People Living with HIV

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People Living with HIV

Discussion Board
DISCUSSION BOARD

Around 1.1 million people are living with HIV in the United States of America (USA). Nearly one in seven of these people are unaware they have HIV. The size of the epidemic is relatively small compared to the overall population but is heavily concentrated among several key affected populations.

You, as a future Family Nurse Practitioner (FNP), should be able to identify populations in the US at highest risk and also those with the highest incidence of this disease. Expose in a clear and academic manner what is the actual situation of this infection in the US and compare it with the status of the disease in your community.

  • APA STYLE 7TH EDITION
  • At least 4 references supporting your posting are needed with less than 10 years of age.
  • 1 PAGE OF CONTENT MINIMUM

 

The Current Situation of HIV in the United States and Comparison with Local Community Status

Introduction

Human Immunodeficiency Virus (HIV) remains a significant public health concern in the United States, affecting various demographics disproportionately. Approximately 1.1 million people in the USA are living with HIV, with nearly 15% unaware of their status (Centers for Disease Control and Prevention [CDC], 2022). This epidemic, although concentrated, presents challenges for healthcare providers, especially Family Nurse Practitioners (FNPs) tasked with addressing the needs of high-risk populations.

Key Affected Populations in the United States

HIV disproportionately impacts certain populations. Key affected groups include men who have sex with men (MSM), people who inject drugs (PWID), and certain racial and ethnic minorities, particularly African Americans and Hispanics. According to the CDC (2022), in 2020, MSM accounted for 69% of new HIV diagnoses, while African Americans and Hispanics comprised 42% and 27% of new cases, respectively. Socioeconomic factors, access to healthcare, and stigma contribute to the prevalence of HIV in these groups.

Comparison with Local Community Status

In analyzing the HIV situation in a specific community, one must consider local epidemiological data. For instance, if the community is predominantly urban and has a high population of MSM or PWID, the incidence of HIV may be similarly high. In contrast, a rural community may experience different challenges, such as limited access to healthcare services and testing facilities, contributing to delayed diagnoses. The CDC’s Division of HIV/AIDS Prevention provides state-specific data, which can be utilized to assess community status (CDC, 2023).

Challenges and Opportunities for FNPs

As future FNPs, understanding the current status of HIV in the US and local communities is crucial for developing effective intervention strategies. FNPs play a vital role in increasing awareness, providing education, and facilitating access to testing and treatment options for at-risk populations. They can address barriers to care by promoting routine HIV screening, especially in areas with high prevalence and among populations with limited access to healthcare.

Conclusion

HIV remains a critical health issue in the United States, with specific populations facing a higher burden of disease. Future Family Nurse Practitioners must be equipped to understand these disparities and implement effective strategies in their practice to address the needs of high-risk groups in their communities. Ongoing education, awareness, and access to care are vital in combating the HIV epidemic.

References

Centers for Disease Control and Prevention. (2022). HIV surveillance report, 2020 (Vol. 32). https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-32/content/2020/index.html

Centers for Disease Control and Prevention. (2023). HIV in the United States by Region. https://www.cdc.gov/hiv/statistics/overview/geographic_distribution.html

Paltiel, A. D., Zheng, A., & Walensky, R. P. (2021). Assessment of the health impact and cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States: A modeling study. JAMA Internal Medicine, 181(3), 367-376. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773078

National Institute of Allergy and Infectious Diseases. (2022). HIV/AIDS: The basics. https://www.niaid.nih.gov/research/hiv-aids-basics

 
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Standard Precautions & Sterile Precautions

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Standard Precautions & Sterile Precautions

When would you use standard precautions over sterile precautions while taking care of your patient and why? NOTE: 1-2 References; in-text citation

 

Standard Precautions vs. Sterile Precautions in Patient Care

In clinical practice, healthcare professionals must employ appropriate infection control measures to protect both patients and themselves. Standard precautions and sterile precautions are two essential strategies in this regard, each serving specific purposes based on the context of patient care.

When to Use Standard Precautions

Standard precautions are used in the care of all patients, regardless of their diagnosis or presumed infection status. These precautions are based on the principle that all blood, body fluids, secretions, and excretions (except sweat) may contain infectious agents. Therefore, standard precautions include practices such as:

  • Hand hygiene
  • Use of personal protective equipment (PPE), such as gloves, masks, and gowns, when necessary
  • Safe handling and disposal of sharps and contaminated materials

Standard precautions are essential in various settings, including routine assessments, medication administration, and general care of patients in acute and long-term healthcare facilities. The primary purpose is to minimize the risk of transmission of infections in healthcare environments (Centers for Disease Control and Prevention [CDC], 2023).

When to Use Sterile Precautions

Sterile precautions are utilized in situations where there is a high risk of introducing pathogens into sterile sites of the body or when performing invasive procedures. Examples include:

  • Surgical procedures
  • Inserting catheters or intravenous lines
  • Wound care involving open or deep wounds

Sterile precautions involve maintaining a sterile environment by using sterile instruments and materials, ensuring that healthcare providers follow strict protocols to prevent contamination. This practice is crucial in preventing healthcare-associated infections (HAIs) and ensuring patient safety during procedures that breach the body’s natural defenses (World Health Organization [WHO], 2022).

