Respond of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings as a Psychiatric Nurse Practitioner.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be able to reveal if the patient consumes a vast amount of sugar or caffeine which could interrupt sleep.
Questions to the son would surround the family’s psychiatric history. These questions will help the nurse practitioner construct the family history of the patient and rule out or consider familial history as a cause for her symptoms.
Can you recall any maternal family members with psychiatric disorders including depression and insomnia?
Did the symptoms start after the death of the client’s husband?
This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.
Physical Examinations and Tests
Sleep Study:
Polysomnogram – The sleep study or polysomnogram measures the brain waves, blood oxygen, leg movements and breathing during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be able to rule out physiological reason’s ad the cause for the patient’s insomnia.
Actigraphy: This is where a small device is worn on the wrist and it measures the person’s sleep wake cycle for a specified period (Meghdadi et al., 2019). This is convenient for this client and the Nurse Practitioner would be able to monitor the client’s sleep health and gauge the severity of the disruption of her sleep.The nurse practitioner could also physically examine the patient’s nares for septal occlusion.
Septal occlusion or deviation could lead to problems with sleeping even during sleep, this would be important for the nurse practitioner to evaluate as this could be interfering with the patient’s sleep.
Epworth sleepiness scale – assesses the patient’s tendency to nod off in various situations (Meghdadi et al., 2019). For this client it would be necessary for the nurse practitioner to assess the severity of her nodding off during the day time especially at unexpected times like during eating and other activities that would put her safety at risk.
Differential Diagnosis
G47.00 Unspecified Insomnia Disorder– The patient is experiencing insomnia at nighttime that could be related to several factors. She reports staying up late to watch T.V., depressive symptoms, restless leg syndrome, sleep apnea and sleeping during the daytime. Some of these factors have not been ruled out yet as the cause of her anxiety.
G47.23 Persistent Irregular Sleep Wake type severe
F32.9 Unspecified Depressive Disorder
G25.81 Restless legs syndrome
Medications:
Trazodone 50 mg – This medication would be the first choice as it offers antidepressant properties as well as promotes sleep in those diagnoses with insomnia. It is generally safe for the elderly population at low doses (Pagel et al., 2018). The Nurse Practitioner should monitor the patient and evaluate the needs to slowly increase or in some cases decrease the dose.
Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep. The patient would benefit from his, but an added benefit would be that she would be at a diminished risk of falls as this is a concern following the use of hypnotics in the elderly. This drug is reported as one that would prevent less falls from over sedation (Pagel et al., 2018).
Lessons Learned
This writer has learned that it is important to conduct a complete evaluation of the patient and not just focus on the presenting symptoms. There are additional environmental and physiological symptoms that could be attributed to the patient’s insomnia. In this case the patient had several factors that could be contributing her insomnia and they needed to be ruled out. The cause of her insomnia could have been physiological from the sleep apnea or from her habits of staying up tool late at nights and sleeping during the daytime. It is also important to evaluate medications, social and economic factors before the resorting to pharmacological interventions.
References
Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2020). Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332.
FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., &
Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68.
Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., & Verma, A. (2019). Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE Journal of Translational Engineering in Health and Medicine, Translational Engineering in Health and Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.
Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K,
Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 155.
Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J., Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.
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Post Samatha P Nursing Informatic
/in Uncategorized /by developerRespond to the post bellow, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Technology and data sharing have becoming a vital part of the healthcare industry. Information technology has made many strides in the areas of patient care, communication and record storage (Funk, 2015). In the past, retreiving a piece of health record would take an extensive amount of time and records were at risk of being lost on paper files.
Healthcare Technology Trends and Benefits
Through information technology, physicians are able to perform laparoscopic surgeries and bypass invasive procedures. This not only cuts the cost for the patient and facility but in turn decreases the amount of complication the patient could receive from a more extensive surgery (Funk, 2015). In terms of patient care, we are introduced to the electronic medical record. Health team members are able to view patient information and clinicals, even from a remote area. This has expedited patient care as providers are able to make prompt decisions and capable of amending the treatment plan from any location (Funk, 2015). In terms of communication, each discipline has the capability of documenting the patient’s progress to regression and communicate this information to the rest of the healthcare team.
