Category: Nursing

NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper

The advanced practice registered nurse or APRN position has steadily grown in importance in the United States. This is because the role that they play in plugging the gap between physicians and the population is immense. It is a common fact that the number of physicians practicing is virtually inversely proportional to that of the population they are supposed to be serving. To become an advanced practice nurse, one must complete a rigorous accredited postgraduate course in their specialty. This postgraduate degree is currently recommended to be a PhD as the entry level to practice. NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper. After meeting these educational requirements, the psychiatric-mental health nurse practitioner (PMHNP) for instance has then to be certified by the American Nurses Credentialing Centre (ANCC) (ANCC, N.D.) and receive licensure to practice from the State in which they intend to practice. The role APRNs have come to play has become quite significant, given the fact that…

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Advanced registered nursing graduates are entering the profession at dynamic time when roles and scope of practice are shifting based on developments in legislation and policy in response to the evolving needs of the health care system. Professional nursing organizations play an important role in making sure the perspectives of advanced registered nurses are heard, and in supporting nurse specialties in their efforts to expand their scope of practice and their full participation throughout the health care system.

For this assignment, you will conduct research on the current scope of practice for your specialty and efforts that are being made to expand that scope and the role of the advanced nurse in positively influencing the health care system. Write a 1,250-1,500-word paper that includes the following:

A discussion of the scope of your future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope. NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper.

A discussion of three professional nursing organizations that you think are most influential in advancing the scope and influence of advanced nursing. Of these organizations, evaluate the one that you would most like to join. How do its goals and mission fit in with your worldview and philosophy of care? How might membership in this organization improve your practice?

A discussion of a controversial or evolving issue that is most likely to affect your scope of practice or role in the next few years. How do you think this issue could influence the profession and other stakeholders, and why does it matters to the advanced registered nurse?

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

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

 

Course Code

Class Code

Assignment Title

Total Points

NUR-513

NUR-513-O102

Benchmark – Future Scope, Role, and Professional Obligations Paper

250.0

Criteria

Percentage

Unsatisfactory (0.00%)

Less than Satisfactory (80.00%)

Satisfactory (88.00%)

Good (92.00%)

Excellent (100.00%)

Content

70.0%

The Scope of Your Future Role as an Advanced Registered Nurse, Including Any Regulatory, Certification, or Accreditation Agencies That Define That Scope

20.0%

A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is not included.

A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is present, but it lacks detail or is incomplete.

A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is present.

A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is clearly provided and well developed.

A comprehensive discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is thoroughly developed with supporting details.

Three Professional Nursing Organizations Identified as the Most Influential in Advancing the Scope and Influence of Advanced Nursing

15.0%

A discussion of three professional nursing organizations identified as the most influential in advancing the scope and influence of advanced nursing is not included.

A discussion of three professional nursing organizations identified as the most influential in advancing the scope and influence of advanced nursing is present, but it lacks detail or is incomplete.

A discussion of three professional nursing organizations identified as the most influential in advancing the scope and influence of advanced nursing is present.

A discussion of three professional nursing organizations identified as the most influential in advancing the scope and influence of advanced nursing is clearly provided and well developed.

A comprehensive discussion of three professional nursing organizations identified as the most influential in advancing the scope and influence of advanced nursing is thoroughly developed with supporting details.

NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper

Evaluate the Professional Organization That Is Most Appealing, Including How Its Goals and Mission Fit in With Worldview, Philosophy of Care, and Ability to Improve Practice (5.3)

15.0%

An evaluation of the professional organization that is most appealing, including how its goals and mission fit in with worldview, philosophy of care, and ability to improve practice, is not included.

An evaluation of the professional organization that is most appealing, including how its goals and mission fit in with worldview, philosophy of care, and ability to improve practice, is present, but it lacks detail or is incomplete.

An evaluation of the professional organization that is most appealing, including how its goals and mission fit in with worldview, philosophy of care, and ability to improve practice, is present.

An evaluation of the professional organization that is most appealing, including how its goals and mission fit in with worldview, philosophy of care, and ability to improve practice, is clearly provided and well developed.

A comprehensive evaluation of the professional organization that is most appealing, including how its goals and mission fit in with worldview, philosophy of care, and ability to improve practice, is thoroughly developed with supporting details.

A Controversial or Evolving Issue That Is Most Likely to Impact Scope of Practice or Role in the Next Few Years, Including How This Issue Could Influence the Profession and Other Stakeholders and Why It Matters to the Advanced Registered Nurse

15.0%

A discussion of a controversial or evolving issue that is most likely to impact scope of practice or role in the next few years, including how this issue could influence the profession and other stakeholders and why it matters to the advanced registered nurse, is not included.

A discussion of a controversial or evolving issue that is most likely to impact scope of practice or role in the next few years, including how this issue could influence the profession and other stakeholders and why it matters to the advanced registered nurse, is present, but it lacks detail or is incomplete.

A discussion of a controversial or evolving issue that is most likely to impact scope of practice or role in the next few years, including how this issue could influence the profession and other stakeholders and why it matters to the advanced registered nurse, is present.

A discussion of a controversial or evolving issue that is most likely to impact scope of practice or role in the next few years, including how this issue could influence the profession and other stakeholders and why it matters to the advanced registered nurse, is clearly provided and well developed.

A comprehensive discussion of a controversial or evolving issue that is most likely to impact scope of practice or role in the next few years, including how this issue could influence the profession and other stakeholders and why it matters to the advanced registered nurse, is thoroughly developed with supporting details.

Required Sources

5.0%

Sources are not included.

Number of required sources is only partially met.

Number of required sources is met, but sources are outdated or inappropriate.

Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content.

Number of required resources is met. Sources are current, and appropriate for the assignment criteria and nursing content.

Organization and Effectiveness

20.0%

Thesis Development and Purpose

7.0%

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

8.0%

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

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

5.0%

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

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

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

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

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

Format

10.0%

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

5.0%

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

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

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

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

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

5.0%

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Weightage

100%

 

Introduction

The advanced practice registered nurse or APRN position has steadily grown in importance in the United States. This is because the role that they play in plugging the gap between physicians and the population is immense. It is a common fact that the number of physicians practicing is virtually inversely proportional to that of the population they are supposed to be serving. To become an advanced practice nurse, one must complete a rigorous accredited postgraduate course in their specialty NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper. This postgraduate degree is currently recommended to be a PhD as the entry level to practice. After meeting these educational requirements, the psychiatric-mental health nurse practitioner (PMHNP) for instance has then to be certified by the American Nurses Credentialing Centre (ANCC) (ANCC, N.D.) and receive licensure to practice from the State in which they intend to practice. The role APRNs have come to play has become quite significant, given the fact that many communities that are socio-economically deprived are not able to access the expensive health services offered by the country’s physicians. What these populations need is affordable healthcare brought to them where they can easily access it, conveniently. This is primary health care (PHC), and the frontline clinicians that are going to champion it going forward are the APRNs. This paper will look at the future roles of the nurse practitioner (in this case a PMHNP) and their scope, the regulatory framework governing their practice, accreditation and credentialing, nursing professional organizations they can join, and one controversial matter related to the practice of a PMHNP. NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper.

Scope of Future Role as a PMHNP, Regulation, Accreditation and Credentialing

At present, the role of the nurse practitioner and its scope are very much a factor of the state legislation and regulations that govern nurse practitioner practice. In states that guarantee full autonomy of practice (full practice authority or FPA), the PMHNP evaluates mentally ill patients, diagnoses, orders investigations and interprets them independently before ordering appropriate treatment and making follow up (Maryville University, 2019). This is the full scope of the role that the PMHNP will be practicing in the future, because the movement to have universal full practice authority across states is unstoppable. Regulation of practice of PMHNPs and by extension all other APRNs is done through state legislation. Different states have different regulatory structures for APRNs (AANP, 2018). Across the fifty states, there are those whose regulatory structure is that of full practice authority. However, other states still have a regulatory structure of either reduced practice or restricted practice (AANP, 2018). These last two regulatory structures are restrictive and prohibitive to the nurse practitioner, preventing them from exercising their knowledge and training to the full extent of their abilities. As stated above, full practice authority regulatory structure permits the nurse practitioner to practice without any supervision or hindrance. Reduced practice, on the other hand, requires that the nurse practitioner enters into a collaborative agreement with a practicing physician so that they can effectively practice under them NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper. Lastly, the worst regulatory framework is the restricted practice arrangement. In the states with this kind of APRN regulation, the nurse practitioner is only allowed to do a few things which also have to be done under the supervision of a physician (AANP, 2018). There are a total of 23 states that have a full practice authority regulatory structure as at 2017. These include Idaho, Iowa, Maryland, Hawaii, Washington D.C., New Mexico, and so on. The remaining are either reduced or restricted practice. Reduced practice states for APRNs include Ohio, Illinois, Wisconsin, Utah, Louisiana, and so on. Lastly are the worst states to practice in as APRNs. These have licensure laws that only allow restricted practice which give the APRN very little room to flourish. These states include Florida, Texas, Michigan, Georgia, and California, amongst others (Maryville University, 2019; AANP, 2018).

The future of the PMHNP and other APRNs however looks bright and their traditional role as seen above is definitely set to expand. This is because there is a shortage of physicians as they move to the super specialties leaving disciplines like family medicine with severe shortages of manpower. APRNs are the cadre that will fill this vacancy (Maryville University, 2019). After education and training the PMHNP is expected to get certification before applying for a practicing licence from the state in which they intend to practice. In the case of the PMHNP, the agency tasked with this certification is the American Nurses Credentialing Centre or ANCC (ANCC, n.d.). All that the graduated nurse practitioner needs to do is to sit for a competency examination that tests for clinical acumen, knowledge, and skills. After passing the examination and the board certification (BC) is awarded, the official title of the nurse practitioner changes to PMHNP-BC (ANCC, n.d.). The certification lasts for five years, after which it needs to be renewed. NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper.

On the matter of accreditation, it is the particular course that the PMHNP does at the university that needs to be accredited. Accreditation of courses and institutions takes place both at the regional level and the national level (EDsmart, n.d.). There is preference, however, for the regional accreditation of courses as it is easy to transfer credits to another institution this way. Some of the regional accreditation bodies include the Higher Learning Commission (which is recognized by the US Department of Education) and the Northwest Commission on Colleges and Universities. In summary, the process therefore starts with enrolling in a duly accredited postgraduate course. After completion of the course, the nurse practitioner applies for board certification and sits for the competency examination. If successful, they then apply for a practice license as per the state’s licensure laws. The licence that they will then get will depend on the state as discussed above and will be for full practice autonomy, a reduced practice, or a restricted practice.

Three Professional Nursing Organizations

           
Professional organizations are an important component for the advance practice nurse professional. This is especially true considering the challenges with the disparate regulatory structures seen above. Policies and their formulation by their very nature are political processes. Political processes require masses and one voice, if anything is to change. This is the reason why PMHNPs must come together in professional bodies so that they can champion their professional causes. Therefore, professional organizations provide a platform and forum on which psychiatric-mental health nurses can stand and articulate their issues (Catallo et al., 2014). These issues include lobbying state legislators for policy changes towards the granting of full practice authority in the states that still do not have it. Professional bodies also help in the exchanging of professional ideas for better and improved practice.