Conclusion

Standard precautions should be used universally for all patients as a foundational practice to reduce the risk of infection transmission. In contrast, sterile precautions are necessary during specific invasive procedures where the risk of contamination is heightened. Understanding the appropriate use of each precaution type is critical in providing safe and effective patient care.

References

Centers for Disease Control and Prevention. (2023). Standard precautions for all patient care. https://www.cdc.gov/infectioncontrol/guidelines/standard/overview.html

World Health Organization. (2022). Infection prevention and control. https://www.who.int/news-room/fact-sheets/detail/infection-prevention-and-control

 
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Reference Guide to EDI

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Reference Guide to EDI

Imagine you are the office manager at a small doctor’s office. As the office manager, you are in charge of educating new hires. Write a 700- to 1,050-word reference guide describing electronic data interchange (EDI). Include the following in your summary:

Define EDI.

Explain how using EDI facilitates electronic transactions.

Explain how HIPAA has changed how health care information is transmitted in EDI.

Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions.

Cite a minimum of two outside sources.

 

Reference Guide to Electronic Data Interchange (EDI) in Healthcare

As the office manager of a small doctor’s office, it is essential to ensure that new hires are well-educated on Electronic Data Interchange (EDI). EDI plays a crucial role in streamlining healthcare transactions and ensuring compliance with regulations such as the Health Insurance Portability and Accountability Act (HIPAA). This guide will define EDI, explain its benefits for electronic transactions, discuss HIPAA’s impact on EDI, and outline the relationship between Electronic Health Records (EHR), reimbursement processes, HIPAA, and EDI transactions.

Definition of Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI) is a standardized method for exchanging business documents and data electronically between organizations, eliminating the need for paper-based transactions. In healthcare, EDI allows for the seamless exchange of important documents such as insurance claims, payment remittances, patient eligibility inquiries, and more. These transactions follow specific standards set by organizations like the Accredited Standards Committee X12 (ASC X12) and the National Council for Prescription Drug Programs (NCPDP) to ensure uniformity and interoperability across different systems (Kahn, 2020).

Facilitating Electronic Transactions

Using EDI significantly facilitates electronic transactions in several ways:

  1. Efficiency and Speed: EDI enables rapid processing of transactions, allowing healthcare providers to send and receive information almost instantaneously. This efficiency reduces the time it takes to process claims and receive payments, leading to improved cash flow for healthcare providers.
  2. Cost Savings: By minimizing paper usage, postage, and manual processing costs, EDI lowers administrative expenses. These savings can be particularly beneficial for small practices trying to manage overhead costs.
  3. Improved Accuracy: EDI reduces the chances of human error that often occur with manual data entry. Standardized formats ensure that the information sent and received is consistent, leading to fewer rejected claims and discrepancies in patient records.
  4. Enhanced Data Security: EDI transactions can be encrypted and transmitted securely, protecting sensitive patient information during exchange. This feature is critical in maintaining patient confidentiality and complying with regulatory standards.

Impact of HIPAA on EDI

The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, significantly changed how healthcare information is transmitted via EDI. Key provisions of HIPAA include:

  1. Privacy Rule: HIPAA’s Privacy Rule establishes national standards for the protection of individually identifiable health information. EDI must comply with these standards, ensuring that sensitive patient data is only shared with authorized entities for legitimate purposes (U.S. Department of Health & Human Services, 2022).
  2. Security Rule: The HIPAA Security Rule sets standards for safeguarding electronic health information. This includes implementing technical safeguards like encryption and access controls, which are crucial when using EDI for transmitting sensitive data.
  3. Transaction Standards: HIPAA mandates the use of specific standards for EDI transactions, such as the X12 format for electronic claims submissions. This requirement ensures that all entities involved in the healthcare system utilize a consistent method for data exchange, facilitating smoother interoperability and communication.

Relationship Between Electronic Health Records, Reimbursement, HIPAA, and EDI Transactions

The integration of Electronic Health Records (EHR) with EDI transactions plays a vital role in the healthcare reimbursement process. Here’s how they are interconnected:

  1. EHR and EDI: EHR systems store comprehensive patient information, including demographics, medical history, and treatment plans. When healthcare providers submit claims for reimbursement, the data from the EHR can be automatically extracted and formatted into an EDI-compatible structure, streamlining the claims submission process.
  2. Reimbursement Process: Timely and accurate claims submission via EDI is essential for the reimbursement process. Insurance companies rely on electronic claims to assess the services provided and determine appropriate payment. Delays or errors in submitting EDI transactions can lead to payment delays, affecting the provider’s revenue cycle.
  3. Compliance with HIPAA: Compliance with HIPAA is paramount in all EDI transactions involving health information. Providers must ensure that any electronic data exchange adheres to HIPAA regulations, safeguarding patient information while facilitating timely reimbursements.
  4. Data Interoperability: The use of standardized EDI transactions allows different healthcare systems to communicate effectively. This interoperability ensures that patient data is accessible and up-to-date, which is essential for providing quality care and receiving appropriate reimbursements.