Potential Risks
Potential risks that could ensue from these trends pose a major threat to the patient’s safety. Through electronic medical record, patient’s personal information and healthcare information at risk for theft (Funk, 2015). Many organizations try to manage theft by only allowing data to be transferred over secured networks only (Nash, 2013). Organizations also spend a lot of time on staff education on keeping data safe and recognizing threats such as malware, viruses and hackers that could cause a threat to the information system (Nash, 2013). With providers gaining access to document from remote locations this increases the risk of others outside of the healthcare team viewing the information. It is up to the provider to maintain privacy and keep the patient’s records confidential. In the area of record storage, organizations invest a lot of money into securing these documents and protecting patient information. When patient’s information moves from paper to electronic, the risk for theft and hacking of the information systems increase (Sheffer, 2017). On the other hand, electronic storage of medical records allows easy retrieval of the records which is why it is highly sought after.
The risks involved in using technology in patient care comes from the increased radiation from some very high-tech procedures and less patient care which is result of healthcare members spending too much time on technology and less on actual patient care (Funk, 2015). It appears that the increased pressure placed on healthcare workers to keep up with electronic documentation has cause healthcare workers to spend less time at the bedside and more documenting.
Promising Trends
The one trend that could impact nursing care would be that of documenting from remote areas. At this time, only providers have this benefit in my organization but I believe it could be helpful for nurses to be able to view patient records, check labs and orders and possibly get prepared for their day ahead all by accessing data from a remote area.
References
Funk, M. (2015). As Health Care Technology Advances: Benefits and Risks. American
Journal of Critical Care, 20(4), 285–291.
Nash, D. B. (2013). Technology Trends in Healthcare. American Health & Drug Benefits, 6(1),
1–2.
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Post Samatha
/in Uncategorized /by developerRespond of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings as a Psychiatric Nurse Practitioner.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake constantly?
Do you ingest any stimulants like coffee or chocolate before bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the patient’s depression. She appears to have been suffering with untreated depression for a long time, however the additional symptoms of insomnia and tearfulness seemed to worsen after his death. With this information the nurse practitioner will know if her depression is in an acute state and the severity of her illness.The patient is reporting sleeplessness; however the nurse practitioner needs to gauge if the patient is participating in restful sleep. Sleep of two hours or less may only consist of REM sleep (Boland et al., 2020). If the patient is not getting restful sleep, she is not benefiting from the bodily repair that takes place during sleep (Fitzgerald et al., 2017). This can place her at an increased risk for other illnesses and heighten depressive symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps consistently throughout those hours of sleep will provide information to the nurse about the kind and amount of sleep the patient is getting. Ingesting certain stimulants like caffeinated drinks, coffee or chocolate can affects the client’s sleep by providing wakefulness (Ulke et al., 2017). If the patient is sleeping during the daytime, her circadian rhythm could have been reversed where she will need less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about observed sleepiness during the daytime. In addition, she will be able to provide information on the patient’s dietary patterns and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.
It appears that she in fact getting sleep but because of a revered circadian rhythm she is not able to get the sleep at the night which is the desired time. Question two will help the nurse practitioner gauge the extent of the effects that non sleep has taken on the patient’s life. The patient, if constantly fatigued throughout the day has a life that has been highly impacted by the lack of sleep. The aide would be able to provide a clear, picture of the patient’s diet. The aide would be able to reveal if the patient consumes a vast amount of sugar or caffeine which could interrupt sleep.
Questions to the son would surround the family’s psychiatric history. These questions will help the nurse practitioner construct the family history of the patient and rule out or consider familial history as a cause for her symptoms.
Can you recall any maternal family members with psychiatric disorders including depression and insomnia?
Did the symptoms start after the death of the client’s husband?
This would help the nurse practitioner rule out depressive symptoms as the cause of her insomnia.
Physical Examinations and Tests
Sleep Study:
Polysomnogram – The sleep study or polysomnogram measures the brain waves, blood oxygen, leg movements and breathing during sleep (Meghdadi et al., 2019). The Nurse Practitioner would be able to rule out physiological reason’s ad the cause for the patient’s insomnia.