Three of the most prominent professional organizations for the PMHNP are the American Psychiatric Nurses Association (APNA), the International Society of Psychiatric-Mental Health Nurses (ISPN), and the American Association of Nurse Practitioners (AANP). The ISPN builds capacity by way of mentorship and sharing of ideas, while at the same time helping with sharing professional ideas. The APNA fosters knowledge dissemination and professional support for its members (Adams &Black, 2016). For instance, by the year 2016 it had come up with a short online course to help its members seal some identified knowledge gaps. The program was titled American Psychiatric Nurses Association Transitions in Practice (ATP) (Adams & Black, 2016). The American Association of Nurse Practitioners (AANP) on its part provides professional support and encouragement by conferring Fellowship status to those members that have done something remarkable to the profession. NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper The Fellowship status is only by nomination. Thus those who have received this prestigious recognition carry the title of Fellow of the American Association of Nurse Practitioners (FAANP) (Rossiter et al., 2017).

Controversial Issue

The most important controversial issue for a PMHNP at the moment is the matter of evidence-based practice. It is only psychiatry and mental health that is lacking behind in implementation of evidence-based practice in all of medicine. This is because of long-held traditions that have proved hard to drop completely (Alzayyat, 2014) NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper.

References

Adams, S.M., & Black, P. (2016). American Psychiatric Nurses Association –Transitions in practice certificate program: Bridging the knowledge gap in caring for psychiatric patients within the general nursing workforce.
Nursing Administration Quarterly
, 40(3), 225-236. Doi: 10.1097/NAQ.0000000000000168

Alzayyat, A.S. (2014). Barriers to Evidence-Based Practice Utilization in Psychiatric/Mental Health Nursing.
Issues in Mental Health Nursing
, 35, 134-143. Doi: 10.3109/01612840.2013.848385

American Association of Nurse Practitioners [AANP] (2018).
State practice environment
. Retrieved 14 September 2019 from
https://www.aanp.org/advocacy/state/state-practice-environment

American Nurses Credentialing Centre [ANCC] (n.d.).
Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC)
. Retrieved 14 September 2019 from
https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/

Catallo, C., Spalding, K. & Haghiri-Vijeh, R. (2014). Nursing professional organizations: What are they doing to engage nurses in health policy?
SAGE Open
, 1-9. Doi: 10.1177/2158244014560534

EDsmart (n.d.).
Regional vs. national accreditation
–
there
’
s a huge difference
. Retrieved 14 September 2019 from
https://www.edsmart.org/regional-vs-national-accreditation/

International Society of Psychiatric-Mental Health Nurses [ISPN] (2019).
International Society of Psychiatric-Mental Health Nurses
. Retrieved 13 September 2019 from
https://www.ispn-psych.org/

Maryville University (2019).
States granting NP full practice authority
. Retrieved 14 September 2019 from
https://online.maryville.edu/nursing-degrees/np/states-granting-np-full-practice-authority/

Rossiter, A.G., Sabol, V.K. & Hicks, R.W. (2017). So you want to be a Fellow in the American Association of Nurse Practitioners: Navigating the Fellowship process to ensure your success.
Journal of the American Association of Nurse Practitioners
, 29, 501-505. Doi: 10.1002/2327-6924.12508 NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper

cushing syndrome essay

This case involves a 12-year old female child who presents with her mother. The clinician notes that the child has a moon face appearance, a buffalo hump fat pad on the upper back and has only grown ½ inch within 2 years now 5 feet tall. The child is reportedly depressed and tired unlike before.

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 Tests I Would Like To Order for This Patient

I would order for a 24-hour urinary free cortisol test, late-night and midnight salivary cortisol tests. These tests would be helpful in establishing the levels of cortisol in urine and saliva to confirm the diagnosis before the initiation of treatment. A low-dose dexamethasone suppression test will help to assess the functioning of the adrenal gland. In this test, a measure on how the levels of cortisol change when responding to injection with dexamethasone is ascertained (Bronstein, 2015).   A CT Scan or MRI of the brain is also significant in establishing any abnormalities in the adrenal or pituitary glands cushing syndrome essay.

Working Diagnosis and Treatment Plan for This Patient

In this case, my working diagnosis is Cushing syndrome. The latter is a condition that results from too much cortisol in the body and results to several symptoms such as; easily bruised skin, mood swings, chronic tiredness, depression, impaired growth in children, a moon face and a back hump due to the accumulation of fat (In Laws & In Pace, 2016).  The treatment plan is highly dependent on the cause. Incase the patient is taking a  corticosteroid medication, the drug will slowly be tapered off. If the cause is found to be an adrenal adenoma, a surgery will  be scheduled for its removal and the child will receive steroid replacement therapy afterwards (In Laws & In Pace, 2016).   Incase it’s a tumor, radiotherapy, surgery and rescriptions of drugs to reduce cortisol effects in the body is the most definitive treatment approach cushing syndrome essay.

 

References

Bronstein, M. D. (2015). 
Cushing’s Syndrome : Pathophysiology,

Diagnosis and Treatment
. Estados Unidos: Humana Press.

In Laws, E. R., & In Pace, L. (2016). 
Cushing’s disease: An often misdiagnosed and not so rare

disorder cushing syndrome essay
.

Eypothyroidism Essay

A 42-year-old female presents to the clinic with complaints of fatigue, weakness, anorexia, weight loss, menstrual changes, and loss of hair. The patient is wearing a thick sweater and it is early October in Phoenix. When you ask the patient about why she is wearing a sweater, you find out that she “has been feeling cold all the time.” What tests would the FNP run on this patient? What are the possible diagnosis and treatment plan for this patient? Eypothyroidism Essay.

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This case involves a 42-year-old female presenting with the complaints of anorexia, weakness, fatigue, changes in menstruation, loss of hair and weight loss. The patient also reports of progressively feeling cold hence, she wears a thick sweater when it is early in the month of October in Phoenix.

Tests that a Family Nurse Practitioner Would Run on This Patient

The tests that a Family Nurse Practitioner can run on this patient include; a thyroid function test which establishes the levels of thyroid stimulating hormone in blood. This test would reveal an elevated level of thyroid stimulating hormone in blood a revelation that the thyroid is no longer producing enough thyroid hormone (McArthur & Merz, 2014).   Additional tests include; a liver function test and a kidney function test. Generally, liver enzymes and creatinine kinase are mildly elevated in blood in patients with the aforementioned symptoms. A T4 test should also be done whereby, most of the T4 indexes are often unattached in blood. A magnetic resonance imaging of the brain can also be done to ascertain the exact cause as hypothalamic or pituitary problems (McArthur & Merz, 2014).   For patients with a mass/swelling on the neck, an MRI can also be done to confirm diagnosis Eypothyroidism Essay.

Possible Diagnosis and Treatment Plan for This Patient

The possible diagnosis for this patient is hypothyroidism. Hypothyroidism is also called underactive thyroid which is an endocrine disorder whereby the thyroid gland fails to produce enough thyroid hormone (McArthur & Merz, 2014).  Its treatment starts with hormone replacement therapy where levothyroxine is prescribed for use whose dose adjustments are dependent on weight. Levothyroxine is taken four hours after feeding or 30-60 minutes before taking breakfast (McArthur & Merz, 2014).   Caution is taken by using lower doses in patients with heart disease or hypertension.

Reference

McArthur, J., & Merz, C. (2014). 
Hypothyroidism: The hypothyroidism solution
. Boston, MA:

Harvard Health Publications. Eypothyroidism Essay.

Nurse Educator Scope of practice essay

1. A discussion of the scope of your future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope.

2. A discussion of three professional nursing organizations that you think are most influential in advancing the scope and influence of advanced nursing. Of these organizations, evaluate the one that you would most like to join. How do its goals and mission fit in with your worldview and philosophy of care? How might membership in this organization improve your practice? Nurse Educator Scope of practice essay.

3. A discussion of a controversial or evolving issue that is most likely to affect your scope of practice or role in the next few years. How do you think this issue could influence the profession and other stakeholders, and why does it matters to the advanced registered nurse?

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Scope of practice

Part 1.

As an advanced registered nurse, my aspiration is to become a nurse educator, an individual who students enrolled in formal academic nursing education programs. In fact, it is defined as an advanced practice role and specialty area that exists within professional nursing. The scope of practice for nurse educators is defined by the presented factors. The first factor is qualification. The qualifications for being a nurse educator is to meet the faculty requirements are presented by each educational institution based on their expectations, accrediting organizations and regulatory agencies. There are general qualification requirements that apply to all nurse educators across the USA irrespective of the institution, which include state credentials for advanced practice and an active current nursing license. The second factor is academic preparation with doctoral preparation being preferred although a master’s degree could also be accepted. A non-nursing major or graduate degree could also be accepted if nursing is the first degree. Doctoral preparation is preferred by educational institutions that focus on research Nurse Educator Scope of practice essay. Practice focused institutions will typically accept doctor of nursing practice (DNP) qualification. Completing academic courses in educational practice and theory is advantageous (National League for Nursing Certification Commission, 2012).

The third factor is position whereby nurse educators can follow a tenure or non-tenured track. A tenured track requires the educators to meet set academic standards within a specified time period to achieve tenure status. In achieving tenure, the educator gains greater permanency in the institution and more academic autonomy. Non-tenured educators only have work contracts for a defined limited time period. The final factor is roles and responsibility. Educators are expected to perform certain roles that are not limited to scholarship, research, practice, service, advising and teaching. The performance expectations for each role depend on the educational institution, rank and type of appointment. In addition, an educator can teach in one or more settings, including health care organizations, simulation and laboratory settings, online (distance learning), and classrooms. Their scholarship role involves engaging in activities that disseminate information through publications and presentations, conduct research to create new knowledge, translate evidence to nursing practice, and advance educational theory and practice. Their professional services role includes consulting, influencing policy, curriculum development and evaluation, program management, and participation in committees (National League for Nursing Certification Commission, 2012) Nurse Educator Scope of practice essay.

The National League for Nursing (NLN) is the national agency responsible for accrediting nurse educators through its Commission for Nursing Education Accreditation (CNEA) that conducts its activities while being guided by the core values of excellence, integrity, diversity and caring. Certification for nurse educators is offered by the National Commission for Certifying Agencies (NCCA) the accrediting body of the National Organization for Competency Assurance (NOCA). NCCA ensures that certification programs adhere to the modern practice standards for certification. Through NCCA, NLN offers two certifications for nurse educators that include certified nurse educator certification (the educator facilitates learning in nursing schools through advisement, evaluation, teaching, curriculum design and other activities) and certified academic nurse educator certification (the educator facilitates learning throughout the clinical components of the nursing academic program) (National League for Nursing Certification Commission, 2012). The Accreditation Commission for Education in Nursing (ACEN) also has an influence through ensuring quality in nursing education by defining the minimum requirements for the educators (Accreditation Commission for Education in Nursing, 2013).

Part 2.

The National League for Nursing (NLN), American Association for Colleges of Nursing (AACN) and Organization for Associate Degree Nursing (OADN) are the three organizations that are most influential in advancing the scope and influence of advanced nursing. NLN is perhaps the oldest premier organization for nurse educators that is focused on realizing excellence in nursing through offering its members testing services, research grants, teaching resources and professional development. Also, NLN offers credentialing services for nurse educators (National League of Nursing, 2019). AACN is a national body that represents academic nursing through promoting public support for professional nursing practice, research and education, improving health care by influencing nursing profession, establishing quality standards for nurse education, and aiding schools in implementing the standards (American Association for Colleges of Nursing, 2019). OADN is the national voice for associate degree nursing (ADN) that is responsible for promoting the future of ADN, strengthening the professional role of ADN, and enhancing the quality of ADN education. Also, OADN promotes academic progression, partnering with other nursing organizations to offer an arena for networking, disseminating information, and facilitating the unity of the nursing profession (Organization for Associate Degree Nursing, 2019).