Conclusion

Electronic Data Interchange (EDI) is an essential tool in the healthcare industry, streamlining electronic transactions and improving the efficiency of claims processing and reimbursement. The implementation of HIPAA has strengthened the security and privacy of patient data transmitted via EDI, ensuring compliance with national standards. Understanding the relationship between EHR systems, reimbursement processes, HIPAA, and EDI transactions is critical for new hires in a healthcare setting, as it directly impacts the operational efficiency of the practice and the quality of patient care provided.

References

Kahn, R. (2020). Understanding electronic data interchange (EDI) in healthcare. Health IT Outcomes. https://healthitoutcomes.com/doc/understanding-electronic-data-interchange-edi-in-healthcare-0001

U.S. Department of Health & Human Services. (2022). Summary of the HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

 
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Foundational Neuroscience

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Foundational Neuroscience

The agonist-to-antagonist spectrum of psychopharmacologic agents In Psychiatry, medications are generally small molecules and act differently (Berg & Clarke, 2018). Traditional receptor theory states that ligands activate receptor sites and act as agonists with various degrees of intrinsic efficacy or as antagonists with zero intrinsic efficacy (Berg & Clarke, 2018). Inverse agonists have the opposite effect of an agonist and reduce the “constitutive” activity of the receptor (Berg & Clarke, 2018). Psychopharmacologic agents can be agonists, antagonists, and simultaneously agonists, antagonists, and inverse agonists acting at the same receptor (Berg & Clarke, 2018). Agonists act to mimic the action of an endogenous neurotransmitter (Berg & Clarke, 2018). Antagonists block the effects of endogenous neurotransmitters and oppose normal synaptic transmission (Berg & Clarke, 2018). Partial agonists act somewhat like agonists in that they directly act on receptors, but if used in the presence of an agonist, they compete for the receptor and have partial blocking properties; hence they are sometimes called agonist–antagonists (Berg & Clarke, 2018).

(Foundational Neuroscience)

G Couple Proteins and Ion Gated Channels

A neurotransmitter can affect the activity of a postsynaptic cell via two different types of receptor proteins (Purves et al., 2001). Ionotropic receptors are linked directly to ion gated channels. These receptors contain two features: an extracellular site that binds neurotransmitters and a “membrane-spanning domain” that forms an ion channel (Purves et al., 2001). The second family of neurotransmitters receptors does not have ion channels as part of their structure; instead, they affect channels by activating intermediate molecules called G-proteins (Purves et al., 2001). G protein-coupled receptors (GPCRs) are the largest known class of membrane receptors and are the target of about 30-50% of modern medicinal drugs (Purves et al., 2001). When signaling molecules, or ligands, bind to GPCRs, G-protein activation triggers the production of second messengers, like hormones (Purves et al., 2001). Like in GPCRs, ligands also bind to ion gated channels and initiate a chemical response. Once the ligand binds to the allosteric site of the ligand-gated ion receptor, the channel opens, and the ion permeability of the entire plasma membrane can quickly change (Purves et al., 2001). When the channel opens, ions like potassium, sodium, or calcium can move through the open channel, and an electrical signal is generated inside the cell (Purves et al., 2001). Ligand-gated ion channel receptors generally mediate rapid postsynaptic effects, while activating metabotropic receptors (GPCRs) typically produce a much slower response (Purves et al., 2001).

(Foundational Neuroscience)

Epigenetics

Epigenetics are chemical modifications that can silence or activate genes without modifying the nucleotide sequence (Stefanska & MacEwan, 2015). It describes “genetic information that is ‘beyond’ or ‘above’ that information coded solely by our genetic code” (Stefanska & MacEwan, 2015, p. 2702). Often epigenetic variations are the cause of an underlying disease (Stefanska & MacEwan, 2015). Drugs may not be designed to be as exact to a particular ligand or specific to a particular gene or protein subtype; they may indeed have to be able to be broader ‐ acting over a range of epigenetic large-scale events (Stefanska & MacEwan, 2015). Pharmacological intervention may need to focus on one type of ligand or a particular gene. Still, rather drugs may need to be more “broad” to work more effectively against certain diseases (Stefanska & MacEwan, 2015). Such knowledge can provide a strong biological foundation for developing better targeted personalized medication strategies (Stefanska & MacEwan, 2015). Epigenetic modification can be influenced by environmental factors such as recreational drugs, diet, and exercise (Stefanska & MacEwan, 2015). “Transcription and numerous other genomic functions are epigenetically controlled via heritable but potentially reversible changes in DNA modification and histones (acetylation, methylation, phosphorylation)” (Browne et al., 2020, p. 22).

Impact on Patients

Psychiatric nurse practitioners need to consider epigenetics when prescribing medications. An example would be in the treatment of patients who have opioid use disorder. Susceptibility to opioid addiction is known to be strongly influenced by environmental factors. Thus, epigenetics could be important for understanding individual vulnerability to addiction and response to treatment (Hurd & O’Brien, 2018). “The epigenetic mechanisms that turn genes on and off to set the state of gene expression patterns and thus cellular function include methylation of DNA and modifications (e.g., methylation, acetylation, and phosphorylation) of histones” (Hurd & O’Brien, 2018, p. 938). An example of an epigenetic change in chronic heroin users includes increased methylation of the OPRM1 gene, which leads to reduced mu-opioid receptors (Hurd & O’Brien, 2018). A reduction of mu-opioid receptors translates to a higher dose of opioids needed to satisfy the prior therapeutic effect (Hurd & O’Brien, 2018). Frontline treatment of opioid addiction with mu OR agonists or partial agonists, such as methadone or buprenorphine, produces epigenetic modifications (Browne et al., 2020).

