Leadership Theories Comparison Chart

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Leadership Theories Comparison Chart

(Leadership Theories Comparison Chart)

Leadership Theories Comparison Chart

Leadership Theory How Theory Supports Organizational Change
Transformational Leadership Theory:

The transformational leadership theory was established in the 1970s by James McGregor Burns. According to the transformational leadership theory, a leader’s vision can inspire a whole team to achieve feats they never imagined possible (Steinmann et al., 2018). As a result, the group members are more inclined to have faith in this visionary who so greatly motivates them. It is frequently applied to staff motivation and general leadership style assessment. Because these leaders are skilled at resolving conflicts, they encourage and drive their teams to find better ways to accomplish a goal (Steinmann et al., 2018). They can organize people into productive groups, improving the group’s well-being, morale, and motivation using strong rapport. Key elements of transformational leadership include individualized consideration, intellectual stimulation, inspirational motivation, and idealized influence. (Leadership Theories Comparison Chart)

 

 More people must act as transformational leaders for organizations to adapt successfully to change. Successful transformational leaders can alter a company’s culture and create a system-wide synchronization of its strategy to respond to external pressures. Transformational leadership affects both social systems and individual behavior during organizational change (Steinmann et al., 2018). In its optimal state, it brings about significant and constructive change in the employees with the ultimate objective of transforming them into leaders. When practiced in its purest form, transformational leadership improves people’s motivation, morale, and output via several processes like encouraging employees to take increased responsibility for their work, challenging them to do so, and recognizing and understanding the strengths and weaknesses of employees so the leader can assign them to tasks that maximize their performance, and linking an individual’s sense of identity and self to the organization’s mission and shared identity (Steinmann et al., 2018). Conclusively, transformational leaders allow employees to own and identify with the change and actually be leaders in the change process.      (Leadership Theories Comparison Chart)
Transactional Leadership Theory:

This leadership theory examines how leaders deal with their staff members. Transactional leaders want their subordinates to abide by their rules. In contrast, the expectations of transformational leaders are higher than those of ordinary leaders. As a result, this concept is frequently applied to people who have little expertise in leadership and who require step-by-step guidance on how to carry out responsibilities efficiently (Richards, 2020).

The premise of the transactional leadership theory is that managers should provide people with what they desire in exchange for cooperation. It asserts that employees need structure, guidance, and supervision to execute jobs correctly and on time because they lack self-motivation (Richards, 2020). After World War II, the transactional leadership style became quite popular in the US. A high level of organization was needed to sustain national stability during this period of government focus on reconstruction. Contingent reward, which entails the establishment of expectations and rewarding employees for achieving them; passive management by exception, in which a leader does not intrude with workflow until a problem occurs; and active management by exception, where leaders foresee issues, track progress, and provide remedial action, are some of the facets of transactional leadership (Richards, 2020). (Leadership Theories Comparison Chart)

 Transactional leaders operate in line with specified operating procedures. They are more focused on maintaining continuity in day-to-day operations, ensuring everything runs smoothly by putting systems and processes in place and concentrating on achieving goals (Richards, 2020). Such leaders can impose punitive measures, create a systematic framework, specify a course of action, develop and carry out policies, and encourage exceptional performance through rewards and incentives. A transactional leader is more interested in ensuring that the planned activities are accomplished on time and to the highest standard than. However, transactional leaders lack a futuristic vision or tactics for gaining market leadership. With this understanding, transactional leaders are more suited to developing and influencing short-term changes or changes in the daily procedures and processes to make task completion more efficient and successful (Richards, 2020). (Leadership Theories Comparison Chart)
Servant Leadership Theory:

According to the philosophy of servant leadership, a leader should set their own needs aside to support others’ development and growth (Allen et al., 2018). It is what they meant when they said, “It is not about me; it is about the patient,” at any time. Putting patients first is the key goal in this theory in healthcare, which is a commendable trait for any leader. Servant leadership suggests that a leader genuinely cares about giving each team member the support and resources they require to be successful. Servant leadership can be incredibly helpful when managing a diversified, varied team. Regardless of the positions, skills, or resource needs of any team member, servant leaders are exceptional at satisfying individual team members’ needs. Servant leadership adopts a holistic approach and wider emphasis on affecting other people and team-level performance like change ownership behavior, job performance, job satisfaction, and organizational commitment and loyalty compared to other theories, which makes it the most promising and explored concept recently (Allen et al., 2018). (Leadership Theories Comparison Chart)

 Servant leaders are considered change agents in organizations, empowering employees to take more responsibility toward organizational change. Servant leaders share visions with employees and lead from behind, supporting individual development in the organization to take more ownership in the change implementation. Servant leaders are also more effective in influencing people and convincing people of the need for change because they instill trust in employees, who, in turn, invest more commitment and energy toward organizational change and achieving desired goals and results (Zhou et al., 2022).

According to Warren Bennis, organization development is a sophisticated approach designed to alter organizations’ attitudes, values, and organizational structure to improve their capacity to respond to emerging markets, technologies, and problems. The leader must therefore be aware of the pulse of their workforce in light of the rapidly and always changing environment and aid in transforming their organizations into vital and successful entities through change initiation and adoption (Allen et al., 2018). A leader who genuinely wants to comprehend others will only be able to determine what direction the organization and individual employees have to move to accomplish desired goals. The demand for servant leaders whose decision-making is comprehensive and who support organizations in thriving has never been greater than it is today. (Leadership Theories Comparison Chart)

References

Allen, G. P., Moore, W. M., Moser, L. R., Neill, K. K., Sambamoorthi, U., & Bell, H. S. (2018). The Role of Servant Leadership and Transformational Leadership in Academic Pharmacy. American journal of pharmaceutical education, 80(7), 113. https://doi.org/10.5688/ajpe807113

Richards A. (2020). Exploring the benefits and limitations of transactional leadership in healthcare. Nursing standard (Royal College of Nursing (Great Britain) : 1987), 35(12), 46–50. https://doi.org/10.7748/ns.2020.e11593

Steinmann, B., Klug, H. J. P., & Maier, G. W. (2018). The Path Is the Goal: How Transformational Leaders Enhance Followers’ Job Attitudes and Proactive Behavior. Frontiers in psychology, 9, 2338. https://doi.org/10.3389/fpsyg.2018.02338

Zhou, G., Gul, R., & Tufail, M. (2022). Does Servant Leadership Stimulate Work Engagement? The Moderating Role of Trust in the Leader. Frontiers in psychology, 13, 925732. https://doi.org/10.3389/fpsyg.2022.925732

 
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NSG 301 Thesis Worksheet

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NSG 301 Thesis Worksheet

(NSG 301 Thesis Worksheet)

Name:

Instructions: Please write your answers directly into this document and do not delete the questions or instructions. I have highlighted wherever a response is required. You may wish to use a different font, text color, or boldface to make your answers more visible, although it’s not required. When completed, “Save as” and add your last name to the file name. (NSG 301 Thesis Worksheet)

 

GATHERING THE PIECES

 

Go back to your Problem Statement Worksheet in LM3. Copy and paste the problem statement (the answer to L, the last question on that worksheet) here.

 

Problem Statement: Poor health-promoting self-care behavior impacts nurses’ health and well-being, contributing to overweight and obesity and mental health issues. (NSG 301 Thesis Worksheet)

NSG 301 Thesis Worksheet

 

I still stand by this statement that “Poor health-promoting self-care behavior impacts nurses health and well-being, contributing to overweight and obesity and mental health issues.” I have searched multiple databases and organizational publications such as the CDC, ANA, and other healthcare organization that offer statistical evidence and found concrete and valid evidence supporting the claim. However, most sources are also addressing root causes, and therefore, I decided to adjust the problem statement to include some of the identified root causes contributing to medication errors. The new statement reads, “Work related factors, including work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime lead to poor health-promoting self-care behavior that impacts nurses health and well-being, contributing to overweight and obesity and mental health issues.” (NSG 301 Thesis Worksheet)

 

Now that you’ve done some research, do you still stand behind this statement? Did you find evidence to support the claim? If not, make a new supportable claim about the same problem below. (If you changed topics since the Problem Statement Worksheet, give your new problem statement below.) Remember, short and simple is best!

For example, I made the claim “Excessive wait times in the ED increase the likelihood that patients will become violent.” Let’s assume that I didn’t find any solid evidence of a causal relationship between wait times and patient violence in the ED, but I did find statistics showing that violence occurs more often in the EDs than any other healthcare setting. I see two possibilities for revision of this claim: 1. I could simplify the claim to remove the cause (e.g., “Violence is more common in the ED than in other healthcare settings.”), or 2. I could claim that wait times in the ED have some other bad effects worth avoiding (e.g., “Excessive wait times in the ED lower patient satisfaction.”), depending on what I discovered in my research and whether I am more interested in pursuing solutions that reduce violence or ones that reduce wait times. (NSG 301 Thesis Worksheet)

 

Revised Problem Statement (if needed): Work related factors, including work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime lead to poor health-promoting self-care behavior that impacts nurses health and well-being, contributing to overweight and obesity and mental health issues.

 

 

Now let’s think about outcomes and solutions. Your Summary Table and any other research you’ve done will help you to complete these lists. Any intervention studies you’ve read will include specific actions taken (interventions) and results that were measured (outcomes) so list those! You shouldn’t need to make any of these up from scratch. (NSG 301 Thesis Worksheet)

 

Examples of MEASURABLE outcomes
Increased satisfaction scores (Be specific: nurse job satisfaction, patient satisfaction, family satisfaction, provider satisfaction, etc. Each of these must be measured independently of the others and so are separate outcomes.)
Conserve a finite resource (Be specific: money, time, vehicle mileage, PPE, etc. Each of these must be measured independently of the others and so are separate outcomes.)
Reduced rates of something bad (such as falls, infections, sentinel events, mortality rates, etc. Each would need to be listed separately.)
Increased rates of something good (such as compliance with a policy, medication compliance, compassion satisfaction, etc. Each would need to be listed separately.)
Some outcomes are related! For exact opposites (e.g., decreased mortality and increased survival) use one, not both. Be careful with closely related outcomes, especially decreased turnover, increased retention, reduced intention to leave, reduced burnout, increased compassion satisfaction, reduced compassion fatigue! These are all related but NOT interchangeable! (Be specific. If more than one applies, list each separately.)
Too vague! Don’t use!
Improved outcomes
Happier nurses (or patients or whoever); Better experience
Address the problem

 

 

Examples of interventions
Training in a specific skill (manager training in X leadership style, online course for nurses on X, interdisciplinary workshop of X skill, etc. Be specific! You may include more than one specific training, but list them separately.)
A particular process change (moving handoff report to bedside, using a new cleanser for catheter insertion sites, add a particular checklist to the EMR, a specific kind of rounding, etc. Be specific! You may include more than one specific process change, but list them separately.)
A specific change to policy (new open bed alert system, longevity incentive pay, maximum patient:nurse ratios, etc.)
Any concrete, recommended action (purchase a new kind of monitor system, enforce an existing policy, hire for a particular role, install massage chairs in the break room, etc.)
Too vague! Don’t use!
Implement solutions
Address the problem
Improve X (Anything you want to improve, increase, or decrease is probably an outcome, not an action.)