Of the three organization, NLN is the most influential organization. Founded in 1893 as the first nursing organization in the USA, its mission is to promote nursing education excellence through building a diverse and strong workforce that advances health in the national and global arena. Unlike AACN and OADN whose activities are restricted to the national boundaries, NLN has national and global reach that embodies the concept of diversity. Membership in NLN includes interested members of the public, health care agencies, education agencies and nurse educators. In fact, the membership includes 1,200 institutional members and 37,000 institutional members. All members have access to public policy initiatives, nursing research grants, testing and assessment, networking opportunities, and development programs that allow the members to grow and develop as professionals. Over the course of its long history, the NLN has been repeatedly renewed to remain relevant in delivering expanded, enhanced and improved services while championing the pursuit of quality nursing education (National League of Nursing, 2019). The NLN aligns with my personal worldview and philosophy of care through embodying the reality that there is always room for improvement. Through gaining membership to NLN, I am assured to engaging a diverse pool of talent as members of the organization who would challenge me to improve my practice while offering me opportunities for improvement through research and education, and access to current evidence. As a member in the organization, I anticipate to improve my practice through contact with a wider range of useful resources that improve my nursing knowledge and skills Nurse Educator Scope of practice essay.

Part 3.

Nurse educators of today have access to online tools that place at their disposal a range of technological advances that include simulators, models, curricula and techniques. These online tools present an advantage by making it possible to teach nursing classes and impart clinical knowledge across long distances. In fact, the use of these tools have made it possible for educators and learners to be located in different continents as the learning process proceeds. Still, they present unique challenges that are peculiar to the online world and were unknown twenty years ago. To be more precise, lecturing remains a valid nursing education approach, but online tools are augmenting lecturing as delivery systems. The challenges are how should educators justify the cost of using online tools, how can the educator verify the learner’s identity, how to handle education security concerns, and how does the educator teach from a distance. These are concerns that become apparent for nurse educators who are keen on effectively teaching since the educator must have a command of the different methods for delivering learning information, and the clinical facets of the nursing concepts being taught. In essence, the concerns can be summarized as how to effectively demonstrate to learner the best way for implementing new knowledge and bring the education experience alive (Morelock, 2019) Nurse Educator Scope of practice essay. The concern is heightened by the different learner requirements in terms of learning approaches and education materials. The concern is advanced by presentation of educational techniques that are targeted at maximizing the efficiency and effectiveness of online tools in the delivery of nursing education. It is important to note that educational techniques and the education process will continue to advance as new communication technologies are adopted. This issue is of concern to advanced registered nurses since it affects their practice as educators, adding on to their practice requirements by presenting new qualifications for delivering online classes. Nurse Educator Scope of practice essay The issue also influences other stakeholders. Communication specialists are influenced to develop systems that improve education content delivery and reduce incidences of fraud, credentialing agencies are influenced to present new requirements, institutions are influenced to acquire online tools, and learners are influenced to appreciate online tools (McGonigle & Mastrian, 2017).

 

References

Accreditation Commission for Education in Nursing (2013).
Home
. Retrieved from https://www.acenursing.org/

American Association for Colleges of Nursing (2019).
About AACN
. Retrieved from https://www.aacnnursing.org/About-AACN

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

Morelock, S. (2019).
Current and future educational challenges for the nurse educator
. Retrieved from https://rn-journal.com/journal-of-nursing/educational-challenges-in-nurse-education

National League for Nursing Certification Commission (2012).
The scope of practice: for academic nurse educators—2012 Revision
. New York, NY: National League for Nursing.

National League of Nursing (2019).
About
. Retrieved from http://www.nln.org/about

Organization for Associate Degree Nursing (2019).
About OADN
. Retrieved from https://www.oadn.org/about-us/about-oadn Nurse Educator Scope of practice essay

Adolescent & Addiction Essay

Below are two case studies: one for an adolescent and one for an adult. For this written assignment, apply the Diagnostic and Statistical Manual on Mental Disorders 5 (DSM5) criteria to each case study using the following guidelines:

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– Identify all the signs/symptoms each individual demonstrates, which diagnostic criteria he/she appears to meet, and what severity specifiers might apply to each individual. Provide examples from the case studies to support your conclusions. (Remember, each individual is using multiple substances.)

– Include in your response – How effectively or not does the DSM 5 criteria apply to each case example? Provide a rationale to support your perspective Adolescent & Addiction Essay.

– Discuss why the ages of each person an important factor when considering a diagnosis or diagnostic criteria.

– What additional questions would you like more information about before arriving at a conclusion? While there may be no definitive or ”clear cut” answers, some responses may be more appropriate than others.

You are expected to develop a coherent response of at least 2-3 pages (12 point font), maximum of 4 narrative pages, excluding a cover page and references. Remember to cite and reference all of your readings and any other source you believe will be helpful in writing the paper. You should explain all the technical terms and cite the course texts. APA formatting is required.

Case Study #1: Gloria.

Gloria is a 16-year-old female. She smokes marijuana once to twice per week, and drinks alcohol at least one to two weekends a month. She has no current health problems. Recently she began dating a man several years older than her and they have been using cocaine together once or twice a month. She plans to graduate from high school next year and attend a local community college; her goal is to work as an Administrative Assistant in an Attorney’s office, and eventually become a paralegal.

Gloria lives with her parents and her younger brother Albert, age 12. Although. Gloria has always gotten along with her parents, they found marijuana in her room twice which resulted in heated arguments. They are also beginning to suspect she has been using other drugs when she returns home late at night from being with her boyfriend, whose age they are unaware of. When they confronted her with their suspicions, more arguments resulted. They have threatened to send her to counseling if this continues, but haven’t followed through with their threats. She wishes they would mind their own business. She has never been in trouble, does not believe her drug use causes problems as she goes to school and has sound academic performance. She does her chores at home. She realizes her marijuana and alcohol use has increased from her initial use, but doesn’t really see this as a problem (and infrequent cocaine use is not a concern) because it hasn’t interfered with her school performance.

Case Study #2: James.

James. is an unemployed 28-year-old Caucasian male. He is 5’ and weighs 229 lbs. He has been drinking heavily for the last three years. Recently he began using cocaine a few times a week and has been doing so for 2 months; his drinking has escalated over the last 7 months. He states he doesn’t feel the effects of alcohol until he has had at least 6 drinks. He has no withdrawal symptoms, however, he has experienced blackouts on a few occasions. He has had some contact with AA (Alcoholics Anonymous), and has gone to three NA (Narcotics Anonymous) meetings with a friend but does not find them helpful. He wonders if his cocaine use is a problem and if it is his alcohol use that causes him to have extreme mood swings. He has had problems with his girlfriend. He stopped drinking completely 2 years ago because of the problems with his girlfriend and noticed changes after he stopped; however, he began drinking again on weekends with friends. He tries to limit his drinking to weekends but he has returned to daily drinking and now includes the use of cocaine.

He currently lives with his girlfriend Janne. She is ”fed up” with his drinking and cocaine use, and gave him an ultimatum ”to do something” or move out. He has high blood pressure for which he’s been prescribed medication. His doctor has told him to cut down on his drinking or stop all together. His doctor is unaware of his cocaine use. James also smokes 1 1/2 packs of cigarettes a day. He has no significant psychiatric symptoms other than his mood swings, although he becomes very angry and hostile when using cocaine and alcohol together. This has added to his problems with his girlfriend.

Abstract: Not required.

 

Substance Use Disorder: Diagnostic Challenges Presented by the DSM-5 as Illustrated by Two Case Studies

Introduction

The phenomenon of substance use is often associated with the use of a single substance. Indeed majority of users abuse a single substance. However, increasing numbers of patients and clients are being seen with multiple substance usage. And therein lays the diagnostic quagmire. In the immediate last edition (fourth) of the
Diagnostic and Statistical Manual of Mental Disorders
or
DSM-4,
a diagnostic entity known as Polysubstance Dependence existed. It referred to the use of multiple substances (three or more) with no particular preference to any of them (Alta Mira, 2019; Connor et al., 2014). This diagnosis has however been eliminated from the latest manual, the fifth edition. This is after years of observation and treatment of these conditions. As a result, the current diagnostic criteria in the
DSM-5
are grouped under the all-encompassing diagnostic classification of Substance Use Disorders. In this and according to the
DSM-5
, the diagnosis is made by specifying the particular substance being used and its severity. This severity is ranked from mild to severe (Alta Mira, 2019; Connor et al., 2014). It is however imperative to note that Polysubstance dependency is not the same as multiple substance use disorder, since in the later there are independent multiple substance use disorders that are co-occurring (Alta Mira, 2019; Connor et al., 2014). This paper discusses two case studies involving multiple substance use disorders in a 16 year-old girl and a 28 year-old man. This is done in the context of the current
DSM-5 Adolescent & Addiction Essay
.

Signs and Symptoms, Met Diagnostic Criteria, and Severity Specifiers  

The hallmark identifier of substance use disorders is that one continues to use the concerned substance despite the problems it may be causing him or her. And as indicated above, the severity of the disorder ranges from mild to moderate to severe. This may of course change with time either for the better or for worse; with mild having 2 or 3 symptoms, moderate having 4 to 5 symptoms, and severe having 6 or more symptoms (APA, 2013). The codes that are used for diagnosis class the substance abused, but the narration of the diagnosis includes the actual name of the substance (APA, 2013) Adolescent & Addiction Essay.

Gloria

Gloria is a 16 year-old school girl who is still living with her parents. She is using cannabis, alcohol, and cocaine. This is Multiple Substance Use with distinct co-occurring substance use disorders. The signs and symptoms she is demonstrating for her alcohol use are:

Tolerance, since she has noted that she is using increasing amounts of alcohol as days go by;

Craving. She has this burning desire to continue taking alcohol at all costs;

She continues to use alcohol despite the risk of strained relations and social problems with her parents. This is evident from their reaction to finding cannabis in her room Adolescent & Addiction Essay.

From the
DSM-5
, the diagnostic criteria that these symptoms appear to meet are A. (1), (4), and (6) (APA, 2013). The severity specifier for this substance use by Gloria is therefore
mild
, as she is displaying a maximum of three symptoms. Her diagnosis in this respect as per the
DSM-5
is therefore 305.00 (F10.10)
Mild Alcohol Use Disorder
. On the other hand, the symptoms she is displaying for cannabis use are tolerance, craving, and continued use in spite of the social problems that this brings between her and her parents. From the
DSM-5
, these symptoms meet diagnostic criteria A. (1), (3), and (6). The severity specifier here is still
mild
as only a maximum of three symptoms are displayed, giving a diagnosis of 305.20 (F12.10)
Mild Cannabis Use Disorder
. Gloria’s cocaine use did not meet any diagnostic criteria; hence she has not yet reached the stage of being diagnosed with its use. Adolescent & Addiction Essay.

James

James is a 28 year-old Caucasian man who is using alcohol, cocaine, and tobacco. This too is Multiple Substance Use with clear-cut co-occurring substance use disorders. His symptoms for alcohol use include tolerance (he does not start feeling the effect of the alcohol until after the sixth bottle), craving (he has attempted to limit his intake of alcohol to the weekends only without success), he has failed in his attempts to stop alcohol use (he ceased the habit two years ago but has resumed), he wastes a lot of time finding, ingesting, and recovering from alcohol, he continues to use alcohol despite having interpersonal problems and social issues with his girlfriend, and lastly; he continues to use alcohol in spite of knowing he has hypertension that may be worsened by alcohol. This symptom profile meets the diagnostic criteria A. (1), (2), (3), (4), (6) and (9) in the
DSM-5
(APA, 2013). The severity specifier for this is
severe
because the symptoms are six; and the diagnosis is 303.90 (F10.20)
Severe Alcohol Use Disorder
.