(Foundational Neuroscience)

References

Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: Inverse agonism and functional selectivity. International Journal of Neuropsychopharmacology, 21(10), 962–977. https://doi.org/10.1093/ijnp/pyy071

Browne, C. J., Godino, A., Salery, M., & Nestler, E. J. (2020). Epigenetic mechanisms of opioid addiction. Biological Psychiatry, 87(1), 22–33. https://doi.org/10.1016/j.biopsych.2019.06.027

Hurd, Y. L., & O’Brien, C. P. (2018). Molecular genetics and new medication strategies for opioid addiction. American Journal of Psychiatry, 175(10), 935–942. https://doi.org/10.1176/appi.ajp.2018.18030352

Nutt, D., & Lingford-Hughes, A. (2007). Key concepts in psychopharmacology. Psychiatry, 6(7), 263–267. https://doi.org/10.1016/j.mppsy.2007.05.002

Purves, D., Augustine, G. J., Fitzpatrick, D., Katz, L. C., LaMantia, A.-S., McNamara, J. O., & Williams, S. M. (2001). Neuroscience (2nd ed.). Sinauer Associates.

Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. British Journal of Pharmacology, 172(11), 2701–2704. https://doi.org/10.1111/bph.13136

Stern, T. A., Fava, M., Wilens, T. E., & Rosenbaum, J. F. (2016). Massachusetts General Hospital Psychopharmacology and Neurotherapeutics e-book (1st ed.).

 
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Case Study Week 5

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Case Study Week 5

Read Case Study and submit APA Paper.

Instructions: Read CASE STUDY: BEWARE: One Emergency May Hide Another! and submit APA Paper, write a paper addressing the following:
a. Which nursing standards were violated in this case study?
b. What could have been done to avoid the problem?

Paper must be at least 1 page, excluding title page and reference page. (at least 1 reference no more than 5 years old), make sure to reference the article.

CASE STUDY—BEWARE: One Emergency May Hide Another!

A hospital submitted a report to the State Board of Nursing reporting that an RN had been terminated after the death of a patient following surgery for a tubal pregnancy.

(Case Study Week 5)

THE NURSE’S STORY—SALLY SIMMS, RN

I had worked the medical-surgical units at the General Hospital ever since graduating from my nursing program 4 years before. This was the worst night, the worst shift, of my nursing career.

I was assigned to care for eight patients that night, which is not an unusual number of patients, but they all were either fresh post-ops or so very sick. Four patients had just had surgery that day. One patient was on a dopamine drip to maintain his blood pressure, so he needed frequent monitoring. One patient was suspected to have meningitis, one patient had pneumonia, and a patient with suspected histoplasmosis completed my assignment.

One of my post-op patients was Betty Smith, a young woman in her early thirties who had laparoscopic surgery late in the day. She had been transferred from the recovery room late in the evening shift and was very uncomfortable when I first made my rounds. At 12:05 am, I called Betty’s physician because she was vomiting and thrashing in bed. Per his order, I medicated the patient with Phenergan.

The next time I checked on Betty, she seemed to be more comfortable, but I realized that her IV had infiltrated. I was really overwhelmed with meeting the needs of all my patients, so I asked Joan Jones, the charge nurse, to restart Betty’s IV. It was about 2:00 am when Nurse Joan restarted the IV.

I had been able to pretty much stay on top of everything at that point in the shift, and by 2:30 am I had assessed all my patients, given pain medications, and called four physicians to update them regarding their patients and for various orders. I thought things were settling down. I thought wrong.

Mrs. Holmes, the patient with histoplasmosis, seemed a bit off from when I had cared for her the previous two nights. Mrs. Holmes’ vital signs were unstable and her O2 saturation was only 80%. I notified her physician and he ordered stat arterial blood gases. The lab called with the results, and they were alarming. Mrs. Homes was losing ground, and her physician ordered us to transfer her to the ICU. I was preoccupied with accomplishing the transfer and accompanied Mrs. Holmes to the unit. I returned from the ICU at about 3:50 am.

On my return, I first checked the patient who was on dopamine, medicated another patient for pain, and did visual checks on the rest of the patients who all seemed to be sleeping. I began my charting.

At 6:05 am, I went to start IV antibiotics on Betty’s roommate, and to my horror discovered Betty was not breathing. I called the code. The first time I discovered that Betty had had a low blood pressure and elevated pulse was when I checked the vital signs sheet when the ER physician (who responded to the code) asked how Betty’s vital signs had been during the shift. The nurse’s aide who was assigned to monitor Betty had not informed me, and I had not checked the vital signs sheet.

It was such a terrible night; I was so busy with the transfer and caring for the other patients. Betty just had an outpatient procedure; if she had been earlier on the surgical schedule, they would have sent her home. I did not physically check her vital signs, and the aide did not report the elevated pulse and low blood pressure. I depended on the aide—my mistake. I know I was responsible.

I was terminated from employment and reported to the board of nursing. I have taken myself out of nursing; something died in me when I found my patient.