 

For the two lists below, come up with at least 1 answer for each list. You should have at least 3 answers in ONE of the lists.

 

List positive MEASURABLE outcomes you would like to achieve in order to mitigate the problem: (There are many ways to measure outcomes. For instance, you might measure “reduced stress” through a pre-/post-intervention survey or by taking subjects’ BP and pulse. For this list, indicate outcomes which are possible to measure, not the methods of measurement.) Put only one outcome on each line. You may add as many lines as you need to.

 

  1. Improved nurses’ health and well-being.
  2. Reduced work-related factors contributing to poor health-promoting self-care behavior.
  3. Improved healthcare quality, patient safety, and patient outcomes.

 

List some of the interventions that have been studied as potential solutions to your problem: Keep in mind that an intervention is a specific solution action, not just a reversal of the problem. Think of each action as a command that someone has to carry out. “Go enforce nurse autonomy!” would be far too open-ended, but “Train providers to respect the scope of nursing practice!” conveys what should be done. Put only one solution action/intervention on each line. You may add as many lines as you need to.

 

  1. Improve the working environment to be more engaging and coordinated, less stressful, and have manageable workloads: (nurse leaders and nurse staff) A, B, C.
  2. Adopt self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth to minimize adverse effects of poor health promoting behavior. (nurses). A, C.
  3. Provide stress management workshops and self-care education sessions during lunch and off-work periods (Hospital administration, nurses, and nurse leaders) A, C.

 

Look at each of your interventions and decide WHO would have the power to make that change happen. Some changes nurses can make themselves, such as adopting bedside handoff or meditating to relieve stress. Other changes require management to get involved, such as adopting or enforcing a bedside handoff policy or bringing in a meditation instructor to offer training. Some changes can only be done by hospital or system administrators, such as adopting a patient:nurse ratio policy or adding incentive pay. In the INTERVENTION list above, next to each intervention, write the appropriate audience in parentheses. If more than one could apply, feel free to indicate that. Ultimately, you will pick just ONE audience capable of the entire proposal, whether it has just one recommended action or three. (NSG 301 Thesis Worksheet)

 

Match up each intervention with the measurable outcomes associated with it, as shown in the literature. You’ve got a list of interventions with a number assigned to each. You’ve got a list of outcomes with a letter assigned to each. In the list of interventions, after the audience, write the letters for ALL the outcomes that come from doing that action.

For example, if my outcome list looks like this:

  1. New nurse retention
  2. New nurse competency
  3. New nurse satisfaction

My intervention list might look like this, once completed:

  1. Nurse residency program (management) A, B, C
  2. Mentorship (management) A, C
  3. Civility training for all staff (management) C

This indicates that I found correlations in the literature between NRPs and all 3 outcomes, between mentorship and both retention and satisfaction of new nurses, and between staff civility training and new nurse satisfaction.

(NSG 301 Thesis Worksheet)

 

 

For this paper, you want to have a 3-part thesis. You may choose 3 interventions which all have the same outcome OR 1 intervention that has 3 distinct outcomes. Which you choose depends on your research; pick the option that lets you use the best of the studies you already have. It’s also OK if you discover that you’ll need to do more research to connect all the pieces you want to include. Pay attention to the audiences you have for each intervention! You should write for only one audience

In my example, there are 2 obvious choices: I could choose 1 intervention (NRP) and 3 outcomes (retention, competency, and satisfaction), or I could choose to write about all 3 interventions, but focus only on how each of them increases the same shared outcome (satisfaction). But I do have other options! Maybe I’m really passionate about retention, and I’d rather write about 3 interventions (NRPs, mentorship, and another TBD by further research) focused on that 1 outcome (retention).

 

Write your choices below. Keep in mind that if you have 3 interventions, you must have only 1 outcome; if you have only 1 intervention, you must have 3 outcomes. You may use up to 1 “placeholder” (such as TBD) that indicates a need to do more research. (NSG 301 Thesis Worksheet)

 

My audience: Nurses

My intervention(s):

  1. Improve the working environment to be more engaging and coordinated, less stressful, and have manageable workloads.
  2. Adopt self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth to minimize adverse effects of poor health promoting behavior.
  3. Provide stress management workshops and self-care education sessions during lunch and off-work periods.

My outcomes(s): Improved nurses’ health and well-being.

 

WRITE YOUR DRAFT/WORKING THESIS STATEMENT

Use one of the templates below to draft your working thesis statement. (“Working” just means that it may still change.) Make sure your thesis statement is a single sentence and grammatically correct. You might need to add some verbs to your interventions (create, implement, enforce, adopt) and outcomes (increase, decrease, improve). Use punctuation, check your spelling, proofread.

 

3 Actions, 1 Outcome:

Since    [Problem Statement]   ,    [audience]    should    [1st intervention], [2nd intervention], and [3rd intervention]   , in order to    [1 positive outcome]   .

 

OR

 

1 Action, 3 Outcomes:

Since    [Problem Statement]   ,    [audience]    should    [1 intervention]    in order to    [1st positive outcome], [2nd positive outcome], and [3rd positive outcome]   .

 

My working thesis statement:

Since work-related factors, including work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime lead to poor health-promoting self-care behavior that impacts nurses health and well-being, contributing to overweight, obesity, and mental health issues, nurses should improve the working environment to be more engaging and coordinated, less stressful, and have manageable workloads, adopt self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth, and provide stress management workshops and self-care education sessions during lunch and off-work periods to improve nurses’ health and well-being. (NSG 301 Thesis Worksheet)

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9761038/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832775/

https://pubmed.ncbi.nlm.nih.gov/2665107/

 
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Benchmark – Human Experience Across the Health-Illness Continuum

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Benchmark – Human Experience Across the Health-Illness Continuum

 (Benchmark – Human Experience Across the Health-Illness Continuum)

Benchmark - Human Experience Across the Health-Illness Continuum

Introduction

An individual’s health state changes continually across the various stages of the health-illness continuum. Individuals move back and forth between illness and health, and it is rare to find an individual in a constant state of either illness or health. The health-illness continuum depicts this process of continual change, in which people experience different states of health and illness, extending from extremely good health to death. Individuals are expected to adapt to the changes in health and learn from states of illness to maintain good health and well-being. Noticeably, people’s adaptation to the changes rather than the change in the state itself impacts their health. A state of wellness is a successful adaptation and effective functioning, even for those experiencing chronic diseases. (Benchmark – Human Experience Across the Health-Illness Continuum)

The Health-Illness Continuum

Nurses adopt the health or illness-wellness continuum to educate patients, demonstrating associations between treatment and wellness elements. The continuum illustrates the path or approaches to a better, healthier life. By incorporating mental and emotional health, this tool shows that well-being is more than merely an absence of a disease or illness. The associations between treatment and wellness paradigms meet at a neutral point on the health-illness continuum diagram (Kishan, 2020). The far left of the diagram represents pre-mature death, and as a person moves from the left, they come to a neutral point, leaving the treatment process and moving into wellness, where high-level wellness is at the far right. This perspective is a fundamental consideration when caring for patients because it allows providers to elaborate on their journey to better health and educate on what should be done to create and maintain a healthy lifestyle and achieve optimal health (Lothes II, 2020). The continuum stresses the need for providers to educate and help patients move further to the left toward high-level wellness.  (Benchmark – Human Experience Across the Health-Illness Continuum)

Benchmark - Human Experience Across the Health-Illness Continuum

The Health-Illness Continuum’s Consistence with the Christian Worldview

In most instances, the typical health system ends at the neutral point, where patients have completed the treatment process and are discharged or achieved a healthy state. However, according to the health-illness continuum, the neutral point is not the endpoint, and healthcare providers should strive to increase awareness, educate patients, and encourage growth toward high-level wellness or optimal health (Wickramarathne et al., 2020). Helping people live a better, healthier life and achieve optimal health income promotes their value and dignity because, according to the Christian Worldview, healthcare providers are caring elements that should demonstrate love and compassion (Ramírez Jiménez & Serra Desfilis, 2020). Offering healthcare reflects the love of God, and adopting the health-illness continuum facilitates efforts to alleviate human suffering, cure disease, grow knowledge through patient education, and extend care beyond illness states. This continuum encourages providers to help patients achieve positive changes in their lifestyle to move to the right of the continuum and live better, healthier lives. (Benchmark – Human Experience Across the Health-Illness Continuum)

Reflection

My overall health is good as I aspire and strive to achieve high-level wellness and live a healthier life. I understand that maintaining optimal health is a personal responsibility, and I fulfill this responsibility by maintaining a healthy diet, engaging in regular physical activity, getting physical examinations regularly, avoiding substance abuse, tobacco, and heavy alcohol consumption, monitoring my body mass index, blood pressure, cholesterol level, and blood glucose level. However, I have not achieved high-level wellness, implying that I need to improve and change some behavior that detracts me from health and well-being, including excessive social media consumption, slacking on sleep, and engaging in negative thinking patterns. Generally, my physical health is good, but I need to improve my mental health to achieve high-level wellness. I fall in the growth state on the health-illness continuum, moving towards high-level wellness. (Benchmark – Human Experience Across the Health-Illness Continuum)

Options and Resources to help achieve High-level Wellness

The greatest resource available to help me move towards wellness includes my nursing knowledge. I have an in-depth understanding of health and well-being, factors affecting health and well-being, behaviors, tools, and options to achieve high-level wellness. Besides sharing this knowledge with patients, I also incorporate it in promoting my health and well-being. Other resources include colleagues at the workplace and family and friends. I can inquire about my health and well-being from my colleagues, who also have comprehensive knowledge about the body and how to achieve optimal health. Friends and family offer social and emotional support on this path to achieving high-level wellness, and I trust them to offer help when I need it. I also have facilities like the community gym, grocery stores selling organic food, my therapist helping with mental health, and infrastructures like bicycle pathways and running trucks to help achieve the optimal physical activity. (Benchmark – Human Experience Across the Health-Illness Continuum)

Conclusion

The health-illness continuum is a graphical tool suitable for healthcare practice, particularly patient education, indicating where an individual is across the various states of health and illness. Individuals can also adopt the tool to guide their path toward better, healthier lives. It offers insights into what point of health or illness an individual is in and prompts decisions regarding behavioral changes to achieve optimal health outcomes. Resources and options to promote wellness are multiple, from our knowledge, people around us, evidence-based publications on the internet, infrastructure like gyms and public parks, and the availability of grocery stores that sell healthy, organic foods. (Benchmark – Human Experience Across the Health-Illness Continuum)

References

Kishan P. (2020). Yoga and Spirituality in Mental Health: Illness to Wellness. Indian journal of psychological medicine, 42(5), 411–420. https://doi.org/10.1177/0253717620946995

Lothes II, J. (2020). Teaching wellness in a college physical education course: Pre/post outcomes over the semester. Building Healthy Academic Communities Journal, 4(1), 28-47.