James’ symptoms for cocaine use on the other hand are craving, tolerance, repeated use of cocaine such that he is unable to fulfil his socio-economic obligations (he is unemployed and is having a strained relationship with the girlfriend at home), he is neglecting important activities, having interpersonal problem with anger and hostility including towards his girlfriend, and wasting a lot of time finding, using, and recovering from cocaine. These symptoms fulfil the criteria A. (1), (3), (4), (5), (6), and (9) in the
DSM-5
(APA, 2013). The severity specifier is
severe
, since six symptoms are involved (APA, 2013). Hence the diagnosis is 304.20 (F14.20)
Severe Cocaine Use Disorder
.

Lastly, the symptoms James has for tobacco use are tolerance, craving, spending a lot of time procuring and using the tobacco, and continuing the use of tobacco despite knowing that he has high blood pressure which is worsened by tobacco. These symptoms meet the
DSM-5
diagnostic criteria of A. (1), (3), (4), and (9) for tobacco use disorder. The severity specifier in this case is
moderate
, since four symptoms are involved. The diagnosis is therefore 305.1 (F17.200)
Moderate Tobacco Use Disorder
.

How Effective or Not the
DSM-5
Criteria Apply to Each Case Example

For both Gloria and James, the criteria of this latest manual indeed apply quite well to their presentations. It is then easy after identifying the symptoms and their number to then specify the severity and make the diagnosis. However, the complication in this kind of diagnosis illustrated by these two case examples is that this is a composite diagnosis with no singular diagnostic statement. This, as stated earlier, is born out of the fact that both of them suffer from Multiple Substance Usage. It can therefore be concluded that Gloria suffers from
Mild Alcohol Use Disorder
and
Mild Cannabis Use Disorder
. For James, he has
Severe Alcohol Use Disorder
,
Severe Cocaine Use Disorder
, and
Moderate Tobacco Use Disorder
.

Why Age Is Important When Considering a Diagnosis and Diagnostic Criteria

The age of the client or patient is an important factor when considering the diagnostic criteria and the definitive diagnosis for several reasons. Two of the most important are that tailoring individual treatment modalities will require knowledge of the patient’s age for the appropriate evidence-based approach; and also that psychotherapeutic approaches like cognitive behavioral therapy or CBT require knowledge of the patient’s age in order to be fine-tuned to their circumstances (Alta Mira, 2019).

Additional Questions Before Making a Conclusion

For Gloria, the one question would include “Do you normally take marijuana to forget about problems you have or just to enjoy yourself?” For James, some of them would be “Do you wake up at night to smoke tobacco?” and “Do you have a problem with remembering recent events?” (Wernicke-Korsakoff syndrome caused by alcohol) (APA, 2013).                 

References

Alta Mira (2019).
Polysubstance abuse and multiple addiction treatment
. Retrieved 18 September 2019 from
https://www.altamirarecovery.com/polysubstance-abuse/

American Psychiatric Association [APA] (2013).
Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
5
th
ed. Arlington, VA: Author.

Connor, J.P., Gullo, M.J., White, A., & Kelly A.B. (2014). Polysubstance use: Diagnostic challenges, patterns of use and health.
Current Opinion in Psychiatry
, doi: 10.1097/YCO.0000000000000069 Adolescent & Addiction Essay

Concept Analysis Paper on Pain

Concept Analysis Paper

Purpose of Assignment
:  Discover the process of concept analysis and its importance in theory development.  The student will choose and analyze a concept of importance to nursing by synthesizing literature related to the chosen concept.

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Assignment:
  Submit a scholarly 10-12 page Paper that clearly and accurately addresses the following:

Select a concept

Determine the aims or purpose of analysis? What will be achieved by analyzing the concept you selected?  Why is it important to understand this concept?

Identify all uses of the concept that you can discover. Thoroughly search the literature for how this concept is defined and how it is used in the literature.  A total of four different sources are required and one reference must be from a different discipline other than nursing (sociology, psychology, theology).

Determine the defining attributes of this concept. Concept Analysis Paper on Pain.

Identify model, borderline, related, and contrary and compare how they differ from the concept you chose.

Identify antecedents and consequences of the concept.

Give an example of any empirical referents used to measure this concept. (Tools or surveys?)

Describe how the concept will be useful in your nursing practice.

Concept Analysis and PowerPoint Grading Rubric

Criteria

Possible Points

1. The aims of the analysis are clearly identified

10

2. A thorough literature review is completed using at least four different sources with at least one being from a different discipline

10

3. Defining attributes are listed.

15

4.  Model, borderline, related, and contrary cases are listed and compared with the chosen concept

Concept Analysis Paper on Pain

 

10

5. Antecedents and Consequences are listed and explained

10

6. Empirical referent(s) are listed and explained

10

7.  Description of how concept is used in Evidence Based Practice

10

8.  PowerPoint of 10-12 pages submitted with Paper

15

9.  Correct APA and scholarly grammar style

10

10. Timely submission, 5 points are deducted for every day late.

Total points

100

 

Introduction

Most patients who visit primary healthcare providers to seek for medical help often present with pain as a key symptom. Pain is an extremely stressful and unpleasant feeling which negatively impacts one’s quality of life with significant emotional, physical, psychological and social effects. Apart from impacting individuals, families, and society at large, it also increases healthcare-related costs (Watson & Sminkey, 2014).  This explains why it is a major issue in the American healthcare system. Researchers in the fields of nursing, sociology, and philosophy have studies the concept of pain with most studies focusing on how to measure pain, pain outcomes and how patients experience pain. According to existing literature pain cannot be completely controlled either with the use of medications or technology. Inadequate knowledge of pain management among healthcare providers and the concept of pain are potential reasons for the currently existing gaps in practice.

Concept analysis helps to clarify concepts that are either poorly or vaguely understood in theory and practice for the development of more specific and practical descriptions. An investigator can later construct and tests hypotheses which precisely reflect the associations which exist between theoretical concepts. Similarly, the findings obtained from a concept analysis are essential in developing research instruments or guidelines for interviews when refining some of concepts in a theory that may appear to be ambiguous. In this paper, the concept analysis of pain will be analyzed since it is an issue of public health significance for healthcare professionals and patients. Literature also reveals that unrelieved pain has numerous consequences which negatively impact care.

Aims/Purpose of Analysis

Utilizing the concept analysis approach by Walker and Avant, this paper aims at analyzing the concept of pain.  Attributes used to define pain, the antecedents which influence how pain is perceived and the resultant consequences of pain as a response will be discussed. The empirical referents of pain will also be discussed. Pain is the commonest symptom that prompts individuals to frequently visit primary healthcare providers. It is also inarguable that, there are other concepts such as the concept of fear and suffering which have a close association with the concept of pain which can promote misunderstandings in the clinical setting. However, with this concept analysis, it will be possible to distinguish it from interrelated concepts and promote the best care from healthcare providers. The literature used in this concept analysis was obtained from the online library using CINAHL scientific database and online literature.

Uses of the Concept

Pain is described as i)
a form of grief, trouble, sorrow or mental suffering
iii)
a physical or mental sensation felt by an individual when he/she is hurt
ii)
a form of distress/suffering
iv) suffering
in accomplishing a difficult task
according to the OED (Oxford English Dictionary). It is
a feeling that exhibits agony and sorrow which occurs when specific nerve endings get stimulated
(Exhibit, 2014) according to the description from the According to the definition from
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing and Allied Health
. It is a warning sign of damage to tissues which signals an individual to pull out from a source.

Philosophical Perspectives of Pain

Some of the great philosophers whose pain perspectives influenced the analysis of this concept are: Aristotle, Plato, and Descartes’. Plato emphasized how both peripheral stimulation and emotional experiences within a person’s soul influenced pain (Doleys, 2017). This idea was later integrated by Aristotle while discussing pain and sensation. According to Aristotle, pain is an unpleasant feeling that is opposite to pleasure. Descartes’ on the other hand emphasized a lot on the connection which exists between the emotion, thoughts and how it’s related to pain (Doleys, 2017). He explained that pain is both internal and external as an emotional feeling and psychological stimulus respectively.

Theoretical Perspectives of Pain

The psychological theory and pattern theory can be used to describe pain from a theoretical perspective. The pattern theory clearly explains that, to perceive pain, three interactive cerebral processes should be involved (Watson & Sminkey, 2014). These processes are: sensory, motivational and cognitive. The sensory process involves the transmissions by nerves from peripheral to the higher centers of the brain via the spinal cord. On the other hand, the motivational process is that which provokes motives and an aversive drive. Lastly, the cognitive process is that which influences the response strategies and may involve activities in attention, culture, and anxiety (Kumar & Elavarasi, 2016).

According to the behavioral/psychological theory, a lot of emphases is laid on the roles of a person’s surrounding environment, culture, cognition, personality, emotional and psychological factors. Therefore, pain can be learned from the conditions of either operant or a respondent (Kumar & Elavarasi, 2016).  In the former, pain is a response to environmental cues with consequences, in the latter, an antecedent stimulus elicits pain. As a learned stimulus, some of its responses can either by through superstitious and avoidance learning or subjective reinforcement.

Nursing Professional Perspective  

The IASP (
International Association for the Study of Pain
) defines pain
as a feeling that a subject experiences it is and occurs whenever he/she says it does.
It is an idiosyncratic and unpleasant emotional or sensory experience related to damage to tissues since every person applies it based on individual experiences associated with injury (Cohen, Quintner & van Rysewyk, 2018).  Some researchers, however, argue that not all pain is distressful and unpleasant since it can signal both negative and positive functions. For instance, in cases of injury, pain is a warning sign for potential trauma to tissues. Pain is described as a subjective experience of severe discomfort and an uncomfortable sensation in nursing diagnosis (Williams& Craig, 2016).  Thus, from a professional perspective, pain response and sensation is highly dependent on the physical stimulus and is influenced by psychological, social and cultural aspects.

Uses in Sociology  

According to the sociological viewpoint of pain, pain experiences should incorporate automatic responses, sensation, and feelings. Cultural and social patterns of an individual are believed to significantly impact on how an individual experiences pain. This can best be described through the attitudes of acceptance and expectance which can be learned from peers, parents, and siblings (Lukewich et al., 2015). Sociology focuses more on response to pain as compared to the reaction to pain which widely based on behavioral and emotional aspects. Besides, there are particular social circumstances based on an individual’s cultural background which influence a person’s response to pain (Kumar & Elavarasi, 2016).

Defining Attributes

These are the primary features linked to a concept for it to be properly explored.  The most identifiable defining attributes of pain are:

i) an unpleasant experience that causes extreme distress that originates from physical perception and results to both negative and positive meanings ii) an individualized human experience iii)a sensational state with emotional, behavioral and psychological aspects iv) mental and physical responses to a stimulus v) individualized responses influenced by socio-cultural factors, personality, emotions and the surrounding environment (Doleys, 2017).

Cases

Model Case

A model case is that which incorporates all of a concept’s defining and critical attributes. The following is a perfect example:

Mrs. Thompson, a 38 year-old African American recently diagnosed with colorectal cancer and had a planned colostomy as recommended by her surgeon. During hospitalization to undergo the planned surgery, Stacy, a RN who was taking care of her noted that she often lay on the bed with bent knees with tightly held arms close to her chest. Upon making an inquiry, Stacy also noted that although she cooperated, her eyes remained closed. A physical exam of her vital signs revealed that the PR and BP were slightly elevated.