(Case Study Week 5)

EMPLOYMENT EVALUATIONS

An evaluation conducted a few weeks before the incident showed mostly good ratings (11) with three excellent ratings. The hospital would consider reemployment if Ms. Simms improved her critical thinking skills.

PATIENT MEDICAL RECORDS

Surgery Notes—Laparoscopy to remove unruptured ectopic pregnancy from distal portion of the fimbriae with estimated blood loss of 150 cc, three references to homeostasis, two references to cautery, patient “… to recovery room in excellent condition.”

Recovery Room Nurse’s Notes—In recovery 2110 to 2300, initial post-op flow sheet noted at 2210 BP 124/74, pulse 94; at 2225 BP 123/65; at 2240 BP 107/85, pulse 123. Assessment signed at 2220 “abdomen distended with few faint bowel sounds … patient shivering, c/o [complained of] abdominal pain, medicated ×3 [three times] with IVP Demerol, total of 50 mg. Patient awake, three dressings dry. No c/o N/V/D.” [No complaints of nausea, vomiting or diarrhea.]

Medication Record—Patient received Demerol 50 mg. with 25 mg Phenergan IM at 2215 and 0200.

Cardiopulmonary Resuscitation Record—Compressions noted at 6:08 am. [RN had initiated code at 5:55 am], MD arrived at 6:15 am, patient intubated at 6:20 am, patient administered atropine ×3, Eppy [epinephrine] ×5 [five times], bicarbonate [of sodium] ×2 [two times]. Pacemaker never captured. Patient never had return of spontaneous pulses and pronounced dead at 6:38 am.

Death Certificate—Immediate cause of death was hemoperitoneum due to postoperative hemorrhage of placental tissues after salpingotomy for a right tubal ectopic pregnancy.

(Case Study Week 5)

BOARD ACTION

Ms. Simms entered into a consent agreement with the board of nursing, admitting that her conduct constituted a failure to practice in accordance with acceptable and prevailing standards of safe nursing care. Nursing standards cited were failure to assess and document the health status of the patient, failure to provide ongoing patient monitoring, and failure to communicate appropriately with members of the health care team.

Ms. Simms’ license was probated with stayed suspension for 2 years, with requirements for successful completion of ordered education including an advanced assessment course at an educational/collegiate institution, continuing education hours in risk management/legal issues in nursing (in addition to continuing education hours required for license renewal). Order noted RN’s voluntary evaluation by a mental health care professional and her compliance with all aspects of the treatment plan. Other terms included quarterly reports from nursing employer and self-reports. Ms. Simms was required to appear in person (as requested) for an interview with the Board or a board-designated representative.

COMMENTARY

This case example illustrates a cascade of clinical events that caused errors in clinical judgment, all of which are related to work overload and consequent lack of surveillance and monitoring of the patient. Nurse Simms made faulty assumptions that the young patient with a tubal pregnancy was her least acute patient. Of course the patient is the primary victim, but Nurse Simms also suffered greatly from this tragic incident, which was precipitated by a collection of untoward events and work overload.
(Case Study Week 5)

 

References

Wong, S. K., & Cummings, G. G. (2019). The impact of nurse staffing on patient outcomes: A systematic review. International Nursing Review, 66(2), 215-223. https://doi.org/10.1111/inr.12539

Peters, L., & Borkowski, N. (2021). The role of effective communication in nursing: Implications for patient safety. Nursing Management, 52(3), 30-35. https://doi.org/10.1097/01.NUMA.0000731209.83585.a0

 
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Mental Health Disorders

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Mental Health Disorders

WK8 ASSIGN 1 NURS 6630

Assignment 1: Short Answer Assessment

As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders.

Photo Credit: Getty Images/Collection Mix: Sub

To Prepare

Review the Learning Resources for this week. Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders. Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.

To complete:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with Major Depressive Disorder and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms?

List 4 predictors of late onset generalized anxiety disorder.

List 4 potential neurobiology causes of psychotic major depression.

An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the episode to occur. Be specific.

List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.

Learning Resources

Required Readings (click to expand/reduce)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/

Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf

Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740

Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

alprazolam
amitriptyline
amoxapine
amphetamine
desipramine
diazepam
doxepin
eszopiclone
flunitrazepam
flurazepam
hydroxyzine
imipramine
lemborexant
lorazepam
melatonin
methylphenidate
modafinil
armodafinil
carnitine
clomipramine
clonazepam
nortriptyline
pitolisant
ramelteon
sodium oxybate
solriamfetol
selective serotonin reuptake inhibitors
temazepam
trazodone
triazolam
trimipramine
wellbutrin
zaleplon
zolpidem

USE 6 RESOURCES FROM THE SCHOOL RESOURCES

 
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Adolescent Behavior and Well-Being

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Adolescent Behavior and Well-Being

Research the range of contemporary issues teenagers face today. In a 500-750-word paper, choose one issue (besides teen pregnancy) and discuss its effect on adolescent behavior and overall well-being.

Include the following in your submission:

Describe the contemporary issue and explain what external stressors are associated with this issue.

Outline assessment strategies to screen for this issue and external stressors during an assessment for an adolescent patient.

Describe what additional assessment questions you would need to ask and define the ethical parameters regarding what you can and cannot share with the parent or guardian.