Ramírez Jiménez, M. S., & Serra Desfilis, E. (2020). Does Christian Spirituality Enhance Psychological Interventions on Forgiveness, Gratitude, and the Meaning of Life? A Quasi-Experimental Intervention with the Elderly and Youth. Nursing reports (Pavia, Italy), 10(2), 182–206. https://doi.org/10.3390/nursrep10020022

Wickramarathne, P. C., Phuoc, J. C., & Albattat, A. R. S. (2020). A review of Wellness Dimension models: For the advancement of the Society. European Journal of Social Sciences Studies.

 
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Week 6 Final DNP Project Manuscript

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Week 6 Final DNP Project Manuscript

(Week 6 Final DNP Project Manuscript)

Methodology

This section describes organizational setting, project population translation science model and project management, plans for sustainability, and anticipated outcomes.

Week 6 Final DNP Project Manuscript

Organizational Setting

The healthcare setting is a general mental health facility for treating various mental health disorders. The organization adopts mental health teams based in communities, especially for schizophrenia patients, that offer daily support and treatment while helping schizophrenia patients gain as much independence as possible. Mental health teams based in communities are more suitable for the patient population because most schizophrenia patients live with their families. The teams include nurses, therapists, psychiatrists, psychologists, and social workers. The healthcare organization is located in Los Angeles, California. The healthcare organization is located in Los Angeles, California.

The study focuses on schizophrenia patients with schizophrenia as the primary diagnosis. Schizophrenia is associated with significant thinking or cognitive, behavioral, and emotional problems. Individuals between the ages of 16 and 25 years are the most vulnerable, although new schizophrenia cases begin increasing in their teenage years. Most patients present with hallucinations, delusions, and confused or disturbed thoughts that impact behavior and social and occupational functioning. About 150-230 schizophrenia patients are seen each month either at the facility or in their respective homes by the mental health teams based in the communities. On average, a hospitalized schizophrenia patient can stay in the hospital for days, ranging between 11 days to 23 days, depending on the condition and symptoms severity. A full-team approach is adopted in addressing schizophrenia at the healthcare organization. A combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome. The psychiatrist experienced or specialized in treating schizophrenia guides disease treatment and management, supported by other members of the treatment team that help coordinate care. (Week 6 Final DNP Project Manuscript)

Population

The project population typically includes schizophrenia patients experiencing thinking or cognitive, behavioral, and emotional problems. The patient population consists of both men and women reporting at the facility or requesting home visits from the mental health team based in the communities. The study will include 50 consecutive schizophrenia patients following up with treatment at the facility or home. The inclusion criteria required patients diagnosed with schizophrenia according to the International Statistical Classification of Diseases-10 criteria, patients aged between 18 and 65 years, patients receiving treatment for the last 6 months, follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapse after nonadherence to treatment. The exclusion criteria include acutely psychotic patients during the interview and patients with cognitive deficits impacting the interview or data collection. Existing users of health services at the facility will be requested to participate in the study. Informed consent will be required to collect data on the participants. Any follow-up schizophrenia patient attending psychiatric evaluation in the inpatient or outpatient departments will be recruited for the study after consent. The first 50 consecutive schizophrenia patients that fit the inclusion criteria will be involved in the study. Participation requests and details of the study will first be communicated via text messages, which are suitable even for older patients. (Week 6 Final DNP Project Manuscript)

Translational Science Model and Project Management Plan

The Iowa model of evidence-based practice will help implement motivational interviewing to enhance medication adherence among schizophrenia patients. It supports evidence-based practice implementation, research utilization, and knowledge transformation processes (Duff et al., 2020). The Iowa model offers a systematic approach to synthesizing knowledge and research findings transformation to enhance patient outcomes and quality of care. The primary purpose of this model is to increase research findings’ meaningfulness and utility in clinical decision-making (Iowa Model Collaborative et al., 2017). The Iowa model is an application-oriented EBP process guide with the following primary steps:

  1. Identifying either a knowledge-focused or problem-focused trigger that warrants EBP adoption.
  2. Determining if the identifying problem is a priority for the institution, practice, department, or clinical setting (Cabarrus College of Health Sciences, 2023).
  3. Establishing a team to develop, examine, and implement the required EBP change. This must be representative and interdisciplinary to evaluate and adopt the EBP change better.
  4. Gathering and analyzing evidence related to the identified change, including developing the research question and performing a literature search using identified keywords.
  5. Critiquing and synthesizing the collected research evidence to determine whether the EBP change is scientifically supported, sound, and clinically significant.
  6. Assessing whether the evidence is sufficient to implement the EBP change.
  7. Implementing the EBP change into a pilot program rather than a full practice change, for instance, implementing the change in a single nursing unit rather than the entire organization.
  8. Evaluating outcomes or results to determine whether the change achieves its objectives, is feasible, and if it is appropriate to adopt it within the organization. Implementation results’ observation, evaluation, and analysis should continue even after full-practice implementation (Cabarrus College of Health Sciences, 2023).

Per the Iowa model, the DNP practice project development and implementation includes the following steps:

  1. I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
  2. Medication non-adherence is a priority for the organization as it is linked with increased treatment failure, hospitalization, readmission, and mortality rates. Addressing this problem would improve hospital and patient health outcomes.
  3. I developed a team comprised of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers to develop, examine, and implement motivational interviewing to address medication non-adherence among schizophrenia patients.
  4. I developed a practice question “For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication nonadherence (O) in 8-10 weeks (T)?” to guide literature search and the DNP project. I searched for peer-reviewed articles from various databases, including PubMed, MEDLINE, and CINAHL, addressing the impact of motivational interviewing on medication adherence.
  5. I reviewed the articles based on their abstract, research purpose, methodology, research findings, evidence level and quality and presented results of 10 articles on the evidence synthesis summary tool/table. Based on the evidence, motivational interviewing is scientifically supported, sound, and clinically significant.
  6. Ten articles were identified as providing the best evidence to help answer the research question. Based on the assessment, the evidence is sufficient to guide and inform the implementation of motivational interviewing at the healthcare facility.
  7. The project team and I will implement motivation interviewing into a pilot program that include follow-up schizophrenia patients only.
  8. The team and I will evaluate the implementation results to determine the impact of motivational interviewing on medication adherence among schizophrenia patients. Clinically significant results will warrant the implementation of motivational interviewing organization-wide. (Week 6 Final DNP Project Manuscript)

Project Management Plan

The DNP project implementation will take 12 weeks to complete. Week 1 will involve identifying participants and collecting pre-implementation data. In week 2, steps 1, 2, and 3 will be completed, which include problem identification, determination of priority, and team development. In week 3, steps 4, 5, and 5, involving evidence gathering and analysis, research articles critiquing and synthesis, and evidence assessment for adequacy will be completed. The implementation of motivational interviewing will begin in week 4 and through weeks 5, 6, 7, 8, 9, 10, and 11. In week 12, post-summative data after intervention implementation will be collected and outcomes evaluated, which is step 8 of the project implementation plan, to determine the effectiveness of motivational interviewing in addressing medication adherence among schizophrenia patients and whether it is suitable to implement in the rest of the organization and patient populations. (Week 6 Final DNP Project Manuscript)

Table 1: Implementation Plan

Week Activity
Week 1 Pre-implementation data collection.
Week 2 Step 1: Problem identification

Step 2: Determining whether the problem is priority to the organization

Step 3: Team development
Week 3 Step 3: Evidence gathering and analysis

Step 4: Research articles critique and synthesis

Step 5: Evidence assessment for adequacy
Week 4 Step 7: Intervention implementation
Week 5 Step 7: Intervention implementation
Week 6 Step 7: Intervention implementation
Week 7 Step 7: Intervention implementation
Week 8 Step 7: Intervention implementation
Week 9 Step 7: Intervention implementation
Week 10 Step 7: Intervention implementation
Week 11 Step 7: Intervention implementation
Week 12 Post-summative data collection

Step 8: Outcome evaluation

Formative Evaluation Plan

The formative evaluation will include individual evaluation conducted before, during, and after intervention implementation aiming to improve project development and implementation design and performance and ensure activities are completed effectively and efficiently. This formative evaluation will help understand why and how the project works and other factors at work during project development and implementation. This evaluation plan will increase the likelihood of attaining successful results or outcomes through continuous improvements informed by evaluation results at different project implementation steps. (Week 6 Final DNP Project Manuscript)

Table 2: Formative Evaluation Plan

Week When Why How (Oversight)
Week 1 Pre-project implementation ·         Understand the need for the project ·         Leadership meetings
Week 2 Project development ·         Clarify the need for the project ·         Problem tree analysis

·         Priority Matrix

·         Stakeholder analysis
Week 3 Project development ·         Clarify the need for the problem

·         Identify problem impact

·         Clarify intervention selected

 ·         Literature review

·         Solution tree analysis
Week 4 Project implementation ·         Develop project design before roll-out ·         Focus group

·         Discussions
Week 5 Project implementation ·         Improve project design as it is rolled out ·         Semi-structured interview

·         ORID

·         Project diary
Week 6 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 7 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 8 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 9 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles
Week 10 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and meetings
Week 11 Project implementation ·         Ensure project implementation activities are delivered efficiently and effectively. ·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

·         Huddles and discussions
Week 12 Post-project implementation ·         Ensure project is completed successfully. ·         Leadership meetings

·         Project team discussions

·         Schedule tracking

·         Budget tracking

·         Observation

·         Dartboard

·         Questionnaire

 

Plans for Sustainability

The sustainability objective is to ensure motivational interviewing is adopted organization-wide and the organization continues to enjoy its benefits in improving medication adherence over time. The sustainability plan will ensure the sustainability objective is achieved. Continuous quality and performance improvement is a post-implementation objective to help ensure the project’s sustainability. First, critical success factors will be developed, including medication adherence measures that will help assess the continued effectiveness of the intervention. Critical success factors include a substantial decrease in treatment failure, hospitalization, readmission, and mortality rates among schizophrenia patients. Consistent improvement of medication adherence and persistent behavior, including patient motivation, self-efficacy, and change and sustain talk, are critical success factors that will also help determine sustainability.