Thompson informed Stacy that despite being in severe pain that radiated to the lower outer abdominal quadrant. This prompted Stacy to immediately administer pain medications. One hour later, Stacy questioned how Thompson felt and she replied, “I feel better.”  For around six seconds, Thompson paused and said, “One year ago, I had a bloody stool and abdominal pain during bowel movements. I was scared that I could have an advanced form of cancer. Later on, I was diagnosed with colorectal cancer. I must admit that the genes in my family were bad. My paternal grandmother died of cervical cancer, my aunt died of endometrial cancer and my sister died of leukemia. Here I am diagnosed with colorectal cancer.” Shaking his head, he continued, “Sooner than later, I was certain of what would happen to me and I openly admitted the state of affairs Concept Analysis Paper on Pain. I am happy that I was not married since I would have left my husband and children vulnerable in this journey of sickness.

The case described clearly depicts all the attributes of pain. Mrs. Thompson complained of pain, positioned herself protectively and demonstrated pain on her facial expression. Her behavioral, verbal and non-verbal responses revealed that the feeling she experienced was not only distressful but also unpleasant.  Similarly, she tried to avoid learning how to respond to pain which is a sign of mental response to pain. The indication to undergo colostomy following the diagnosis of colorectal cancer signified physical damage of tissues from the pain stimulus. Mrs. Thompson was suspicious of her cancer two years ago when she had symptoms of persistent abdominal pain and stool in blood.  The cultural and social dimensions of pain were illustrated by Mrs. Thompson’s response to bad familial genes. African Americans generally consider cancer to be an incurable condition which causes severe physical pain. African Americans also believe that a responsible woman should care for her husband and family. Although she was diagnosed with a severe form of cancer, she was comfortable that she wasn’t a burden to her family (Doleys, 2017).  Based on her responses, she has accepted her pain and illnesses. This has likely been influenced by cultural and social factors, her environment, personality and experiences in the past Concept Analysis Paper on Pain.

Borderline Case

A borderline case does not have all of a concept’s defining attributes.  A perfect example of a case scenario that reveals a borderline case is as follows:

FG is a 56-year-old Asian American who was a religious leader diagnosed with esophageal that in its advanced form. During routine care, the nurse who attended to her noted that his eyes were always closed and that he maintained a specific position which gave him comfort  his left side with bent legs. He was very spiritual, hopeful and faithful. When with his family, they occasionally prayed together. When questioned how he was doing, FG always replied that he was fine. He also denied experiencing pain and appreciated her concern Concept Analysis Paper on Pain. His PB and PR were slightly elevated. The nurse was always curious about FG’s response to pain since her clinical knowledge informed her that patients whose cancer has metastasized often experience some degree of pain which requires pain medications.  The nurse became curious about why FG did not have this response and raised this concern with him. FG responded, “Mine is a negligible physical discomfort which is incomparable to the discomfort Jesus experienced when he died for our sins on the cross. I wouldn’t mind experiencing the same suffering for God’s love.” Two days later, FG died.

The case clearly lacks all of the defining attributes of pain. FG’s behavioral responses demonstrated pain although this was never verbalized. The mental sign of pain was also revealed by learning the behavior of avoidance. When the patient’s family visited, they fellowshipped together; a social pattern within the family that influenced the responses of the patient to pain. How the Asian-American culture influences FG’s response to pain was not revealed. Instead, family and religious factors had a lot of influence on FG as compared to other factors. Concept Analysis Paper on Pain.

Contrary Case

This case does not have any of the primary defining characteristics of a concept. A perfect example of a contrary case is as follows:

Ivy is a 1and a half yrs. She was brought to the outpatient pediatric clinic in her mother’s and father’s company for routine immunization.  Upon arrival at the facility, Ivy was fearful and had a lot of anxiety thus; she tightly held onto her mother and couldn’t remain calm. When an attending nurse tried to start a conversation with her, Ivy started crying and acknowledged that she didn’t anyone close to her apart from her mother. She persistently cried and asked her mother to return home.

This case example has no defining attributes of pain. On the contrary, the classical concepts that it presents is that of fear. Fear usually occurs as a reaction either as an event or a particular form of danger. Immediately the threat is removed, fearfulness is also forgotten. Ivy is fearful of what will happen in the clinic since she remembered her past experiences in the clinic Concept Analysis Paper on Pain. It is also likely that she remembered she was at the clinic for immunization which will result in pain.

Antecedents and Consequences

Antecedents

           
Antecedents refer to incidences which occur before a concept. The most notable antecedents are cultural, environmental and personal values which are interrelated.   The environment harbors a pain trigger which can affect an individual’s mind, body or both resulting in significant damage of tissues. A person’s attitude and knowledge as it relates to an event have an essential role in pain perception. This may also be determined by pain experienced in the past, pain acceptance or expectance and coping mechanisms (Watson & Sminkey, 2014).  Personal values are determined by a person’s current status physically and emotionally, gender, personality, and socioeconomic status. The emotional aspect is primarily characterized by the levels of anxiety and stress such that in high levels, pain can easily be felt and vice versa. Besides, a person whose attitude towards pain is optimistic makes use of positive methods to address pain and vice versa. Women’s sensitivity to perceiving pain is higher as compared to men thus, the latter are openly allowed to express it (Doleys, 2017) Concept Analysis Paper on Pain.

The socio-cultural viewpoint reveals that pain can be discussed in different ways depending on one’s socio-cultural status.  A perfect example is given by Doleys (2017) whereby, individuals with a high socio-economic status express their pain more and are aware of it when compared to those from a lower socioeconomic status. As another antecedent of pain, cultural values shape how individuals from specific cultures perceive and respond to pain.

Consequences

Based on Walker ad Avant’s concept analysis approach, consequences refer to incidences that occur as an outcome of a concept. The consequences of pain can directly be associated with how an individual reacts to and its subjectivity.  The reaction to pain can best be explained from a physical and biological perspective whereby, the behaviors can be categorized as either a voluntary or involuntary response (Bastian et al., 2014).  Involuntary responses are unconsciously controlled by the autonomic nervous system and are non-verbal. These may include changes in the heart rate and heart rhythm and reflex reactions. On the other hand, responses that are voluntary at are consciously controlled and involve motor activity. They involve both non-verbal and verbal reactions such that, an individual can cry, moan or change position for relief (Bastian et al., 2014). The verbal perspective can be expressed using the following symbols: interpersonal, intrapersonal and complex communication.

The other consequence of pain is meaning development for the pain experienced.  A person can transfer pain encounters and positively or negatively give to it meaning and this determines how they cope with pain. Thee major processes used to seek for the meaning of pain are widely used namely: understanding the immediate causes, the immediate effects and lastly the ultimate causes (Bastian et al., 2014). Although healthcare providers are less likely to be informed on the meaning of a pain experience, the meaning will significantly impact a person’s interaction with the environment and how they relate with others Concept Analysis Paper on Pain.

Empirical Referents

Empiric referents provide an explanation on the best strategy to measure pain and how the concept should be in reality. Based on this analysis,   is inarguable that the attributes may be abstract which explains their real presentation and can be used to develop measuring tools and instruments. Pain is a feeling that is distressful, unpleasant and uncomfortable. As described by Lukewich et al., (2015), it’s the most effective and reliable indicator based on a patient’s verbalization. Concept Analysis Paper on Pain However, there are case scenarios where verbalization may not be enough probably due to restricted verbal abilities. Pain should be measured based on where it is located, its quality and intensity. Assessments can be completed through behavioral cues such as being restless, avoiding movement or crying.

A widely recommended tool that can be used to measure pain is the
McGill Pain Questionnaire
(Lukewich et al., 2015). It is an assessment tool which comprises of three pain measures namely: the current intensity of pain, the index of rating pain, and the selected number of words. A numerical rating scale can also be used to measure the severity of pain where a patient is asked to rate his pain on a scale of 1-10. The verbal rating scale is another effective measure of pain. It requires a patient to fill a questionnaire that describes the intensity, location and severity of their pain more comprehensively to improve provider’s knowledge in making a diagnosis.

Application In Nursing Practice

Nurses have an ethical responsibility to manage patients experiencing pain and the resultant consequences of unrelieved pain in clinical practice.  In the recent past, fulfilling this ethical obligation was met with numerous constraints including deficits in knowledge, moral disengagement and biases. However, the knowledge gained from this pain concept analysis will be used in the clinical setting to identify patients’ origin and perception of pain, how they response to the pain stimulus and some of the most effective coping mechanisms used by patients for relief.  Since pain is a subjective experience, this knowledge will be applied in determining the cultural, environmental and personal values that influence a patient’s perception and response to pain to promote culturally competent care. In order to successfully implement effective strategies to manage pain, knowledge on the concept of pain is mandatory. This benefits both the patient and healthcare providers and result to better health outcomes. Concept Analysis Paper on Pain.

 

References

Bastian, B., Jetten, J., Hornsey, M. J., & Leknes, S. (2014). The positive consequences of pain: A biopsychosocial approach. 
Personality and Social Psychology Review
, 
18
(3), 256-279

Cohen, M., Quintner, J., & van Rysewyk, S. (2018). Reconsidering the International Association for the Study of Pain definition of pain. 
Pain reports
, 
3
(2).

Doleys, D. M. (2017). Chronic pain as a hypothetical construct: a practical and philosophical consideration. 
Frontiers in psychology
, 
8
, 664.

The exhibit, D. (2014). Excerpt from Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, & Allied Health (5
th
) Concept Analysis Paper on Pain.

Kumar, K. H., & Elavarasi, P. (2016). Definition of pain and classification of pain disorders. 
Journal of Advanced Clinical and Research Insights
, 
3
(3), 87-90.

Lukewich, J., Mann, E., VanDenKerkhof, E., & Tranmer, J. (2015). Self‐management support for chronic pain in primary care: a cross‐sectional study of patient experiences and nursing roles. 
Journal of advanced nursing
, 
71
(11), 2551-2562.

Pain. (n.d.). In the
Oxford English dictionary.
(2
nd
. ed.).

Watson, A. C., & Sminkey, P. V. (2014). Pain management: Screening and assessment of pain as part of a comprehensive case management process. 
Professional case management
, 
19
(3), 126-134.

Williams, A. C. D. C., & Craig, K. D. (2016). Updating the definition of pain. 
Pain
, 
157
(11), 2420-2423. Concept Analysis Paper on Pain.

Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree

Practicum: Decision Tree

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.

Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree

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Learning Objectives

Students will:

• Evaluate clients for treatment of mental health disorders

• Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

The Assignment:

Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

• Decision #1: Differential Diagnosis

o Which Decision did you select?

o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

• Decision #2: Treatment Plan for Psychotherapy

o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

• Decision #3: Treatment Plan for Psychopharmacology

o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

• Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Below is a sample paper for this assignment, use it as a guide.

Clinical Judgement on Katie’s Disorder

One of the vital roles of nurse practitioners is formulating the appropriate diagnosis whenever they encounter clients with symptoms that resemble different disorders. When such situations arise, it becomes imperative for the practitioners to develop the right diagnosis by utilization of the standardize diagnostic tools to rule out other differential diagnoses which will assist practitioners in the initiation of the treatment plan that will lead to a favorable outcome as well as increase patient satisfaction. The focus in this paper is about an eight-year-old girl Katie that was brought to the clinic by her parents due to the child is suspected of suffering from attention deficit hyperactive disorder (ADHD) from the assessment her teacher performed with the assessment tool called Conners’ Teacher Rating Scale. While inside the practitioner’s office, Katie was exhibiting some behavior that aligns with ADHD for example, inability to pay attention or sit still, continually interrupting the parents and the practitioner. She also revealed that she has difficulty paying attention in class or complete her school work. It is the responsibility of the mental health nurse practitioner that is managing this client to perform further diagnostic evaluations to establish the appropriate diagnosis and treatment plan. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Decision Point One

After evaluating all the information provided including the independent and objective evidence, the carefully chosen judgement for Katia is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. An additional diagnostic evaluation tool to use to assess the Katia and her parents are the Child Behavior Check List (CBCL) since the teacher has already evaluated the child with Conners’ Teacher Rating Scale. CBCL is a user-friendly, cost-effective, reliable, and valid standardized assessment tool that is generally used in mental health services, schools, medical settings, child and family services, public health agencies, child guidance, and training programs for assessing children’s behavioral/emotional problems from the perspectives of multiple informants including parents, caregivers, and teachers (Mazefsky, Anderson, Conner, & Minshew, 2014).

