBP-intervention.

 

 

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention.

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention.

 

Will be included in the EBP project since it matches the scope and proposed EBP-intervention.

 

 

Levels of Evidence Table

 

Use this document to complete the
levels of evidence table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Author
and
year
of selected article

Article #1

Article #2

Article #3

Article #4

 

Ford, C., & Park, L. J. (2018). Hand hygiene and Handwashing: key to preventing the transfer of pathogens. 
British Journal of Nursing, 27
(20), 1164–1166.

 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
BMC Infectious Diseases, 17
, 1–9

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
Nurse Education Today, 63
, 112–118.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs. Handwashing. 
American Journal of Critical Care, 27
(4), 334–337.

Study Design

Theoretical basis for the study

 

Clinical practice guideline that is based on the review of literature on hand hygiene and handwashing by NICE, WHO and other studies.

 

 

Randomized control trial where 1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).On a weekly basis self-reported data of GTI and RTI symptoms were collected through emails. The multilevel binary regression model was used to analyze data.

Observational cross-sectional design where a questionnaire was administered electronically to 872 medical and nursing students in a university and outcome data analysed using relevant software.

Systematic review that involved a comprehensive search of literature in the electronic databases of MEDLINE and CINAHL using the keywords: contact dermatitis, handwashing, dermatitis and hand hygiene.

Sample/Setting

The number and

characteristics of

patients

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting.

 

1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).

323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines.

3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.

Evidence Level *

(I, II, or III)

 

Level VII

Level II

Level IV

Level I

Outcomes

 

 

 

Decontamination of the hands through handwashing using soap and water is the most effective and easy way to prevent the spread of infections in the clinical setting. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

 

Within 16 months of the trial, 238 people who used alcohol-based handrubs, 297 who used soap and water and 230 who used nothing provided their reports. An increase in RTI and GTI exposure was reported in both the intervention and control groups. Among those who used soap and water, the prevalence of GTI reduced to 24% as compared to the control group. Alcohol rubs did not affect the prevalence of the symptoms.

 

 

Of the 872 participants, 323 responded. Nursing students complied more with the WHO “my five moments for hand hygiene” model as compared to medical students. Compliance with hand hygiene was high after being exposed to body fluids (MS 91%. NS 99.5%) and low after contact with a patient’s environment (MS-57.5%, NS-61.5%). Both disciplines had a positive attitude towards hand rubbing. 45% of MS and 16% of NS were not aware of the clinical contraindications to using ABHR. 36% of MS and 9% of NS did not know when to use ABHR and when to use soap and water. 22% NS and 46% MS routinely used ABHR for decontamination.
 

3 relevant studies were retrieved. ABHRs were not linked to reduced skin hydration, allergic reactions and disruption of the skin barrier. Skin tolerance of ABHRs was high with reports from healthcare providers on less irritation of the skin and less dryness in comparison to the use of lotions, creams or handwashing.

 

 

 

General Notes/Comments

Low evidence

 

 

 

 

High evidence

 

 

Medium evidence

 

 

 

High evidence

 

 

* Evidence Levels:

 

Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

 

Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

 

Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

 

Outcomes Synthesis Table

 

Use this document to complete the
outcomes synthesis table
requirement of the Module 4 Assessment,

Evidence-Based Project, Part 4A: Critical Appraisal of Research

 

 

Author
and
year
of selected article

Article #1

Article #2

Article #3

Article #4

Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. 
British Journal of Nursing, 27
(20), 1164–1166.

 

 

 

 

 

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
BMC Infectious Diseases, 17
, 1–9

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
Nurse Education Today, 63
, 112–118.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
American Journal of Critical Care, 27
(4), 334–337.

Sample/Setting

The number and

characteristics of

patients

Step by step clinical guidelines on how to maintain hand hygiene and to conduct handwashing in the clinical setting.

 

1270 people from designated clusters were randomized to two different interventions (either the use of alcohol hand-rubs or water and soap).

323 medical and nursing students responded to online questionnaires on the barriers to adherence to hand hygiene guidelines.

3 studies which assessed the impact of handwashing vs. alcohol-based handrubs on the skin were reviewed.

Outcomes

 

 

NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

Key Findings

 

Washing hands with soap and water is the best decontamination method in preventing HAIs.

 

Handwashing with soap and water safeguarded the participants from GTI and RTI. In clinical settings, it should be adopted as an infection control measure to prevent/reduce the incidence and prevalence of HAIs.

 

Gaps in knowledge on hand hygiene and handwashing are a potential barrier to deficits in hand hygiene practice and use of ABHRs. In clinical settings, leadership should identify potential knowledge gaps, frequently review hand hygiene policies and address them as required.

Evidence on how ABHRs influence contact dermatitis and the effectiveness of antiseptic hand hygiene protocols in preventing dermatitis was level II and III. Lipid-emulsifying alcohols or agents disrupt the skin barrier and cause a lot of skin irritation thus should be avoided.

Appraisal and Study Quality

 

Adds to clinical knowledge on how to prevent the transfer of pathogens in healthcare settings through handwashing and hand hygiene. It has no risks associated with implementation in clinical practice.

Medium  quality

The study adds to the nursing knowledge on how to prevent RTI and GTI infections in the clinical setting.

A major strength is that since a wide study sample was used, the results can be applied to wide population settings. However, since the data collected on RTI and GTI symptoms were based on electronic self-reporting; varied reports might include biased data which affects the validity and reliability of the results.

High quality

The research adds to nursing knowledge on the potential barriers in observing hand hygiene practices in clinical settings. Its major limitation is that since it had a self-reporting design, the likelihood of potential biases is high. However, the huge random study sample increases the validity, reliability and applicability of the results.

Medium quality

The study adds to the nursing knowledge on health worker perceptions that influence compliance with hand hygiene practices and its influence on the rates of HAIs. Since it is a systematic review that included only 3 articles, the reliability and applicability of its findings is not entirely guaranteed. A major strength of the study is that it recommends the use of ABHRs to reduce bacterial count since it causes less irritation to the skin.

High quality

General Notes/Comments

Highly feasible in practice

Feasible in practice

Feasible in my practice

Feasible in my practice

 

Conclusion

 

Based on this critical appraisal, the studies recommend routine hand hygiene with soap and water as the effective decontamination method to reduce the spread of pathogens and rates of HAIs in the clinical setting.

 

References

Ford, C., & Park, L. J. (2018). Hand hygiene and handwashing: key to preventing the transfer of pathogens. 
British Journal of Nursing, 27
(20), 1164–1166. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template

Hovi, T., Ollgren, J., & Savolainen-Kopra, C. (2017). Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial. 
BMC Infectious Diseases, 17
, 1–9.

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. 
Nurse Education Today, 63
, 112–118.

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs Handwashing. 
American Journal of Critical Care, 27
(4), 334–337. NURS_6052_wk_6-7_assign_CriticalAppraisalTools_template