Data collection, observation, and analysis will allow the organization to measure the continual effectiveness of the intervention. Patient records and the organization’s medical data will provide information regarding treatment failure, hospitalization, readmission, and mortality rates over time. Self-reported surveys and interviews will help gather qualitative data to determine changes in medication adherence behavior over time. Project auditing and feedback collection from various stakeholders will also offer insights into the performance of the intervention after implementation and over time. The team selected for patients’ health management and outcome, patients, leaders, and observers will offer feedback regarding the project to help with continuous improvement. Opinion leaders’ involvement and evaluation will help improve the intervention and ensure sustainability. Opinion leaders include external and internal experts, educators, and organizations that advocate for the project; their insights will be critical. The data from these data and insight sources will inform sustainability strategies for continuous quality improvement. Additionally, continuous quality and performance improvement and suitability over time will be achieved through continuous patient and provider education on motivational interviewing and medication management and summative evaluation of education outcomes. Ongoing provider and patient education will help ensure the sustainability of project benefits over time. (Week 6 Final DNP Project Manuscript)

Anticipated Outcomes

Relationship between Motivational Interviewing and Medication Adherence

The primary purpose of motivational interviewing is to enhance medication adherence among schizophrenia patients. Motivation interviewing and medication adherence have a direct relationship, which involves one value directly affecting another, such as variables increasing and decreasing together. In this case, motivational interviewing has no values that increase or decrease, and the presence or absence of it will be analyzed in this paper. Data will be collected for medication adherence measures, which include treatment failure rate, readmission rates, hospitalization rates, and mortality rates, before implementing motivational interviewing and after the implementation. The expectation is a direct causal relationship such that when motivational interviewing is implemented, medication adherence behavior, which will be measured using the indicated medication adherence measures. This direct causal relationship is described as “the implementation of motivational interviewing improved medication adherence” or “motivational interviewing was positively associated with medication adherence.” (Week 6 Final DNP Project Manuscript)

Expected Change after Implementing Motivational Interviewing

Implementing motivational interviewing is expected to improve medication adherence behavior, which is indicated by measures including treatment failure rate, readmission rates, hospitalization rates, and mortality rates. The desired changes based on these measures include decreased treatment failure rate, reduced readmission rate, decreased hospitalization rates, and decreased mortality rate associated with schizophrenia. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. According to Papus et al. (2022), MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. Additionally, Zomahoun (2018) established that MI interventions might help improve medication adherence for chronic conditions in adults. The evidence indicates a positive relationship between motivational interviewing and medication adherence, although measures used vary for the different studies. (Week 6 Final DNP Project Manuscript)

References

https://www.ncbi.nlm.nih.gov/books/NBK20369/#:~:text=There%20are%20many%20different%20mental,or%20behaviors%20in%20distinct%20ways.

 
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Literature Review

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Literature Review

(Literature Review)

Introduction

Falls are common in older adults, leading to serious injuries, including fractures and head injuries, and death in worst-case scenarios. Falls are also associated with disability and significant morbidity and mortality among older adults. Old age leads to overall poor physical and mental or cognitive status, which makes older adults prone to falls that cause physical injury and, in some instances, fear and psychological trauma. Statistically, a third of older adults experience at least one fall annually, while 10% fall multiple times yearly (Lloyd, 2021). Medical conditions increase the risk of falls, jeopardizing an older adult’s independence, and associated socioeconomic and personal consequences. Falls can occur at home or in any healthcare setting, including nursing homes. Hospitals are responsible for adopting interventions to minimize or prevent falls in older adults. Many interventions are adopted to prevent falls, including improving the environment and the terrain to make walking easy, providing non-slippery footwear, patient education, adequate lighting, installing handrails in hallways and bathrooms, and raising the bed to a comfortable height. This paper focuses on the role fall prevention interventions in reducing the risk factors of falls and associated effects among older adults. The primary themes addressed are; effects of falls on older adults, risk factors most frequently associated with falls in elderly patients, and impact of fall prevention programs on number of falls experienced by elderly patients. (Literature Review)

Literature Review

PICOT Question

Among older patients, do fall prevention interventions reduce the risk factors of falls and associated effects compared with no intervention? (Literature Review)

 

Primary Themes

Effects of Falls on Older Adults

Falls among older adults are one of the most prevalent and dangerous issues causing disabilities, physical injury, and cognitive impairment. Falls are directly correlated with mortality, morbidity, and decreased functionality. Falls are widespread among the elderly, kids, and athletes. Studies have indicated that a higher tendency to fall and, thus, a higher risk of injury is connected with medical comorbidities in the elderly (Appeadu & Bordoni, 2022). Falls are also linked to socioeconomic and personal effects, including direct and indirect healthcare costs such as paying for fall-related injury treatment and financial loss from the patient’s or the caregiver’s work absence to attend to the injury or impaired functionality. According to Appeadu and Bordoni (2022), the US incurs over $31 billion, which could rise to 74 billion by 2030, associated with falls among older adults 65 years and over. Conclusively, falls impact the patient and the healthcare system in multiple ways, including increasing healthcare costs, contributing to medical conditions, financial loss, and impaired functionality. Therefore, it is critical to prevent falls and reduce the risk of falls for hospitalized patients to promote their quality of care.

Falls lead to different injuries, including minor and major fractures and head injuries. Approximately 30%-50% are minor, 10% major injuries, and 1% hip fractures, with the last one increasing post-fall morbidity and mortality risk. Approximately 20% lead to serious injuries, including fractures in other body parts or head injuries. Studies have shown that, annually, fall-related injuries lead to over 800,000 hospitalizations, with 300,000 requiring hip fracture treatment (Vaishya & Vaish, 2020). Falls are estimated to be the leading cause of traumatic brain injury and associated deaths among older people aged 65 years and above. Repeated falls increase the risk of severe injury, hospitalization, and death because of frail body structures (Vaishya & Vaish, 2020). About half of the falls lead to an injury, with major ones including head injuries and fractures. Frailty rather than age determines the severity of an injury and associated consequences. In conclusion, falls cause different types of injuries that can lead to morbidity, disability, loss of function, and mortality among older adults. Therefore, preventing falls and their associated injuries is critical to promote patient safety and experience during their hospital stay. (Literature Review)

Literature Review

Risk Factors Most Frequently Associated with Falls in Older Patients

Inpatient falls, and fall-related injuries can be caused by various factors, including physical or cognitive impairments, environmental hazards, inadequate staff supervision, and age-related, such as hearing and vision impairment, vibration sensation and proprioceptive reduction, altered gait, and declining positional control. Age-related factors and changes do not cause falls directly but significantly contribute to most falls. Research shows that falls in older adults are also associated with physical diseases, medication side effects, cognitive deterioration, and environmental hazards (Vaishya & Vaish, 2020). According to Vaishya and Vaish (2020), environmental factors increase the risk of falling and can occur independently or interact with other factors, especially when postural control and mobility are needed, like walking on slippery and uneven surfaces. Maintaining balance becomes a problem as people age because of an impaired nervous system, which makes recovering balance challenging (Cuevas-Trisan, 2019). Furthermore, older age causes muscle weaknesses that make balancing and positioning difficult, leading to increased fall risk. Also, inadequate staffing or insufficient staff supervision can mean potential fall risks are not identified and addressed quickly enough (Vaishya & Vaish, 2020). In conclusion, inpatient falls, and fall-related injuries can be caused by a variety of factors, including physical or cognitive impairments, environmental hazards, and inadequate staff supervision. It is important to identify these potential causes to reduce the risk of falls and fall-related injuries. (Literature Review)

Impact of Fall Prevention Programs on Number of Falls Experienced by Older Patients

Falls prevention programs are implemented to reduce the risk of falls and fall-related injuries among hospitalized patients, especially older patients. There are many fall prevention programs, including patient education, hourly rounding, and medication management. Other interventions include reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, reorganizing leadership systems, standardizing fall prevention equipment, adapting to new hospital buildings, investigating root causes, and helping nurses think critically regarding risk. Additionally, falls prevention interventions can include alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks. Studies indicate that fall prevention programs have varying effectiveness, but using several interventions at once increases the efficacy of fall prevention efforts. Based on research, patient education, medication management, and hourly rounding generate consistent fall prevention results and reduce risk factors associated with falls among older adults (Daniels, 2016; Mant et al., 2016; Goldsack, 2015; Walsh et al., 2018; LeLaurin & Shorr, 2019). In conclusion, there are many interventions to prevent fall risk, but with varying effectiveness. A nurse’s role is to conduct evidence-based research on various interventions and select the one with more benefits to the particular patient population. (Literature Review)

The following fall prevention interventions or programs are reviewed for their effectiveness in preventing risk factors of falls and associated effects among older adults:

Patient Education

Patient education helps influence patients towards the desired behavior and produces knowledge, attitude, and skills changes required to promote health and improve patient outcomes. Fall prevention education includes strategies such as increasing awareness of slippery surfaces, using equipment installed in hallways to aid walking, communicating with providers, and taking caution about medications that increase the risk of falling. Studies indicate that incorporating patient education into other fall prevention strategies helps reduce fall risks. Heng et al. (2020) explored the effectiveness of patient education in preventing falls among older adults. Findings indicate that direct face-to-face patient education, educational materials like handouts, pamphlets, brochures, hospital policies, procedures, and systems can help reduce falls and associated injuries. Fall prevention programs incorporating patient education reduce the risk of falling because patients are empowered and more aware of themselves and their surroundings. Heng et al. (2021) also explored patient education’s impact on fall rate and found that consistent, patient-centered education and small interactive groups helped prevent falls among hospitalized patients. Conclusively, patient education programs are effective in helping reduce the risk of falling among older adults, and studies recommend incorporating patient education into other fall prevention programs to increase effectiveness. (Literature Review)