The reason for choosing the above diagnosis is due to the symptoms the client exhibited in concurrent with the criteria for the selected diagnosis as listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: (DSM-5). The requirements to make the determination is when the client meets up to six or more of the rules, for example, exhibits concentration difficulty, inability to complete a task promptly, difficulty retaining simple instructions, avoids activities that require cognition, and paying attention to unnecessary distractions (American Psychiatric Association [APA], 2013). The target outcome is to link the symptoms to the right diagnostic criteria in DSM-5 before establishing the appropriate treatment plan, and that matches with the expected result.

Decision Point Two

The initial pharmacological agent to use for the client is Adderall XR 10mg by mouth every day. The medication is also known as Amphetamine is an approved medication to treat kids from six to 17 years with ADHD and it belongs to the group of drugs called stimulants that functions by improving the chemical irregularity in the brain which is prompting the symptoms (Stahl, 2014). The basis behind this judgment is that it reduces the symptoms of inattentiveness, motor hyperactivity, and impulsiveness that interrupt social, school, and occupational functioning which is the goal of treatment for this client. The common side effects of Adderall XR to explain to the parents of the client includes; insomnia, shivering, vertigo, dehydrated mouth, constipation, diarrhea, reduced appetite, and weight loss (Felt, Biermann, Christner, Kochhar, & Harrison, 2014). The effectiveness of the medication can be apparent right after the first dose while in some patients, it can take several weeks to achieve the most therapeutic effect.

After four weeks of initiating this choice of medication, the parents of the client and the teacher noted some positive changes in the morning but not so much improvement in the afternoon and also complained of reduced appetite. The updates from the parents and teacher are the regular occurrence that is associated with medication which was explained to the parents at the initial visit, and the full effect of the drug takes several weeks in some individuals. Therefore, the result at hand is not different from what the practitioner expected. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Decision Point Three

Although the client has shown some improvement in the morning, modification in her attentiveness in the afternoon is yet to be achieved. Therefore, the next action is to supplement Adderall XR with a minute dose of instant release Adderall for the client to take in the afternoon that will sustain the client in the afternoon to complete her homework as well. The reason is that the overall result for initiating treatment is to improve the client’s attentiveness and concentration in school work including homework. At this point, the practitioner will schedule a follow-up visit in four weeks to assess for the effectiveness of the instant release on the client’s symptoms. American Academy of Pediatrics (2017), recommends that Continuous monitoring of the client’s behavior and medications are necessary to assess if the treatment strategy is functioning and one of the ways to achieve it is by follow-up visits.

Ethical Consideration

The dominant interest of mental health practitioner that is managing the mental health of children and adolescents is the safety of the child while upholding the moral principle of doing no harm and also address the rights and privileges of both children and their parents/legal caregivers, interpret consent as well as confidentiality (Jackson, Burns, & Richter, 2014). Therefore, mental health practitioners to should be watchful of different forces that could play roles in the diagnostic method while preserving the knowledge that their attempts will significantly reshape the near- and likely longer-term expectations of their child patients. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Conclusion

When practitioners encounter a patient with symptoms that resemble other conditions, establishing the appropriate diagnosis by ruling out other possible conditions becomes imperative like the case of Katie who was accompanied to the clinic by her parents. Therefore, it is the sole obligation of the mental health practitioner that is managing this client to perform further diagnostic evaluations to establish the appropriate diagnosis and treatment plan. They should also remember the importance of maintaining confidentiality and ensuring that the authorized person signs the treatment consent before initiating treatment.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

American Academy of Pediatrics. (2017). Treatment & Target Outcomes for Children with

ADHD. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Treatment-of-ADHD-and-Related-Disorders.aspx

Felt, B. T, Biermann, B., Christner, J. G., Kochhar, P. & Harrison, R. V. (2014). Diagnosis and

management of ADHD in children. American Family Physician, 90(7), 456-464.Retrieved from https://www.aafp.org/afp/2014/1001/p456.html

Jackson, M. K., Burns, K. K., & Richter, M. S. (2014). Confidentiality and treatment decisions

of minor clients: a health professional’s dilemma & policy makers challenge. Springer Plus, 3, 320. https://10.1186/2193-1801-3-320 Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Mazefsky, C. A., Anderson, R., Conner, C. M., & Minshew, N. (2014). Child Behavior Checklist

Scores for School-Aged Children with Autism: Preliminary Evidence of Patterns Suggesting the Need for Referral. Journal of psychopathology and behavioral assessment, 33(1), 31-37. https://doi.org/10.1007/s10862-010-9198-1

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New

York, NY: Cambridge University Press.

Practicum: Decision Tree

Introduction

Nurse practitioners have the role of making a suitable diagnosis for the clients and prescribing the appropriate treatment regimen. The diagnosis should be performed using suitable diagnostic tools in order to exclude other differential diagnoses in order to facilitate appropriate treatment and ensure better health outcomes for the patient/client. This case study presents an 8-year-old female client, who presented after being suspected of having ADHD. The “Conner’s Teacher Rating Scale-Revised” showed that the client was forgetful, inattentive, distractible easily, and poor in reading, spelling, and math. The teacher further reported that the client had short attention span, did not have interest in schoolwork, left school work uncompleted, and did not follow instruction.  After the mental status exam, her mood was euthymic while the clinical interview indicated that her concentration and attention were fairly limited. Accordingly, this paper will present three decisions made about the diagnosis and treatment choices for this client and the rationale behind the selected decisions. The paper will conclude by discussing ethical considerations during the client’s treatment. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Decision Point One

From the provided information and the findings of the mental status exam, the diagnosis of the client is attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. The Child Behavior Check List (CBCL) can be used to further evaluate the client and her parents because the reliability and validity of the tool in evaluating mental health issues in children have been verified. The rationale for selecting the diagnosis, attention deficit hyperactivity disorder (ADHD) is because the client manifests symptoms consistent with clinical symptoms listed within the DSM-5 diagnostic criteria. As per the DSM-5 criteria for ADHD, individuals with ADHD manifest hyperactivity-impulsivity or/and inattention that affect an individual’s development or functioning (American Psychiatric Association, 2013). For inattention, children should manifest 6 or more inattention symptoms for a minimum of 6 months and the symptoms include: lack of attention to details and mistakes in classwork and other activities; lack of attention during play/tasks; inability to listen directly; inability to follow instructions; failure to finish classwork or assigned chores; disorganization; avoiding activities needing mental effort; losing essential things such as books; forgetfulness; and being easily distracted (Tong et al, 2016). On the other hand, hyperactivity/impulsivity is characterized by fidgeting; running/climbing inappropriately; inability to play quietly; excessive talking; blurting out answers prior to question completion; problem waiting for ones turn, and interrupting/intruding others. The client manifests more than six symptoms of inattention and hence fits the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation American Psychiatric Association, 2013). Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

With this decision, the hope was that the appropriate diagnosis would lead to the appropriate treatment for this client, and hence ensure better health outcomes.

Decision Point Two

The first treatment choice is for the client to start Adderall XR 10 mg orally every day. The reason for choosing Adderall is because evidence shows the efficacy of the pharmacological agent in the treatment of ADHD. Adderall is FDA approved for treatment of children aged from 6-17 years. The medication is a stimulant and works by improving stimulation within the prefrontal cortex; specifically, Adderall is a competitive inhibitor of dopamine and hence acts on the dopamine and norepinephrine transporters and hence boosts neurotransmission of both dopamine and norepinephrine within the prefrontal cortex, improving the symptoms of ADHD such as inattentiveness, impulsivity, and hyperactivity (Brown et al, 2018).  Side effects that have been reported in Adderall include increased aggressiveness, appetite suppression, sleeplessness, weight loss, mouth dryness, diarrhea, vertigo and constipation (Weyandt et al,2018).

The expected outcome was that there will be significant symptom improvement because the pharmacological agent has been demonstrated to be effective in improving ADHD symptoms. It was also hoped that she would not experience side effects after initiation of the medication. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Comparable with the expected outcome, after four weeks of starting Adderall, there was significant symptom improvement for the client in the morning. However, there was no significant improvement during the afternoon hours because the client was unable to maintain attention in the afternoon. This is attributable to the Adderall being
an immediate release amphetamine pharmacological agent and thus the medication was short-acting, leading to decreased effectiveness to last for the whole day (
Weyandt et al, 2018)
. In addition, the client reported appetite loss which is a major side effect in amphetamines.

Decision Point Three

The third decision is the addition of a slight dose of Adderall during the early afternoon. The reason for this decision is to make sure that the client will be able to maintain attention even during the afternoon because, with the previous decision, the client was not able to achieve attention in the afternoon (Huss et al, 2017).

By adding a small dose in the afternoon, it is hoped that the client will maintain attention throughout the day and thus she will concentrate on her school work and other activities (Huss et al, 2017). The client will be monitored by a PMHNP after every four weeks in order to have her progress assessed. In addition, the assessment will be able to inform the ability of the client to tolerate the additional dose.

Ethical Considerations

Medications such as stimulants like Adderall have various side effects and hence the PHHNP should ensure no harm to the client. In addition, informed consent is an important ethical aspect during the treatment of this client. Therefore, it is the duty of the PMHNP to explain to the parents of Katie regarding the available treatment options, including the side effects associated with stimulants such as Adderall (Committee on Bioethics, 2016). This will ensure that the parents of the client make an informed decision prior to selecting any treatment option.

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Conclusion

According to the presented symptoms, the diagnosis for this client was attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. The first pharmacological agent for the client was Adderall XR 10 mg because Adderall is approved for treatment of the pediatric population and its efficacy in treating ADHD has been demonstrated. Even though, the symptoms improved, the client was not able to maintain attention in the afternoon. Accordingly, the third decision was addition of a slight dose of Adderall during the early afternoon in order to ensure that she was able to maintain attention even in the afternoon hours. In conclusion, it is important for the PMHNP to ensure that the selected treatment regimen does not cause harm to the client and also seek informed consent from the parents of Katie prior to starting any treatment. This will ensure the parents make an informed choice, regarding their daughter’s treatment. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

References

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

Brown K, Samuel S & Patel D. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners.
Transl Pediatric
. 7(1): 36–47.

Committee on Bioethics. (2016). Informed Consent in Decision-Making in Pediatric Practice.
American Academy of Pediatrics
.
96(5):981
.

Huss M, Duhan P, Gadhi P, Chen C, Carsten S & Kumar V. (2017). Methylphenidate dose optimization for ADHD treatment: a review of safety, efficacy, and clinical necessity.
Neuropsychiatr Dis Treat
. 1(13), 1741–1751.

Tong L, Xiong X, Tan H (2016) Attention-Deficit/Hyperactivity Disorder and Lifestyle-Related Behaviors in Children.
PLoS ONE
. 11(9): e0163434.

Weyandt L, White T, Gyda B, Adam N, Leon K & Bjorn S. (2018). Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students.
Pharmacy (Basel)
. 6(3): 58. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

NURS6051. Transforming Nursing and Healthcare through Technology. The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

NURS-6051N,Transforming Nursing & HC

Week 3 Assignment: 
The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined? NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

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Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

To Prepare:

Review the concepts of technology application as presented in the Resources.

Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

Describe the project you propose.