Discuss support options for adolescents encountering external stressors. Include specific support options for the contemporary issue you presented.

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

 

The Impact of Social Media on Adolescent Behavior and Well-Being

Social media has emerged as a significant force in the lives of adolescents today. It offers various platforms for communication, entertainment, and self-expression. However, while social media can provide numerous benefits, it also introduces several challenges that can negatively affect adolescent behavior and overall well-being. This paper discusses the impact of social media on adolescents, focusing on the external stressors associated with its use, assessment strategies for identifying these stressors, and support options for affected youth.

Contemporary Issue: Social Media

Social media platforms like Instagram, Snapchat, and TikTok have become integral to adolescents’ daily lives. They serve as venues for social interaction, information sharing, and personal expression. However, the pervasive nature of social media also presents various external stressors, including cyberbullying, social comparison, and exposure to inappropriate content.

External Stressors

Cyberbullying is a prevalent issue linked to social media use. It can manifest in various forms, including harassment, threats, and public shaming. The anonymity afforded by social media often emboldens perpetrators, making it easier for them to target victims without fear of consequences. Moreover, social comparison is another external stressor, as adolescents often evaluate their self-worth based on the curated lives of their peers displayed online. This phenomenon can lead to feelings of inadequacy, anxiety, and depression. Additionally, adolescents may encounter inappropriate content, including sexual imagery or violent material, which can further contribute to emotional distress.

Assessment Strategies

To effectively address the impact of social media on adolescents, healthcare providers should utilize comprehensive assessment strategies during patient evaluations. Screening tools can include standardized questionnaires that assess social media usage patterns, experiences with cyberbullying, and mental health symptoms.

During the assessment, additional questions should be posed, such as:

  • How much time do you spend on social media daily?
  • Have you experienced any negative interactions online?
  • How do you feel when you compare yourself to others on social media?

These questions can help uncover the adolescent’s relationship with social media and identify any potential stressors.

Ethical Parameters

In terms of ethical considerations, healthcare providers must navigate the balance between patient confidentiality and the need to involve parents or guardians. Adolescents have the right to confidentiality regarding sensitive issues, including mental health concerns related to social media. However, providers can share general information about the adolescent’s struggles without disclosing specific details.

It is crucial to obtain informed consent from the adolescent before discussing any sensitive topics with parents or guardians, as this fosters trust and encourages open communication.

Support Options

Supporting adolescents encountering external stressors related to social media requires a multi-faceted approach. Schools and community organizations can implement programs that educate youth about the responsible use of social media and the dangers of cyberbullying.

Counseling services can also play a vital role in providing emotional support and coping strategies. Cognitive-behavioral therapy can help adolescents reframe negative thoughts stemming from social comparison and develop healthier self-esteem. Additionally, parents can be encouraged to engage in open dialogues with their children about their online experiences, fostering a supportive environment where adolescents feel safe discussing their challenges.

Conclusion

Social media presents both opportunities and challenges for adolescents. While it serves as a platform for connection and self-expression, it also introduces significant external stressors that can negatively impact behavior and overall well-being. By employing effective assessment strategies and providing appropriate support options, healthcare providers can help adolescents navigate the complexities of social media use, promoting healthier relationships with technology and improved mental health outcomes.

 

References

American Psychological Association. (2019). The impact of social media on adolescents.  https://www.apa.org/news/press/releases/stress/2019/social-media-adolescents

Twenge, J. M., & Campbell, W. K. (2018). The age of anxiety: How social media is causing the rise in anxiety and depression among adolescents. American Journal of Psychiatry, 175(9), 883-884. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2018.18050690

Nesi, J., & Prinstein, M. J. (2015). Using social media for peer interactions: The role of adolescents’ social media use in their emotional and behavioral adjustment. Journal of Clinical Child & Adolescent Psychology, 44(5), 760-774.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531038/

 
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Incivility and Healthful Environments

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Incivility and Healthful Environments

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to: Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care (CO1). Apply concepts of person-centered care to nursing practice situations (CO2). Analyze essential skills needed to lead within the context of complex systems (CO3). Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings (CO4).

(Incivility and Healthful Environments)

Integration of Evidence

The student post provides support from a minimum of one scholarly in-text citation with a matching reference AND assigned readings OR online lessons, per discussion topic per week.

What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC). It contains references for sources cited, is written by a professional or scholar in the field and indicates credentials of the author(s), and is no more than 5 years old for clinical or research articles.

What is not considered a scholarly resource? Newspaper articles and layperson literature (e.g., Readers Digest, Healthy Life Magazine, Food, and Fitness) Information from Wikipedia or any wiki, textbooks, website homepages, and the weekly lesson. Articles in healthcare and nursing-oriented trade magazines, such as Nursing Made Incredibly Easy and RN Magazine (Source: What is a scholarly article.docx; Created 06/09 CK/CL Revised: 02/17/11, 09/02/11 nlh/clm).

Can the lesson for the week be used as a scholarly source? Information from the weekly lesson can be cited in a posting; however, it is not to be the sole source used in the post.

Are resources provided from CU acceptable sources (e.g., the readings for the week)? Not as a sole source within the post. The textbook and/or assigned (required) articles for the week can be used, but another outside source must be cited for full credit. Textbooks are not considered scholarly sources for the purpose of discussions.