Medication Management

Medication management includes strategies that engage patients and healthcare providers to establish a comprehensive, complete, and accurate medication list to help manage potential adverse events, side effects, and what to avoid to reduce the risk of complications. Hospitalized patients, particularly older adults, are under several medications, which increases the risk of medication-induced falls. Medication side effects that increase the risk of falling are often ignored when planning for fall prevention. Fall-risk-increasing drugs should be considered a significant risk factor during fall risk assessment in healthcare settings. About 47% of active substances used by inpatients increase the risk of falling because most affect the nervous and cardiovascular systems (Michalcova et al., 2020). Research shows that medication management can minimize side effects and interactions that contribute to falls. Michalcova et al. (2020) suggest adopting medication management programs such as preliminary categorizing fall-risk-increasing drugs (FRIDs) based on adverse drug effects to reduce fall risk. In support, Ming et al. (2021) report medication review as an effective approach to managing adverse drug reactions and enhancing drug safety among older patients to prevent falls and fall-related injuries among older adults. Medication review also helped reduce the severity of injuries and fall-related fractures (Ming et al.,2021). In conclusion, there are different medication management programs, including risk categorization of drugs according to their adverse effects and medication review of drugs that can help prevent medication-induced falls. Therefore, hospitals should increase awareness of medication-induced falls by adopting medication management programs to prevent falls and fall-related injuries. (Literature Review)

Hourly Rounding

Hourly rounding includes nurses and unlicensed assistive personnel conducting scheduled patient visits to perform interventions specific to or tailored to a particular hospitalized patient. Hourly rounding includes activities like nourishment, pain management, helping with elimination needs, range of motion, proper positioning, helping patients with applicable musculoskeletal needs, and room observation to ensure proper and adequate lighting, call bell and phone are within reach, medical equipment is functioning as expected, and walking areas or hallways are clutter-free (Shepard, 2015). Studies indicate that hourly rounding generates consistent fall prevention results and reduces risk factors contributing to falls and associated effects among older adults (Daniels, 2016; Mant et al., 2016; Goldsack, 2015; Walsh et al., 2018; LeLaurin & Shorr, 2019). According to Daniels (2016), purposeful and timely hourly rounding is effective in helping meet patient needs consistently, ensuring patient safety, lowering preventable events, and proactively addressing patient problems. Mant et al. (2016) also found that implementing hourly rounding effectively prevents fall-related incidents among older patients in acute care settings. Goldsack (2015) further supports this after finding in a pilot test that fall rate was considerably lower, at 1.3 falls/1,000 patient days after implementing hourly rounding during the test period. Furthermore, Walsh et al. (2018) found that when nurses began addressing fall risk during hourly rounds, the fall rate significantly declined, implying hourly rounds’ effectiveness in reducing fall risk among inpatients. Consistently, Manges et al. (2020) found that hourly rounding improved care quality, patient satisfaction, and patient empowerment and helped decrease patient fall rates. In conclusion, hourly rounding is an effective approach to preventing falls among older patients. Therefore, hospitals and nurse leadership should implement intentional and purposeful hourly rounding to reduce risk factors contributing to falls in older adults and associated effects such as disability, loss of independence, and increased healthcare costs due to injury treatment. (Literature Review)

Others Interventions

Besides patient education, medication management, and hourly rounding, other fall prevention interventions can be adopted to help reduce the risk of falling among older adults. These interventions include reorganizing the Falls Committee, flagging high-risk patients, improving fall reports, increasing falls scrutiny, reorganizing leadership systems, standardizing fall prevention equipment, adapting to the new hospital building, investigating root causes, educating patients, and helping nurses think critically regarding risk in reducing patient falls. Walsh et al. (2018) found that implementing these interventions incrementally reduced the fall rate from 3.07 to 2.22 per 1000 patient days and injury rate from 0.77 to 0.65 per 1000 patient days. LeLaurin & Shorr (2019) investigated the effectiveness of alarms, fall risk identification, sitters, intentional rounding, patient education, physical restraints, environmental modifications, and non-slip socks and found that these interventions, coupled with intentional rounding, enhanced patient satisfaction and minimized patient harm. However, these studies indicate that other interventions have moderate effects on fall prevention, associated injuries, morbidity, and mortality and should not be implemented as stand-alone interventions. In conclusion, multiple fall prevention programs are implemented in hospitals, but research shows most fall prevention programs have moderate effects on fall prevention. Therefore, hospitals should consider adopting various interventions to increase the effectiveness of fall prevention efforts in healthcare settings. (Literature Review)

Conclusion

Patient falls are a significant problem in US hospitals, especially among older adults at increased risk of falling due to age-related factors, environmental factors, medical conditions, and frail bodies. Falls lead to injuries and contribute considerably to subsequent morbidity and mortality among hospitalized patients. Many interventions currently used to prevent falls indicate moderate benefits and unknown sustainability. Reviewed articles provide consistent results showing patient education, medication management, and hourly rounding as effective in reducing the risk of patient falls and associated effects, promoting patient safety, and improving patient experience, outcome, and satisfaction. (Literature Review)

References

Appeadu, M. K., & Bordoni, B. (2022). Falls and fall prevention in the elderly. In StatPearls [Internet]. StatPearls Publishing.

Cuevas-Trisan, R. (2019). Balance problems and fall risks in the elderly. Clinics in geriatric medicine, 35(2), 173-183.

Daniels J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI database of systematic reviews and implementation reports, 14(1), 248–267. https://doi.org/10.11124/jbisrir-2016-2537

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing, 45(2), 25–30. https://doi.org/10.1097/01.NURSE.0000459798.79840.95

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Heng, H., Slade, S. C., Jazayeri, D., Jones, C., Hill, A. M., Kiegaldie, D., Shorr, R. I., & Morris, M. E. (2021). Patient Perspectives on Hospital Falls Prevention Education. Frontiers in public health, 9, 592440. https://doi.org/10.3389/fpubh.2021.592440

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in geriatric medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Lloyd, S. L. (2021). Hourly rounding to reduce patient falls – A quality improvement project. University of Texas.

Manges, M. E., Zuver, M. C., Mack, K., & Abraham, S. P. (2020). hourly rounding and medical-surgical patient falls: A review of the literature. International Journal of Science and Research Methodology.

Mant, T., Dunning, T., & Hutchinson, A. (2016). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. JBI Evidence Synthesis, 10(56), 1-12.

Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics, 20(1), 1-11.

Ming, Y., Zecevic, A. A., Hunter, S. W., Miao, W., & Tirona, R. G. (2021). Medication Review in Preventing Older Adults’ Fall-Related Injury: a Systematic Review & Meta-Analysis. Canadian geriatrics journal : CGJ, 24(3), 237–250. https://doi.org/10.5770/cgj.24.478

Shepard, L. H. (2015). Stop going in circles! Break the barriers to hourly rounding. Nursing management, 44(2), 13-15.

Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian journal of orthopaedics, 54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off. Joint Commission journal on quality and patient safety, 44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009

 
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Topic 7 DQ 1

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Topic 7 DQ 1

(Topic 7 DQ 1)

My personal worldview is based on my personal philosophy that has developed through experience, engagement with others, education, cultural beliefs and practices, and religious beliefs. I have grown up in a family and a culture that stresses the need to be decent and do what is right for others and self. My family and friends have specific expectations based on my age, education, and gender, besides those I set for myself that dictate my worldview. For instance, my parents taught me to treat people better and remain consistent in my values and attitudes regardless of how those around me behave or act. These values have grown in me consciously because I can appreciate their benefits and see their needs over time. My parents also expect me to respect and show empathy to other people. These principles have guided and informed my relationship with others, and I have grown to have a conscious mind because I do not treat people like they treat me; rather, I treat people with respect and as decent human beings. Through experience, I have learned to take time before making decisions and consider all perspectives and factors, which has been integral in my problem-solving processes. These principles have helped me build relationships with others, interact with colleagues and patients, make the right decisions, and live with a conscious mind. (Topic 7 DQ 1)

Topic 7 DQ 1

The two core principles that influence my worldview are respect and empathy. I treat the principles of respect for persons seriously in every situation because I understand I can only engage meaningfully with others when I extend respect. I try my best to be respectful even when the other party is disrespectful, and in most situations, I solve conflict through respect for others. Empathy is needed to understand others and their needs. Being in a leadership position requires empathy. You can only understand and treat others right when you share in their experiences. I am open-minded to ideas and perspectives, which is critical in making comprehensive and inclusive decisions. Being open-minded allows me to understand patients and engage with people from different backgrounds and experiences, which is vital in offering patient-centered and holistic care. Generally, I do not sustain my principles to get credit from others, but I cannot ignore when people say I am a good person and would like to share their experiences with me because they believe I can understand them. (Topic 7 DQ 1)

 
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 Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

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(Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

 Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

Patient Information:

S.

CC: “I get this every spring and it seems to last six to eight weeks”

HPI: The patient is a 28-year-old Hispanic female presenting at the clinic complaining of a runny nose and itchy eyes. The patient states runny nose, itchy eyes, and ears felt full approximately 9 days ago. The patient reports experiencing this condition every spring, which lasts six to eight weeks”. She describes the nose as runny with clear mucus. Sneezes on and off all day. Her eyes itch so bad she just wants to scratch them out, sometimes feels a tickle in her throat, and her ears feel full and sometimes pop. Last year she took Claritin with relief. (Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

 Episodic/Focused SOAP Note for Patient with Allergic Rhinitis

Current Medications: Acetaminophen 325mg

Allergies: Dust and pollen.

PMHx: Positive history of Covid-19, controlled and vaccinated.

FH: Father at 66 has a history of kidney stones. Mother died when 37 from accident, and not known medical history
Soc Hx: Negative history of tobacco, alcohol, or substance use. Married and living with the husband.

ROS

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Reports itchy eyes.

Ears, Nose, Throat:  Denies hearing loss. Reports feelings ears are full. Reports sneezing and denies congestion. Reports runny nose and scratchy throat. Throat mildly erythematous.

SKIN:  Denies rash or itching.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Reports shortness of breath due to blocked airways, sneezing on and off throughout the day. Denies cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Denies burning on urination, pregnancy. Last menstrual period, 27/02/2023.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.  (Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Dust and pollen.

O.