Identify the stakeholders impacted by this project.

Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.

Identify the technologies required to implement this project and explain why.

Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

 

NURS_5051_Module02_Week03_Assignment_Rubric

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient care efficiency. Your project proposal should include the following:

Describe the project you propose.

Identify the stakeholders impacted by this project.

Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving, and explain how this improvement would occur. Be specific and provide examples.

Identify the technologies required to implement this project and explain why.

Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.–

The response accurately and thoroughly describes in detail the project proposed.

The response accurately and clearly identifies the stakeholders impacted by the project proposed.

The response accurately and thoroughly explains in detail the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an accurate and detailed explanation, with sufficient supporting evidence of how this improvement would occur.

The response accurately and clearly identifies the technologies required to implement the project proposed with a detailed explanation why.

The response accurately and clearly identifies the project team (by roles) and thoroughly explains in detail how to incorporate the nurse informaticist in the project team.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–

Written Expression and Formatting
– English writing standards:

Correct grammar, mechanics, and proper punctuation–

Uses correct APA format with no errors..

Name: NURS_5051_Module02_Week03_Assignment_Rubric

Possible Resources

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

Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.

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

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019.

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

 

Nursing Informatics Project Proposal

 

Background

In today’s world, there is nothing worrying than the deaths that are recorded on a daily basis emanating from the so-called lifestyle diseases. Thousands of new patients are diagnosed each day with a large number being unaware of being victims of these silent killer conditions. Among the top-rated lifestyle diseases/conditions are diabetes, hypertension, as well as obesity (Moghani Lankarani & Assari, 2017). One in every four Americans suffers from either hypertension or is diabetic. These statistics are alarming and have placed the two conditions among the 10 leading causes of death in the US. Diabetes is ranked number 1 cause of opportunistic diseases such as kidney failure, stroke and heart attack globally (The Observatory. Diabetes in America, 2017). NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

This calls for improved efforts in fighting this menace of lifestyle disease right through the creation of the public awareness, proper follow-up, as well as quality medical services to reduce the cases of diagnosis and the number of deaths associated with the same through proper data and information management (Thew, 2016). This paper will propose a nursing informatics project that will observe application of technology in the advocacy to improve the patient-care efficiency within the health facilities across the US.

The Project Proposal

The project that is proposed will be referred to as “Clinic alert follow-up system” (CAFS). This project will provide alert services to the involved nurses to identify or acquire updates concerning clinic follow-ups for those previously diagnosed with either hypertension, diabetes or obesity. Upon the first or subsequent visit to a health facility, and with the initial patient examination in the triage, the patient will undergo a routine checkup which must include the three crucial checkups of the diabetes, hypertension as well as BMI. If the patient is diagnosed with one or more of the conditions, the nurse will log in into the “Clinic alert follow-up system” (CAFS) and enter the patient medical code to perform a search. NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

If the patient details are not found, that means the patient is either visiting the facility for the first time or in the previous visits, they had not been diagnosed with either of the conditions. The nurse will key in the checkup results and recommend a further doctor examination and a possible clinic booking for the new patient (Glassman, 2017). This will alert the doctor during the patient session and if the doctor recommends a clinic or therapy session booking, the system will select a date and time upon the availability of the doctor, as well as the matter of treatment urgency. For a regular patient who had been previously diagnosed, the nurse will be able to get alert of the previous clinic follow-ups on whether the patient has been attending clinic/therapy sessions, as well as the treatment progress. This is the most important point of having the CAFS system in place as most diagnosed patients worsen their conditions due to lack of follow-up, especially with the doctor’s recommendation. With the CAFS assistance, the nurse and the doctor can establish the patient progress as every visit to the clinic or therapy session is also recorded and updated within the CAFS system NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

The Stakeholders Impacted by This Project

Clinic alert follow-up system (CAFS) will impact various stakeholders who include the patient, nurses, doctors, therapists, specialists, IT department team as well as the nurse informaticists. The main aim of having CAFS in place is to identify the trend of the three identified lifestyle conditions through diagnosis, clinical and therapy sessions, follow-up, as well as treatment progress (Wang, Kung & Byrd, 2018). With the normal routine checkups, most of the patients who get diagnosed with either hypertension, diabetes or obesity does not get proper follow-up, especially if their intended visit was concerning a different complication away from the tree. This situation has led to increased cases of these conditions as well as other opportunistic diseases such as heart attack, kidney failure and lower limb amputations that are all associated with uncontrolled hypertension, diabetes or overweight. The CAFS system is expected to solve this situation

Patient-Care Efficiencies This Project Is Aimed at Improving

For the patient-care efficiencies, CAFS is aimed at making follow-up from the initial visit of a diagnosed patient and ensure that they adhere to the recommended actions and treatment journey whenever possible. Assistance will also be ensured in terms of availing of the necessary medicine, as well as counseling sessions for those who may be in need. The nurse work will be made easier as the follow-up process will be availed by the system and various informatics within the systems will be alerted on specific actions to undertake within the patient’s treatment journey (Macieria, et al., 2017). It will also be easier to identify the rate of diagnosis among the patients and even in a specific period e.g. Yearly, quarterly or in a month (Glassman, 2017). In the process of follow-up, the patient will be more informed, take care of themselves in terms of diet watch and exercises, as well as adhere to the medication. This will bring an overall positive change and improvement of the condition to the diagnosed patients.

The Technologies Required to Implement This Project

The CAFS will require a standard server to integrate with the rest of the health facility system. The existing computers will be used in the same system, but will need to be upgraded with the latest operating system. For compatibility issues, CAFS will be compatible with both windows and OS. Some orientation will be conducted by the IT experts to familiarize the various stakeholders on the operations of the system and the various processes that will be required during each stage NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

The Project Team (By Roles) and the Incorporation of The Nurse Informaticist In the Project Team

The project team will involve the senior nurse, nurse informatics, IT experts, system developers, a representative from the doctor, therapist and nutritionist representatives. The reason to have everyone on the board is to incorporate all the features that involves the various stages and departments right from the patient visit to the last stage of the treatment processes. The representatives have been carefully and specifically selected from the departments that are deemed to deal with the three critical conditions of hypertension, diabetes as well as obesity/Overweight. The nurse informaticist is of great importance as they will be liable to gather and interpret the complicated patient data and disseminate to the various concerned stakeholders within the CAFS system. Nurse informatics are also important as they are the ones who should initiate the system changes and upgrade in collaboration with the IT department experts, for improved service delivery (McGonigle & Mastrian, 2017). NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

 

 

References

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12 (11), 45–47.

Retrieved from
https://www.americannursetoday.com/wp-
content/uploads/2017/11/ant11-Data-1030.pdf

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G.

(2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Moghani Lankarani, M., & Assari, S. (2017). Diabetes, hypertension, obesity, and long-term risk

of renal disease mortality: Racial and socioeconomic differences.
Journal of Diabetes Investigation
,
8
(4), 590–599. https://doi.org/10.1111/jdi.12618 NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge

(4th ed.). Burlington, MA: Jones & Bartlett Learning.

The Observatory. Diabetes in America. (2017).
MLO: Medical Laboratory Observer
,
49
(2), 6.

Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=120942250&site=ehost-live

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved

from
https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-
challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and

potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126 (1), 3–13. doi:10.1016/j.techfore.2015.12.019. NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

Counseling Essay

Using the case study you will identify key patient problems, stages of change for each identified problem, criteria that supports specific DSM 5 substance use diagnosis, and develop questions about items you would wish to understand in more depth.

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Case Study –

Johanne, is 30-year-old woman and has been drinking alcohol for at least 9 years. At first her drinking modest (1-2 standard drinks) once or twice per week, and at social events with her partner and friends. She reports there were occasional periods of heavy drinking (4 or 5 drinks per event) about 2-3 times per year. When she divorced 4 years ago, she started drinking more frequently, almost every night and most often after her two school-age children and preschool age child had gone to bed Counseling Essay. About 3 years ago, she noticed that she was feeling more anxious and felt stress from efforts to get the children to daycare and school, doing day to daycare, not having enough money, hassling with her ex-husband over child support, and getting to work on time. She received a prescription for benzodiazepine Zanax from her family doctor and after about 6 to 7 more months noticed her frequency of use increased, along with her alcohol use. She began using up the medication 1-2 weeks before her next prescription was due and when she was out of medicine, she felt very anxious. When this occurred, she used alcohol to control her anxiety and feelings of stress. She also began to try to seek out other prescribers for this medication, when her health care provider declined to fill her prescription earlier than planned Counseling Essay.

Johanne grew up in a household she describes a “tense and chaotic”. She describes her mother as being verbally abusive and who has continued to struggle with excess alcohol use most of her life. Johanne recounts drinking alcohol two or three times during high school, yet not liking the taste or effects of alcohol. She then began to smoke cannabis around age 16 and enjoyed that more. Johanne went through a period of smoking cannabis regularly after ending her relationship with her first high school boyfriend. After she began another relationship, she reduced her cannabis use, decided she was becoming too reliant on marijuana stating, “I was afraid I was getting addicted to it”, and quit using entirely. She has been smoking cigarettes for at least 12 years and uses about 15-20 a day, but will smoke even more when “I am anxious”.

Johanne has been drinking regularly (she reports at least 1-2 times a week for about seven years) for at least ten years. After her divorce, her drinking increased to almost daily, and her use of benzodiazepines began three years ago. Johanne started “prescription shopping” like her need for the benzodiazepine increased. She reports feeling a sense of shame, feels regret about her divorce, reports low motivation, little belief in her own ability and low confidence. She reports little social interaction with others outside of teachers at her children’s school and her immediate family. She also reports that she feels like an ineffective parent but insists she has never neglected her children.

On admission, Johanne reports she has felt depressed: feeling sad about the loss of her husband through divorce, guilty about not taking good enough care of her children, anxious, lethargic, and unmotivated. Sometimes she sleeps for hours at a time, and when asked how long, she reports 10-12 hours or more. At other times, she wakes up in the middle of the night, then has trouble falling back to sleep and at other times cannot get to sleep. Her physical complaints include frequent headaches, a chronic cough, and an irregular menstrual cycle. She reports feeling “stressed out,” yet has trouble taking steps to reduce her sense of stress. Prior to entering the detox program, she had not had a physical exam in 4 years. While in the detoxification program, her restlessness, anxiety, and depressive symptoms seemed to increase. She reports feeling overwhelmed with issues of finances, childcare, and isolation.

Her doctor recognized her withdrawal risks and referred her to a psychiatrist trained in substance use disorder. The psychiatrist recommended inpatient treatment. After being monitored in a detoxification program for several days, and referred to an 8-week intensive outpatient treatment program, she is now ready to develop her treatment plan.

Instructions:

– Clearly identifies, defines, and explains key criteria, symptoms, issues, counseling strategies, risk reduction methods, etc.

– Demonstrated ability to effectively apply concepts, techniques, and related learning from case studies, and research.

– Paper must have a logical flow with complete ideas presented, clarity of argument and explanations, and the writing engages the reader.

 

Counseling

Key patient problems

Frequent drinking almost every night with the drinking intensity increasing since the divorce four years ago.

Increasing anxiety and stress from taking care of children, financial issues, dealing with ex-husband, and work responsibilities.

Heavy smoker (smoked for at least 12 years) using 15 to 20 cigarettes every day.

Antisocial behavior by keeping away from social relationships with friends and family.

Depression since the divorce.

Increasing use of benzodiazepine (Zanax) prescribed for the anxiety and stress.

Indications of prescription medication abuse and addiction with benzodiazepine not used as prescribed and alternative sources of medication sourced apart from prescribers.

Has history of child abuse (verbal abuse by mother).

Family history of alcohol abuse by mother.