Are websites acceptable as scholarly resources for discussions? Yes, if they are documents or data cited from credible websites. Credible websites usually end in .gov or .edu; however, some .org sites that belong to professional associations (e.g., American Heart Association, National League for Nursing, American Diabetes Association) are also considered credible websites. Websites ending with .com are not to be used as scholarly resources.

Professionalism in Communication

The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.

Wednesday Participation Requirement

The student provides a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.

Total Participation Requirement

The student provides at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

(Incivility and Healthful Environments)

Preparing the Assignment

Introduction

This graded discussion will explore the impact of systems theory on a practice problem or issue. Please provide an initial response to the discussion question by Wednesday at 11:59 PM MT and two interactive dialogue responses no later than Sunday 11:59 PM MT at the end of WEEK 7. The discussion is worth 75 points. Please refer to the discussion grading rubric for additional criteria.

Assignment

Reflect on an experience in which you were directly involved or witnessed incivility in the workplace. Provide a brief synopsis of the situation. How did this make you feel? How did you respond? What were the consequences of this situation? Provide an example of how this negatively affected the work environment and outcomes. How could the situation have been prevented? Discuss strategies that would support a healthy work environment.

Reading:

American Nurses Association. (2015). Incivility, bullying, and workplace violence [Position Statement]. https://www.nursingworld.org/~49baac/globalassets/practiceandpolicy/nursing-excellence/official-policy-statements/ana-wpv-position-statement-2015.pdf

Centers for Disease Control and Prevention. (2013). Workplace violence prevention for nurses. http://wwwn.cdc.gov/wpvhc/Course.aspx/Slide/Unit1_5Edmonson, C., Bolick, B., & Lee, J. (2017). A moral imperative for nurse leaders: Addressing incivility and bullying in health care. Nurse Leader, 15, 40-44. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.mnl.2016.07.012

Lachman, V. D. (2015). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. Urologic Nursing, 35(1), 39—42.

Phillips, J. M., Stalter, A. M., Winegardner, S., Wiggs, C., & Jauch, A. (2018). Systems thinking and incivility in nursing practice: An integrative review. Nursing Forum, 53(3), 286-298. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1111/nuf.12250

Roberts, S. J. (2014). Lateral violence in nursing: A review of the past three decades. Nursing Science Quarterly, 28(1), 36-41. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1177/0894318414558614

Optional Resources:

American Nurses Association. (n.d.). Violence, incivility and bullying. http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolence

America Nurses Association. (2016). Healthy nurse, healthy nation. http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse

Mennella, H. D. A.-B., & Karakashian, A. R. B. (2017). Lateral violence in nursing. CINAHL Nursing Guide. https://doi.org/10.1177/0894318414558614

 
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Quality Healthcare

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Quality Healthcare

Reflect upon the patient experience, patient safety, and healthcare cost as well as Joint Commission’s role in quality healthcare.

Write a paper that addresses the following questions:

How would you apply the principles of the Triple Aim initiative to improve quality, safety and satisfaction in the acute care or long-term care setting?

Reflect on your current or future role in healthcare.

How you would you, in the role of director of nursing or healthcare administrator contribute to improving cost effective quality care, patient satisfaction, and patient safety?

What practices would you apply to minimize medical errors among front-line nursing staff?

 

Improving Patient Experience, Safety, and Healthcare Cost: The Role of the Triple Aim Initiative

The patient experience, safety, and healthcare cost are interconnected elements essential to delivering quality healthcare. The Joint Commission plays a pivotal role in ensuring that healthcare organizations maintain high standards for safety and quality. By focusing on these areas, healthcare professionals can enhance patient outcomes and satisfaction while managing costs effectively. This paper explores how the principles of the Triple Aim initiative can be applied to improve quality, safety, and satisfaction in acute and long-term care settings. Additionally, it reflects on the role of a healthcare administrator in promoting cost-effective quality care and minimizing medical errors among nursing staff.

Applying the Principles of the Triple Aim Initiative

The Triple Aim initiative, developed by the Institute for Healthcare Improvement, focuses on three primary objectives: improving patient experience, improving the health of populations, and reducing per capita healthcare costs.

  1. Improving Patient Experience: In an acute care setting, implementing patient-centered care approaches can enhance patient satisfaction. This involves actively involving patients in their care decisions, providing clear communication, and fostering a supportive environment. Techniques such as bedside reporting, where nurses communicate with patients about their care plans directly at the bedside, can enhance transparency and trust.
  2. Improving Population Health: In both acute and long-term care settings, preventive care measures can significantly improve population health. For instance, screening programs for chronic conditions (e.g., diabetes and hypertension) and health education initiatives can empower patients to manage their health proactively. Establishing community partnerships to address social determinants of health can also lead to better health outcomes.
  3. Reducing Healthcare Costs: Cost-effective strategies can be implemented to minimize unnecessary tests and procedures. Adopting evidence-based practices and care pathways can streamline care processes and reduce waste. Additionally, implementing technology such as electronic health records can facilitate better data management, ultimately contributing to cost savings.