VS: Temp: 97.8F, B.P.: 110/70, P: 85, R.R.: 19, O2: Room air, Pain: 0/10, Ht: 5’9 feet, Wt: 170 lbs, BMI: 25.1, BMI Range: Overweight

Physical exam: Alert and oriented

HEENT: Her throat was mildly erythematous without exudate. Nasal mucosa was pale, boggy, and erythematous, with clear thin secretions and enlarged nasal turbinates. Only clear drainage was seen. TMs were clear.

Neck: Supple without adenopathy.

Lungs: Clear. (Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

A.

Differential Diagnoses:

1) Allergic Rhinitis: Allergic rhinitis occurs in the eyes, nose, and throat when airborne allergens cause the body to release histamine. Pollen, dust mites, mold, cockroach feces, animal dander, fumes and aromas, hormonal fluctuations, and smoke are some of the most typical triggers of rhinitis. Sneezing, a stuffy, runny, and itchy nose, itchy throat, eyes, and ears, nosebleeds, clear drainage from the nose, recurrent ear infections, snoring, mouth breathing, and fatigue are all signs of allergic rhinitis (Akhouri et al., 2022). The patient presents with itchy eyes and ears, a runny nose with clear discharge, and a sore or itchy throat, guiding the diagnosis of allergic rhinitis, which seems to affect the patient only in spring, implying pollen-induced allergic rhinitis.

2) Vasomotor rhinitis: The most prevalent type of nonallergic rhinitis, vasomotor rhinitis, is diagnosed as an exclusion. Nonallergic rhinitis has a complicated pathogenesis that is still being studied (Leader & Geiger, 2022). The nasal mucosa’s parasympathetic and sympathetic inputs are out of balance, contributing to this condition. In allergic and nonallergic rhinitis, headache, face pressure, postnasal drip, coughing, and throat clearing are typical symptoms. According to the predominating symptomatology, patients with vasomotor rhinitis are typically divided into “blocks” with congestion and “runners” with rhinorrhea. Rhinorrhea patients frequently exhibit an intensified cholinergic response (Leader & Geiger, 2022). Nociceptive neurons in people with nasal blockage may respond more strongly to benign stimuli. This diagnosis was refuted because the patient clearly indicated she experiences the symptoms during spring; hence the cause is known. (Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

3) Acute Sinusitis: Acute sinusitis is an infection of the sinuses. It involves sinus passageways and nasal passages, which are connected. Purulent nasal discharge, along with either a nasal blockage or discomfort, pressure, or fullness in the face, are the three core symptoms that are the most sensitive and specific for acute rhinosinusitis (DeBoer & Kwon, 2019). Patients who could present with general “headache” concerns help to clarify this because an isolated headache is not a symptom. However, sinusitis can be characterized by isolated facial pressure. This diagnosis was refuted because the nasal discharge was clear.

4) Rhinitis Medicamentosa: Rebound congestion, commonly called “rebound rhinitis medicamentosa,” is an inflammation of the nasal mucosa brought on by excessive consumption of topical nasal decongestants. It is categorized as a form of drug-induced rhinitis. While using an intranasal decongestant for an extended period of time, the patient often experiences a recurrence of nasal congestion, especially without rhinorrhea (Wahid & Shermetaro, 2021). Snoring, oral breathing, and dry mouth are all symptoms of severe nasal congestion. A clinical examination will show swollen, erythematous, and granular nasal mucosa. Furthermore, pale and edematous looks can be noticed (Wahid & Shermetaro, 2021). The nasal membrane is crusty and atrophic as the condition worsens. The diagnosis was refuted because the cause is established as pollen common during spring and not any medication. (Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

5) Hormone-Induced Rhinitis: Hormone-induced rhinitis is marked by congestion and nasal symptoms brought on by endogenous female hormones, such as those present during pregnancy. Patients with a history of craniofacial trauma or prior facial surgery with persistent, clear rhinorrhea should be evaluated for a cerebrospinal fluid (CSF) leak (Liva et al., 2021). This diagnosis was ruled out because the patient denied pregnancy, minimizing the likelihood of being affected by endogenous female hormones. Also, the patient has no surgical history.  (Episodic/Focused SOAP Note for Patient with Allergic Rhinitis)

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Akhouri, S., House, S. A., & Doerr, C. (2022). Allergic rhinitis (nursing). In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538186/

DeBoer, D. L., & Kwon, E. (2019). Acute sinusitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547701/

Leader, P., & Geiger, Z. (2022). Vasomotor rhinitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547704/

Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. Journal of clinical medicine, 10(14), 3183. https://doi.org/10.3390/jcm10143183

Wahid, N. W. B., & Shermetaro, C. (2021). Rhinitis medicamentosa. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538318/

 
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Classical Argument: Health-Promoting Self-Care in Nursing

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Classical Argument: Health-Promoting Self-Care in Nursing

(Classical Argument: Health-Promoting Self-Care in Nursing)

The healthcare environment is challenging and pressuring for nurses, impacting their health and well-being. Nurses have in-depth knowledge regarding health-promoting behaviors and practices, but they continue to report high overweight and obesity levels and mental health issues. Contributing factors include work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime, which leaves nurses with little time to practice self-care.

Lack of self-care is linked to unhealthy nurses, physically and psychologically, which negatively impacts nursing practice and patient outcomes. It is also related to health-risk behaviors like excessive alcohol consumption, smoking, and substance use. However, health-promoting self-care impacts nurses’ health and well-being, nursing practice, and overall institutional and patient outcomes. Therefore, adopting self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth would help minimize the adverse effects of poor health-promoting self-care. (Classical Argument: Health-Promoting Self-Care in Nursing)

Classical Argument: Health-Promoting Self-Care in Nursing

Background

Self-care is related to any intentional effort to activity to cater to one’s mental, physical, and spiritual well-being. Nurses spend extended periods caring for others, and they can forget about themselves, which is detrimental to their and other people’s health (Ross et al., 2019). The American Nurses Association completed a survey that indicated the increased urgency to improve nurses’ health, especially in nutrition, safety, life quality, and physical activity. About 70% of the nurses surveyed admitted prioritizing patients’ needs, safety, health, and wellness before theirs (Purdue University Global, 2021). Also, 77% of the nurses reported being at a significant risk level for work-related stress (Purdue University Global, 2021). To care for others, nurses should first care for themselves because compassion fatigue is associated with poor health-promoting self-care. Nurses’ health impact patient care in all healthcare settings.

The nursing field can be traumatic for nurses because of increased exposure to trauma, suffering, and pain, ending up traumatized without realizing it most of the time. However, the Code of Ethics recognizes self-care as a nurse’s responsibility because when nurses are not caring for themselves, they cannot care for their patients (Purdue University Global, 2021). In addition, the American Nurses Association Code of Ethics posits that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to other individuals (Purdue University Global, 2021).

Nurses are responsible for promoting their health and safety, preserving their character and integrity’s wholeness, maintaining competence, and ensuring personal and professional growth through continuing education and training. Self-care is considered a self-management tool for nurses to reduce the stress from working in the healthcare environment. Lack of self-care is linked with burnout, poor physical and mental health, depression, weight gain or extreme weight loss, unhealthy eating patterns, demoralization, back injury, and reduced job satisfaction (Williams et al., 2022). More attention is needed to enhance self-care in nurses because self-care helps minimize stress, replenish nurses’ compassion capacity and ability to care for others, and improve the quality of care. (Classical Argument: Health-Promoting Self-Care in Nursing)

Self-Care Minimizes Stress

Self-care serves as a stress management tool, helping nurses reduce work-related stress. Adopting self-care practices like mindfulness, self-compassion, and emotional regulation can help nurses reduce stress and attend to their physical, mental, emotional, and spiritual needs (Hofmeyer et al., 2020). In this case, nurses should perceive self-care as integral to preventative care. Although individual factors can impact an individual’s ability to cope, control themselves, tolerate uncertainties, and resilience, self-care helps acquire and sustain these positive aspects of life. Per Hofmeyer et al. (2020), control is critical to an individual’s well-being. Still, work-related factors beyond a nurse’s control can disrupt the power to self-regulate and the need for control, adding to work-related stress.

Classical Argument: Health-Promoting Self-Care in Nursing

Self-care begins with self-awareness, understanding how difficult events, uncertainties, and powerlessness impact oneself. For instance, it is normal to feel anxious, sad, and grief in difficult situations or crises, begging individuals to accept their vulnerability and learn how to self-regulate to control emotions and feelings attached to such conditions. In this case, self-regulation, self-compassion, and mindfulness allow nurses to focus on the positives rather than the negatives and uncertainties, accept situations, especially those that cannot be changed, like the death of a patient, and find meaningful ways to cope with the nursing environment, which helps reduce stress (Hofmeyer et al., 2020). Additionally, self-care builds resilience, allowing nurses to manage stress, maintain their health and well-being, and respond appropriately and effectively when facing crises and uncertainties. Self-efficacy, mindfulness, and emotional regulation strengthen psychological resilience. (Classical Argument: Health-Promoting Self-Care in Nursing)

Self-Care Replenishes Nurses’ Compassion Capacity and Ability to Care for Others

The ANA Code of Ethics highlight that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to others. Poor health-promoting self-care is associated with burnout and compassion fatigue, leading to poor patient outcomes and the risk of medical errors. Nursing care relies on empathy and compassion; the more burned out or stressed a nurse is, the more their capacity to offer kindness and compassion suffers (Monroe et al., 2021). Nurses often show empathy and compassion to their patients daily without a chance of replenishing them. However, nurses should learn and be able to extend empathy and compassion to themselves because failure to invest in themselves puts their and patients’ health and well-being at risk.

Moreover, nurses tend to be difficult on themselves when they make a mistake, and they do not console or talk to themselves as they would talk to a patient or a friend. Nurses are overly critical and judgmental of themselves, which, according to Hofmeyer et al. (2020), stimulates the sympathetic nervous system, activating a stress response that is harmful to an individual’s health and well-being. Engaging in self-care strategies, including having enough sleep, healthy eating patterns, regular physical activity, mindfulness, and social connections, can help replenish nurses’ compassion capacity and ability to care for others.