Has history of cannabis use as a teenager.

Detoxification program was not helpful with her anxiety and depression increasing.

Withdrawal risks identified (disturbed sleep, irritability, anxiety, and tension) and client referred to counseling.

Stages of change for overcoming the alcohol and prescription Zanax addiction

The stages of change are suitable for describing the case details. These stages help in understanding the range of behaviors that the client exhibits as she wants to reverse her addiction but has difficulty in doing so. Through understanding the stages of change that apply to the client, it is possible to present an effective recovery plan that applies person-centered and motivational approaches rather than pathological and confrontational approaches. The client began at the pre-contemplation stage when she ignored the negative effects of the addiction and only focuses on what she perceives as the positive effects. At this stage, she was not ready to change the addictive behavior. This is seen when she drank alcohol after her children had gone to bed, and used alcohol to supplement Zanax. At this stage, the client viewed the Zanax and alcohol addiction as a pleasant and positive experience. However, the negative effects were apparent although she ignored them (such as prescription shopping that could land her in jail and depression), choosing to use more alcohol and prescription Zanax (Hartney, 2019b).

The client moved into the second stage (contemplation) when she became aware of the negative consequences of the addiction and started thinking about changing through quitting, moderating and cutting down on the addictive behaviors. At this point, she was considering changing the addictive behavior, open to listening to information about the negative consequences of the addictive behavior, and learning strategies for addressing the addictive behavior. The contemplation stage concluded when she made the decision to seek treatment for the addictive behavior (Hartney, 2019b).

The client moved into the third stage (preparation) when she started planning and preparing for the treatment for addictive behavior, and carrying out the changes she contemplated. At this point, she planned about the change to be made: cutting down on the alcohol and Zanax, and reducing the harm. Also, she planned on how to make the change: seeking professional treatment to guide her through the treatment process. Besides that, she put support in place by booking a place in a detoxification program. In addition, she sought help from a social worker/counselor to help with the preparation. Once the preparation for treatment was complete, the client moved on to the next stage (Hartney, 2019b) Counseling Essay.

The client moved into the fourth stage (action) when she attempted to overcome the addictive behavior and actively sought to control the behavior. At this stage, she began the real change when she entered the detoxification program where trained professional personnel were on site to support her through the treatment and make informed decisions for therapy when necessary. However, this stage turned out to be more challenging than the client had anticipated, causing her to develop withdrawal symptoms that complicated the treatment effort. Her restlessness, anxiety and depressive symptoms increased, causing the medical personnel to be concerned (Hartney, 2019b).

The trained professional personnel at the detoxification program deemed the withdrawal symptoms dangerous and though it prudent to refer the patient to an intensive outpatient treatment program for additional monitoring. This caused the client to move back into the preparation stage where new treatment options were explored before moving back into the action stage with a new treatment plan being applied with a focus on minimizing the withdrawal symptoms, and addressing the issues that overwhelmed her (Hartney, 2019b) Counseling Essay.

Criteria that supports specific DSM 5 substance use diagnosis

DSM 5 identifies addictive behavior as substance use disorder, noting that the client qualifies for such a diagnosis since she uses alcohol and prescription Zanax in excessive amounts that cause her significant health and life issues to include having difficulties in meeting her home and work responsibilities. In fact, she is diagnosed with severe substance use disorder since she meets eight of the criteria for diagnosis within a 12-month period as presented in DSM 5. Firstly, she has used Zanax and alcohol in a hazardous manner when she was taking care of her children after the divorce thus placing them in a dangerous situation. Secondly, the alcohol and prescription medication use has caused her to experience social problems as she keeps away from social interactions and opts to be on her own. Third, the substance use has caused her to neglect major roles as she fails to meet home and work responsibilities owing to the substance use Counseling Essay. Fourthly, she experienced withdrawal symptoms when she stopped using alcohol and Zanax in the detoxification program. Fifthly, she had built up a tolerance causing her to require more of the substances to get the same effect. Sixthly, she uses larger amounts of the substance for longer periods of time. Seventhly, she spends a lot of her time using the two substances. Eighthly, she had developed psychological issues related to the use to include anxiety and depression (Hartney, 2019a; Sperry, 2016). As a result, the criteria presented in DSM 5 supports the client’s diagnosis as suffering from substance use disorder Counseling Essay.

In addition to the presented criteria, the client’s age of onset of substance use would also be considered since it has implications for the diagnosis. That is because it is significantly associated with psychological problems. To be more precise, the client began drinking alcohol at 21 years of age and Zanax at 24 years of age. This identifies her as a late onset substance user thereby reducing her risk for psychosocial problems in different life areas (when compared to early onset substance use) to include work adjustment, recreation/leisure, peer relationships, family system, psychiatric disorders, and behavior patterns (Poudel & Gautam, 2017).

Questions to ask for in-depth understanding before diagnosis conclusion

What are the patterns of the substances use? Should include longest periods of abstinence from the substances, duration of sobriety, and date of last substance use.

Have you had any legal consequences and/or complications from using the substances? Such as trafficking, selling, arrests and convictions.

Have you had any cravings? As manifested in desires, thoughts and dreams.

Do your parents, siblings, friends, ex-husband use the same substances? Probes for the types of substances use since this could be an important problem indicator Counseling Essay.

Have you had any interruptions in social (home) and professional (work) history from substance use? Explanation required.

What is your work/occupational history? Probes for source of finances linked to the substances use, such as stealing, skimming from family accounts, and participating in the commercial sex industry.

Do you have a citation/arrest history caused by substance use? Such as probation, incarceration, and legal infraction.

Conclusion

One must accept that psychotherapy offers an opportunity for understanding and intervening in psychiatric issues. In addition, one must acknowledge that substance use disorder is a generalized diagnostic term that characterizes the excessive and uncontrollable use of chemical substances to include prescription medication and alcohol. Besides that, it is clear that persons with substance use disorder go through different stages of change that include pre-contemplation, contemplation, preparation and action stages. Still, there is a need for DSM 5 criteria to be applied to ensure that the correct diagnosis is presented. Also, age should be considered as it has implications for associated psychological problems and eventual diagnosis. Additionally, leading questions should be asked to understand patterns of use, relevant family history, and professional and social effects as they have implications for the implications. These issues have been discussed in the present case to show the complexities of diagnosis substance use disorder Counseling Essay.

References

Hartney, E. (2019a).
The 11 official criteria for addiction/substance use disorder
. Retrieved from https://www.verywellmind.com/what-are-the-official-criteria-for-addiction-22493 Counseling Essay

Hartney, E. (2019b).
The stages of change model of overcoming addiction
. Retrieved from https://www.verywellmind.com/the-stages-of-change-model-of-overcoming-addiction-21961

Poudel, A. & Gautam, S. (2017). Age of onset of substance use and psychosocial problems among individuals with substance use disorders.
BMC Psychiatry
, 17, 10. Retrieved from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1191-0

Sperry, L. (2016).
Handbook of diagnosis and treatment of DSM-5 personality disorders:
assessment, case conceptualization, and treatment
(3
rd
ed.). New York, NY: Routledge Counseling Essay.

Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay

Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

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Students will:

• Analyze salient ethical issues in psychiatric mental health practice

• Compare ethical dilemmas with state health laws and regulations

• Analyze ethical decision-making processes

To prepare:

• Review literature for moral/ethical issues encountered by a PMHNP.

• Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

• Summarize the moral/ethical issue in the article (no more than 1 paragraph).

• Describe the moral and ethical dilemmas surrounding the issue Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

• Analyze the ethical issue and compare them to the state health laws and regulations in your state.

• Outline the process of ethical decision making you would use to address this ethical dilemma.

Note: Be sure to use the Practicum Journal Template, located in this week’s Learning Resources.

 

Summary of the Moral/Ethical Issue

Confidentiality is key to maintaining the therapeutic relationship that exists between patients and mental health practitioners. It is for this reason that as healthcare providers, they are required to value privacy and confidentiality as a patient’s basic right by not sharing a patient’s medical data to unauthorized persons or without a client’s consent. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay Except for legal situations, while the law considers confidentiality to be absolute, there are unavoidable yet ethical clinical scenarios where confidentiality may be breached. In mental health practice, confidentiality as an ethical principle is defined as only availing patient information to authorized persons with a patient’s informed consent.

The Ethical/Moral Dilemma Surrounding The Issue

The case scenario as presented by Jie (2015) involved a 57-year-old male patient who was diagnosed with aggressive end-stage prostate cancer. The shared with a nursing staff his attempt to commit suicide and requested the nursing staff not to share with other healthcare providers. This positioned the nursing staff in a difficult scenario where she had to decide between mutually exclusive options. The nursing staff had two morally upright choices to make: to remain silent as requested by the patient or to share the information with staff and prevent a suicide attempt. If she decides to remain silent as requested by the client, the patient’s decision will be respected. However, this decision may result to harm as the patient may commit suicide without any interventions. On the other hand, should the nursing staff share this information with other healthcare providers, through teamwork, the patient would be closely monitored to prevent suicide? However, his confidentiality and autonomy would be violated. The major ethical dilemma is if or not the nurse should share with colleague staff members on the client’s suicide attempt without his consent.

Ethical Issue In Comparison to State Health Laws And Regulations

The state health laws and regulations require all healthcare providers to focus on decisions and actions which benefit patients. This implies that healthcare professionals are only obligated to take positive actions which promote the wellbeing and health of patients. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay Despite being required to maintain confidentiality, there are specific exceptions which are considered ethical and acceptable to breach patient confidentiality by the law (Barnhorst, Wintemute & Betz, 2018). Most of these exceptions involve circumstances which can easily result in personal harm, harm to society or another person. The HIPAA law allows healthcare providers to disclose protected health information (PHI) when it can help to either reduce or prevent an immediate threat to themselves, a family member or anyone in the public. Similarly, the state law requires that confidentiality can be broken and mandatory reporting done in cases that involve self-harm or harm to the public to safeguard individuals (Barnhorst, Wintemute & Betz, 2018).  Therefore, based on state laws, the nursing staff had to do take steps that would promote and maintain the patient’s health. Mandatory reporting to the relevant authority or sharing with staff would be the best choice Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

Process of Ethical Decision Making To Address This Ethical Dilemma

Mental health practitioners have an ethical, legal and professional role of safeguarding patient privacy and confidentiality except for specific legal situations or when found incompetent by a judge. When comparing the two choices that the nurse staff had to make based on a nurse’s ethical-legal roles and the state laws, the choice to maintain confidentiality would be of no essence and the patient could have probably committed suicide (Hiriscau et al., 2014). This decision only benefits the patient and satisfies his desire to die. On the other hand, it could negatively impact healthcare staff and family members. However, the decision to share with third parties such as staff as required by law could promote avoidance and prevention. This could be of significance to the patient, his family and healthcare providers. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

References

Barnhorst, A., Wintemute, G., & Betz, M. E. (2018). How should physicians make decisions about mandatory reporting when a patient might become violent?. 
AMA journal of ethics
, 
20
(1), 29-35.

Elger, B. S., Handtke, V., & Wangmo, T. (2015). Informing patients about limits to confidentiality: a qualitative study in prisons. 
International journal of law and psychiatry
, 
41
, 50-57 Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

Hiriscau, I. E., Stingelin-Giles, N., Stadler, C., Schmeck, K., & Reiter-Theil, S. (2014). A right to confidentiality or a duty to disclose? Ethical guidance for conducting prevention research with children and adolescents. 
European child & adolescent psychiatry
, 
23
(6), 409-416.

Jie, L. (2015). The patient suicide attempt–An ethical dilemma case study. 
International Journal of Nursing Sciences
, 
2
(4), 408-413. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.