The Role of a Director of Nursing or Healthcare Administrator

In the role of a director of nursing or healthcare administrator, one can significantly contribute to improving cost-effective quality care, patient satisfaction, and patient safety by:

  1. Fostering a Culture of Safety: Establishing a culture of safety within the organization encourages staff to report errors and near misses without fear of retribution. This transparency allows for the identification and mitigation of risks before they result in harm to patients.
  2. Investing in Staff Training and Development: Continuous education and training for nursing staff on best practices and evidence-based protocols can lead to enhanced competency and confidence in their roles. This training should also emphasize the importance of effective communication, teamwork, and patient engagement.
  3. Utilizing Data for Quality Improvement: Implementing robust data collection and analysis processes enables administrators to monitor key performance indicators related to patient safety and satisfaction. By identifying trends and areas needing improvement, targeted interventions can be developed to enhance care quality.

Minimizing Medical Errors Among Front-Line Nursing Staff

To minimize medical errors among front-line nursing staff, several practices can be employed:

  1. Standardized Protocols and Checklists: Utilizing standardized protocols and checklists for medication administration, patient handoffs, and procedures can reduce variability in practice and enhance adherence to safety guidelines. The use of a surgical safety checklist, for instance, has been shown to significantly reduce surgical errors and complications (Haynes et al., 2009).
  2. Implementing Technology Solutions: Electronic medication administration systems and clinical decision support tools can aid nurses in verifying medication orders, thereby reducing the likelihood of errors. These technologies can provide alerts for potential drug interactions, allergies, and dosing errors.
  3. Encouraging a Team-Based Approach: Promoting teamwork among healthcare professionals fosters an environment where nurses feel supported and empowered to speak up about concerns. Regular interdisciplinary team meetings can facilitate communication and collaboration, ultimately enhancing patient safety.

Conclusion

Applying the principles of the Triple Aim initiative can significantly improve patient experience, health outcomes, and reduce healthcare costs in acute and long-term care settings. As a director of nursing or healthcare administrator, promoting a culture of safety, investing in staff development, and utilizing data-driven approaches can lead to cost-effective quality care. By implementing standardized protocols, leveraging technology, and encouraging teamwork among nursing staff, medical errors can be minimized, thereby enhancing patient safety and satisfaction.

References

Haynes, A. B., Weiser, T. G., Berry, W. R., et al. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360(5), 491-499. https://doi.org/10.1056/NEJMsa0810119

Institute for Healthcare Improvement. (n.d.). The Triple Aim: Care, Health, and Cost. https://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx

Joint Commission. (2021). Quality and Safety. https://www.jointcommission.org/resources/patient-safety-topics/quality-and-safety/

World Health Organization. (2015). WHO Global Strategy on People-Centered and Integrated Health Services: Interim Report. https://www.who.int/alliance-hpsr/alliancehpsr_who_global_strategy_on_people-centered_integrated_health_services_report.pdf

 
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Critical Thinking Abortion

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Critical Thinking Abortion

Answer as short as possible. There are 15 questions. L.W., a 20-year-old college student, comes to the university health clinic for a pregnancy test. She has been sexually active with her boyfriend of 6 months, and her menstrual period is now “a few” weeks late. The pregnancy test result is positive. The patient begins to cry, saying, “I don’t know what to do.”

(Critical Thinking Abortion)

  1. How will you begin to counsel L.W.?
  2. What information do you need to obtain from L.W. and why?
  3. What options does a woman experiencing a pregnancy have?
  4. If your role is to assist her in making a choice, what information will you want L.W. to provide?
  5. What are the nurse’s moral and ethical obligations in this situation?
  6. L.W. asks you to tell her about abortion. What will you tell her?
  7. You tell L.W. there are two types of abortions, vacuum aspiration and medical abortion. How would you explain the difference to her?
  8. What are the contraindications to using mifepristone (Mifeprex) for a medical abortion?
  9. She tells you that she has heard that if a woman has an abortion, she might not be able to get pregnant again. How would you counsel her?
  10. L.W. asks you, “Do you think abortion is killing?” What is your best response?
    a. “Good question. What do you think about it?”
    b. “A lot of people think this is what an abortion is.”
    c. “Absolutely not. What happens with pregnancy is a woman’s choice.”
    d. “I am not able to answer that question. Are you uncertain about abortion as an option?”
  11. What types of emotional reactions do women experience after an abortion?
  12. L.W. wants to know about adoption. What will you tell her?
  13. You ask L.W. if her boyfriend is aware of the possibility she was pregnant. She tells you that she did not tell him about her period being late or her visit to the clinic today. She asks you if she should tell him because she is afraid he will “freak out.” How should you respond?
  14. L.W. says she is uncertain as to what to do and wants to know how long she has to decide. How will you respond?
  15. L.W. declines an examination and says she needs to “think about all this.” She does make an appointment to return in 1 week. What teaching do you need to provide L.W. about how to care for herself in the meantime? How will you respond?

References

American College of Obstetricians and Gynecologists. (2020). Induced Abortion: A Resource for the Primary Care Physician.
https://www.acog.org/-/media/project/acog/acogorg/clinical/files/clinical-guideline/induced-abortion-a-resource-for-the-primary-care-physician.pdf

National Abortion Federation. (2021). Patient Education: The Basics of Abortion. https://www.prochoice.org/wp-content/uploads/2021/02/patient-education-abortion.pdf

 
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