Therefore, nurses must practice self-compassion and understand their needs before helping others. Nurses should also learn to talk kindly to themselves because kind self-talk is linked to increased compassion capacity and pro-social behaviors like kindness, empathy, and altruism, helping them communicate better with colleagues, patients, and their families (Hofmeyer et al., 2020). In addition, acting with kindness and compassion helps reduce patient suffering and distress. (Classical Argument: Health-Promoting Self-Care in Nursing)

Self-Care Improves the Quality and Safety of Care

Nurses caring for themselves and bringing the effects to the workplace helps promote safe and high-quality care. Nurses with self-compassion have better physical and psychological health, motivation, happiness, relationship-building, and perspective-taking, which are linked to better health outcomes (Hofmeyer et al., 2020). In addition, self-compassionate nurses report decreased anxiety, depressive symptoms, fear of failure, shame, and rumination, implying a greater capacity to work for others.

On the contrary, stressed, burned out, overwhelmed, and unsatisfied nurses are more likely to be involved in medical errors, including medication administration errors that negatively impact the quality of care and patient safety (Hofmeyer et al., 2020). Therefore, adopting self-care strategies like seeking a therapist’s support, taking breaks, engaging colleagues to stay connected, and maintaining physical activity can help reduce burnout, stress, and feeling confused, overwhelmed, frustrated, and angry, increasing nurses’ capacity to promote quality and safe care. (Classical Argument: Health-Promoting Self-Care in Nursing)

Opposition and Barriers to Implementing Self-Care

Implementing self-care requires commitment, planning, and joint efforts of nurses and hospital administrators. There are multiple factors presented as hindering nurses from implementing self-care to ensure a healthy workforce. A survey reported that nurses complained about insufficient time and overwork as barriers to implementing self-care activities (Wolters Kluwer, 2020). Most nurses are overworked with poorer health and well-being and lack time to participate in healthy habits. Additionally, nurses reported a lack of facilities and resources and other commitments as reasons for not engaging in self-care. About 25% of nurses point to lack of access to a gym, exercise classes, changing facilities, showers, and lack of refrigerators or microwaves as barriers to implementing self-care (Wolters Kluwer, 2020). Over 50% of nurses stressed outside commitments like family responsibilities and school activities as interfering with the ability to live more healthily. (Classical Argument: Health-Promoting Self-Care in Nursing)

Refutation

These barriers are genuine concerns about the nurses’ ability and capacity to implement self-care. The barriers are true across the board, but there are ways to encourage nurses to embrace healthy habits and self-care, like eating healthy and exercising regularly. Leadership and peer support can help guide and adopt healthier practices. Leaders can expand opportunities for nurses to have more breaks and provide facilities like gyms, showers, and refrigerators to store healthy food snacks (Wolters Kluwer, 2020). Allowing breaks at the facility would help schedule time for self-care practices like establishing supportive connections with colleagues and exercising. (Classical Argument: Health-Promoting Self-Care in Nursing)

Conclusion

Health-promoting self-care can help improve nurses’ health and well-being, reduce stress, replenish nurses’ compassion capacity and ability to care for others, and improve the quality and safety of care. Conversely, poor health-promoting self-care is associated with increased nurses’ stress, burnout, lack of job satisfaction, compassion fatigue, chances of making medical errors, and decreased motivation. Nurses can adopt self-care strategies, including mindfulness, emotional regulation, self-compassion, regular physical activity, healthy eating patterns, personal and professional growth, and maintaining connectivity to promote health and well-being. Self-care is multifaceted, and improving self-care should address intrinsic and extrinsic motivators. (Classical Argument: Health-Promoting Self-Care in Nursing)

References

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse education today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503

Wolters Kluwer. (2020). Nurses and self-care: Factors influencing healthy behaviors during COVID-19. https://www.wolterskluwer.com/en/expert-insights/nurses-and-selfcare-factors-influencing-healthy-behaviors-during-covid19/

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi.org/10.1016/j.apnu.2020.10.003

Purdue University Global. (2021, April 28). The importance of self-care for nurses and how to put a plan in place. https://www.purdueglobal.edu/nursing/self-care-for-nurses/

Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and health-promoting self-care: Do we practice what we preach? Journal of nursing management, 27(3), 599–608. https://doi.org/10.1111/jonm.12718

Williams, S. G., Fruh, S., Barinas, J. L., & Graves, R. J. (2022). Self-Care in Nurses. Journal of radiology nursing, 41(1), 22–27. https://doi.org/10.1016/j.jradnu.2021.11.001

 
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Week 5 Discussion Post: Cognitive Behavioral Therapy

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Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings

(Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings)

How the use of CBT in groups compares to its use in family or individual settings

Cognitive behavioral therapy (CBT) is a psychosocial treatment that improves impaired thinking and behavior patterns. CBT treats various mental health diseases, including depression, anxiety disorders, alcohol and substance use, eating disorders, and marital issues. According to Guo et al. (2021), CBT significantly improves functioning and quality of life by helping individuals identify and acknowledge thinking and behavior distortions, understand behaviors and motivations better, learn problem-solving skills to address the distortions, and bolster confidence in their abilities. CBT is applicable in individual, group, and family settings. (Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings)

Cognitive-behavioral group therapy is a group approach adopting behavioral, cognitive, relational, and group strategies and procedures to improve the coping skills of group members and enhance the relational and interpersonal issues that participants are experiencing. CBT in group settings involves a practitioner or various practitioners offering therapy to several individuals with common goals and issues and seeking mutual reinforcement. The practitioner is responsible for guiding and managing group processes, including setting engagement rules, setting expectations, objectives, and icebreakers, managing interpersonal dynamics, and ensuring the success of group CBT (Guo et al., 2021). Managing interpersonal dynamics is imperative to successful group processes because group members differ in personalities, attitudes, goals, characters, and perceptions. These differences can be a barrier to a successful group or an opportunity to learn from each other. Per Guo et al. (2021), compared to individual CBT, group CBT is more effective in treating conditions like anxiety and drug and alcohol abuse because it enhances opportunities for mutual support, normalization, positive peer modeling, exposure to different situations and perceptions, and reinforcement. (Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings)

CBT in family settings involves a practitioner or practitioners providing psychotherapy to family members designed to improve family dynamics and relationship building. When applied in family settings, CBT evaluates interactional dynamics in the family and their contribution to family functioning and dysfunction (Pagsberg et al., 2022). The therapist engages family members to highlight problems in emotions, beliefs, and behavioral exchanges and how they can be addressed to improve interaction and family dynamics. Cognitive behavioral therapy is often applied in individual settings involving a practitioner working with a single patient. CBT for individuals focuses on personal development and is appreciated by those seeking interaction at a personal level and a high degree of attention (Guo et al., 2021). The therapist works with the client on their personal goals, and the client’s needs and preferences guide decision-making and patient care. The practitioners select an approach that best suits the client and contributes to personal development. The treatment plan is tailored to the client’s needs and depends on what strategies are effective in different situations. Guo et al. (2021) compared individual CBT to group CBT and found that individual CBT expands opportunities for treatment individualizations and addressing a client’s specific needs. It is also more effective for conditions like avoidant behavior and conduct disorder. (Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings)

Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings

Challenges PMHNPs might encounter when using CBT in group settings

Implementing CBT in group settings can be challenging, particularly due to individual differences and conflicting goals and needs. Common problems include the emergence of sub-groups attributed to individual differences like race and ethnicity and high dropout rates when individuals feel their needs are not adequately addressed, or the process is no longer beneficial (Rasmussen et al., 2021). People with a desire for individual attention can be problematic in group settings. It is also unsuitable for persons with social anxiety or fear of shame and humiliation despite it being used in some cases to improve social skills and self-confidence by encouraging social interactions and the development of interpersonal skills. (Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings)

Why Sources are Scholarly

Selected sources to support the discussion include Rasmussen et al. (2021), Guo et al. (2021), and Pagsberg et al. (2022). These sources are peer-reviewed and scholarly and obtained from the PubMed database. Authors have the background knowledge to address the discussion topic, and they are affiliated with professional and academic institutions, including the Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Child and Adolescent Mental Health Center, Copenhagen University Hospital – Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Copenhagen, Denmark, and Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway. These attributes give the authors authority to research the topic and make the sources scholarly. (Week 5 Discussion Post: Cognitive Behavioral Therapy: Comparing Group, Family, And Individual Settings)

References

Guo, T., Su, J., Hu, J., Aalberg, M., Zhu, Y., Teng, T., & Zhou, X. (2021). Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Frontiers in psychiatry, 12, 674267. https://doi.org/10.3389/fpsyt.2021.674267

Pagsberg, A. K., Uhre, C., Uhre, V., Pretzmann, L., Christensen, S. H., Thoustrup, C., Clemmesen, I., Gudmandsen, A. A., Korsbjerg, N. L. J., Mora-Jensen, A. C., Ritter, M., Thorsen, E. D., Halberg, K. S. V., Bugge, B., Staal, N., Ingstrup, H. K., Moltke, B. B., Kloster, A. M., Zoega, P. J., Mikkelsen, M. S., … Plessen, K. J. (2022). Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial). BMC psychiatry, 22(1), 204. https://doi.org/10.1186/s12888-021-03669-2

Rasmussen, L. P., Patras, J., Handegård, B. H., Neumer, S. P., Martinsen, K. D., Adolfsen, F., Sund, A. M., & Martinussen, M. (2021). Evaluating Delivery of a CBT-Based Group Intervention for Schoolchildren With Emotional Problems: Examining the Reliability and Applicability of a Video-Based Adherence and Competence Measure. Frontiers in psychology, 12, 702565. https://doi.org/10.3389/fpsyg.2021.702565

 
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Nursing Paper Example on Loiasis [SOLVED]

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Nursing Paper Example on Loiasis [SOLVED]

Loiasis, commonly known as African eye worm disease, is a neglected tropical disease caused by the filarial nematode Loa loa. This parasitic infection predominantly affects individuals residing in rainforest regions of West and Central Africa. Loiasis is characterized by the migration of adult worms through the subcutaneous tissues, leading to various clinical manifestations. In this paper, we will look into the causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, patient education, and conclude with insights into managing this parasitic affliction effectively. This paper aims to provide a comprehensive understanding of loiasis, shedding light on its impact on affected communities and elucidating strategies for diagnosis, treatment, and prevention. By explaining the complexities of loiasis, we can better equip healthcare professionals and policymakers to address this public health challenge in endemic regions. (Nursing Paper Example on Loiasis [SOLVED])

Nursing Paper Example on Loiasis [SOLVED]

Causes

Loiasis, also known as African eye worm disease, is caused by the filarial nematode Loa loa, endemic to the rainforest regions of West and Central Africa. The transmission of Loa loa occurs through the bite of infected deerflies or mango flies of the genus Chrysops, which serve as intermediate hosts for the parasite. When an infected fly takes a blood meal from a human host, it deposits infective larvae into the skin. These larvae then penetrate the skin and migrate through the subcutaneous tissues, where they develop into adult worms. Once matured, adult worms can live for several years in the human body, perpetuating the parasitic lifecycle.

The presence of adult worms in the subcutaneous tissues triggers an inflammatory response, leading to the characteristic symptoms of loiasis. The lifecycle of Loa loa within the human host is intricately linked to the lifecycle of the Chrysops fly, with transmission occurring during the fly’s blood meal. Environmental factors such as temperature and humidity influence the distribution and abundance of Chrysops flies, contributing to the geographic distribution of loiasis.

Furthermore, human activities such as deforestation and agricultural development can alter the ecological balance of rainforest ecosystems, potentially increasing the risk of exposure to Chrysops flies and subsequent transmission of Loa loa. The complex interplay between environmental, ecological, and socioeconomic factors underscores the multifactorial nature of loiasis transmission. Efforts to control and prevent loiasis must consider these interconnected factors, emphasizing the importance of integrated approaches that address both the biological and environmental aspects of disease transmission. (Nursing Paper Example on Loiasis [SOLVED])

Signs and Symptoms

The clinical presentation of loiasis can vary widely, ranging from asymptomatic to severe manifestations. One of the hallmark features of loiasis is the presence of migratory swellings known as Calabar swellings, which are transient, localized edematous areas that often occur on the extremities. These swellings typically resolve spontaneously within a few days to weeks and may recur at different sites. Additionally, individuals with loiasis may experience pruritus, or itching, particularly at the site of larval entry into the skin.

Another characteristic symptom of loiasis is the subconjunctival migration of adult worms, which manifests as a visible worm-like movement beneath the conjunctiva of the eye. This phenomenon, known colloquially as “eye worm,” can cause discomfort and irritation but is usually harmless. In some cases, individuals may present with systemic symptoms such as fever, headache, and malaise, which are often nonspecific and can mimic other infectious diseases prevalent in endemic regions.

Nursing Paper Example on Loiasis [SOLVED]

Joint pain, or arthralgia, is another common manifestation of loiasis, particularly in individuals with high parasite burdens. The inflammatory response triggered by the presence of adult worms in the subcutaneous tissues can lead to joint inflammation and pain, which may affect mobility and quality of life. Furthermore, severe cases of loiasis may involve neurologic manifestations, including peripheral neuropathy, meningitis, and encephalopathy, although these complications are relatively rare.

The clinical course of loiasis is variable, with some individuals experiencing mild symptoms that resolve spontaneously, while others may develop chronic or recurrent manifestations requiring medical intervention. Understanding the diverse spectrum of signs and symptoms associated with loiasis is essential for accurate diagnosis and management, particularly in endemic regions where the disease burden is high. Effective control and prevention strategies rely on early detection, prompt treatment, and community-based interventions aimed at reducing transmission and morbidity associated with loiasis. (Nursing Paper Example on Loiasis [SOLVED])

Etiology

The etiology of loiasis revolves around the complex lifecycle of the Loa loa parasite and its interaction with both the human host and its vector, the Chrysops fly. The lifecycle of Loa loa begins when an infected Chrysops fly takes a blood meal from a human host, depositing infective larvae into the skin during the feeding process. Once deposited into the human host, the larvae penetrate the skin and migrate through the subcutaneous tissues, where they develop into adult worms.

Within the human host, adult worms of Loa loa reside primarily in the subcutaneous tissues, where they can live for several years, perpetuating the parasitic lifecycle. The presence of adult worms triggers an inflammatory response, leading to the characteristic symptoms associated with loiasis, including migratory swellings and subconjunctival migration of adult worms.

Nursing Paper Example on Loiasis [SOLVED]

The lifecycle of Loa loa within the human host is intricately linked to the lifecycle of the Chrysops fly, which serves as an intermediate host for the parasite. Environmental factors such as temperature and humidity influence the distribution and abundance of Chrysops flies, thereby impacting the geographic distribution of loiasis.

Human activities such as deforestation, agricultural development, and urbanization can alter the ecological balance of rainforest ecosystems, potentially increasing the risk of exposure to Chrysops flies and subsequent transmission of Loa loa. Additionally, socioeconomic factors such as poverty and limited access to healthcare infrastructure contribute to the persistence of loiasis in endemic regions, highlighting the importance of addressing underlying social determinants of health in disease control efforts.

Overall, the etiology of loiasis is multifactorial, involving complex interactions between the parasite, the vector, and the human host, as well as environmental and socioeconomic factors. Understanding these underlying mechanisms is crucial for developing effective strategies for the control and prevention of loiasis in endemic regions. (Nursing Paper Example on Loiasis [SOLVED])

Pathophysiology

The pathophysiology of loiasis is characterized by the migration of adult worms through the subcutaneous tissues, leading to inflammatory reactions and tissue damage. Upon entering the human host through the bite of an infected Chrysops fly, the larvae of Loa loa migrate through the skin and mature into adult worms within the subcutaneous tissues. As adult worms move through the tissues, they elicit an inflammatory response, which manifests clinically as migratory swellings and localized edema known as Calabar swellings.

The inflammatory response triggered by the presence of adult worms can lead to tissue damage and disruption of normal physiological processes. In particular, the migration of adult worms through the eye region can cause subconjunctival migration, resulting in irritation and discomfort for the affected individual. The presence of adult worms in the subcutaneous tissues can also lead to joint inflammation and pain, contributing to the arthralgia commonly associated with loiasis.

Furthermore, severe cases of loiasis may involve neurologic manifestations, including peripheral neuropathy, meningitis, and encephalopathy. The inflammatory response elicited by the parasite can lead to neurological complications, which may manifest as cognitive impairment, motor deficits, and sensory disturbances. Although neurologic involvement is relatively rare, it can have significant consequences for affected individuals, necessitating prompt medical intervention.

The pathophysiology of loiasis underscores the importance of understanding the interactions between the parasite and the host immune system in driving disease progression. The inflammatory response triggered by the presence of adult worms plays a central role in mediating tissue damage and clinical manifestations observed in affected individuals. Insights into the pathophysiological mechanisms of loiasis are essential for developing targeted interventions aimed at mitigating disease burden and improving patient outcomes. (Nursing Paper Example on Loiasis [SOLVED])

DSM-5 Diagnosis

Diagnosing loiasis typically involves a combination of clinical assessment, patient history, and laboratory investigations. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides criteria for the diagnosis of loiasis based on the characteristic signs and symptoms associated with the disease. Clinicians evaluate patients presenting with symptoms suggestive of loiasis, such as migratory swellings, subconjunctival migration of adult worms, and eosinophilia on laboratory testing.

Clinical assessment begins with a thorough history-taking, including inquiries about recent travel to endemic regions, exposure to insect bites, and onset and progression of symptoms. Physical examination may reveal characteristic signs such as Calabar swellings and subconjunctival migration of adult worms, providing valuable diagnostic clues. Laboratory investigations play a crucial role in confirming the diagnosis of loiasis and assessing disease severity.

Eosinophilia, or an elevated eosinophil count, is a common finding in individuals with loiasis and can be detected through routine blood tests. Microscopic examination of blood smears or skin snips may reveal the presence of microfilariae, the larval stage of the Loa loa parasite, further supporting the diagnosis. Serologic testing and molecular assays, such as polymerase chain reaction (PCR), may also aid in confirming the presence of Loa loa infection.

The DSM-5 criteria for the diagnosis of loiasis emphasize the importance of recognizing the characteristic signs and symptoms associated with the disease. A comprehensive diagnostic approach, incorporating clinical assessment, patient history, and laboratory investigations, is essential for accurate diagnosis and management of loiasis. Timely identification of the disease allows for prompt initiation of treatment and implementation of appropriate public health measures to prevent further transmission. (Nursing Paper Example on Loiasis [SOLVED])

Treatment Regimens and Patient Education

The management of loiasis primarily involves pharmacologic therapy aimed at eliminating the parasite from the human host. The drug of choice for treating loiasis is diethylcarbamazine (DEC), which effectively targets both adult worms and microfilariae. DEC is typically administered orally in a single dose regimen, although the duration and frequency of treatment may vary depending on the severity of the infection and the presence of complications.

However, treatment with DEC requires careful monitoring due to the risk of severe adverse reactions, particularly in individuals with high parasite burdens. Adverse reactions to DEC may include fever, headache, dizziness, nausea, and vomiting, as well as more serious complications such as encephalopathy and neurologic impairment. Therefore, healthcare providers must assess the risk-benefit ratio of DEC therapy on a case-by-case basis, weighing the potential benefits of treatment against the risk of adverse effects.

In addition to pharmacologic therapy, patient education plays a crucial role in the management of loiasis, emphasizing the importance of preventive measures and early treatment seeking. Patients should be educated about the transmission of loiasis through the bite of infected Chrysops flies and instructed on strategies to prevent insect bites, such as wearing protective clothing, using insect repellents, and avoiding outdoor activities during peak fly activity hours.

Furthermore, patients should be informed about the signs and symptoms of loiasis and encouraged to seek medical attention promptly if they experience any suggestive symptoms. Early diagnosis and treatment of loiasis are essential for preventing complications and reducing the risk of transmission to others. Patients should also be educated about the potential adverse effects of DEC therapy and instructed to report any adverse reactions to their healthcare provider immediately.

Healthcare providers play a critical role in patient education, providing accurate information about loiasis and its management, addressing any concerns or misconceptions, and promoting adherence to treatment recommendations. By empowering patients with knowledge and resources to prevent and manage loiasis effectively, healthcare providers can contribute to improved health outcomes and reduced disease burden in endemic regions. (Nursing Paper Example on Loiasis [SOLVED])

Conclusion

Loiasis, a neglected tropical disease caused by the filarial nematode Loa loa, presents significant challenges in diagnosis, treatment, and prevention. This paper has explored the multifaceted nature of loiasis, delving into its causes, signs and symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education. By dissecting the intricate interplay between the parasite, the vector, and the human host, we gain valuable insights into the mechanisms driving disease progression and transmission. Furthermore, through targeted treatment regimens and comprehensive patient education, healthcare providers can mitigate the burden of loiasis, improve health outcomes, and enhance community resilience in endemic regions. Moving forward, efforts to control and prevent loiasis must adopt integrated approaches that address both the biological and social determinants of disease, emphasizing the importance of collaborative efforts between healthcare providers, policymakers, and affected communities in combating this debilitating parasitic affliction.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824532/

 
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