Actigraphy: This is where a small device is worn on the wrist and it measures the person’s sleep wake cycle for a specified period (Meghdadi et al., 2019). This is convenient for this client and the Nurse Practitioner would be able to monitor the client’s sleep health and gauge the severity of the disruption of her sleep.The nurse practitioner could also physically examine the patient’s nares for septal occlusion.
Septal occlusion or deviation could lead to problems with sleeping even during sleep, this would be important for the nurse practitioner to evaluate as this could be interfering with the patient’s sleep.
Epworth sleepiness scale – assesses the patient’s tendency to nod off in various situations (Meghdadi et al., 2019). For this client it would be necessary for the nurse practitioner to assess the severity of her nodding off during the day time especially at unexpected times like during eating and other activities that would put her safety at risk.
Differential Diagnosis
G47.00 Unspecified Insomnia Disorder– The patient is experiencing insomnia at nighttime that could be related to several factors. She reports staying up late to watch T.V., depressive symptoms, restless leg syndrome, sleep apnea and sleeping during the daytime. Some of these factors have not been ruled out yet as the cause of her anxiety.
G47.23 Persistent Irregular Sleep Wake type severe
F32.9 Unspecified Depressive Disorder
G25.81 Restless legs syndrome
Medications:
Trazodone 50 mg – This medication would be the first choice as it offers antidepressant properties as well as promotes sleep in those diagnoses with insomnia. It is generally safe for the elderly population at low doses (Pagel et al., 2018). The Nurse Practitioner should monitor the patient and evaluate the needs to slowly increase or in some cases decrease the dose.
Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes sleep. The patient would benefit from his, but an added benefit would be that she would be at a diminished risk of falls as this is a concern following the use of hypnotics in the elderly. This drug is reported as one that would prevent less falls from over sedation (Pagel et al., 2018).
Lessons Learned
This writer has learned that it is important to conduct a complete evaluation of the patient and not just focus on the presenting symptoms. There are additional environmental and physiological symptoms that could be attributed to the patient’s insomnia. In this case the patient had several factors that could be contributing her insomnia and they needed to be ruled out. The cause of her insomnia could have been physiological from the sleep apnea or from her habits of staying up tool late at nights and sleeping during the daytime. It is also important to evaluate medications, social and economic factors before the resorting to pharmacological interventions.
References
Boland, E. M., Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2020). Is sleep disturbance linked to short- and long-term outcomes following treatments for recurrent depression? Journal of Affective Disorders, 262, 323–332.
FitzGerald, J. M., O’Regan, N., Adamis, D., Timmons, S., Dunne, C. P., Trzepacz, P. T., &
Meagher, D. J. (2017). Sleep-wake cycle disturbances in elderly acute general medical inpatients: Longitudinal relationship to delirium and dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 7, 61–68.
Meghdadi, A. H., Popovic, D., Rupp, G., Smith, S., Berka, C., & Verma, A. (2019). Transcranial Impedance Changes during Sleep: A Rheoencephalography Study. IEEE Journal of Translational Engineering in Health and Medicine, Translational Engineering in Health and Medicine, IEEE Journal of, IEEE J. Transl. Eng. Health Med, 7, 1–7.
Pagel, T., Seithikurippu R. Pandi-Perumal, & Jaime M. Monti. (2018). Treating insomnia with medications. Sleep Science and Practice, (1), 1. Uchmanowicz I, Markiewicz K,
Uchmanowicz B, Kołtuniuk A, & Rosińczuk J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 155.
Ulke, C., Sander, C., Jawinski, P., Mauche, N., Huang, J., Spada, J., Hegerl, U. (2017). Sleep disturbances and upregulation of brain arousal during daytime in depressed versus non-depressed elderly subjects. World Journal of Biological Psychiatry, 18(8), 633–640.
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Post Saudatu Fg
/in Uncategorized /by developerRespond to this post with a positive response :
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
Initial post
Blood Glucose Management By Nurses Article
Blood glucose management in the neuro-intensive care by neurologists and neurosurgeons is not as aggressive as physicians in the cardiac, surgical and medical unit. One example, this week I have a patient admitted for seizures and he is in three different types of seizures medications which makes him lethargic and unable to eat. There were no orders for glucose checks and I chased the neurology for almost two days to get an order for a glucose blood check. The truth I was checking the patient sugar for safety and preventing comatose from hypoglycemia. In my practice the article researching “Nurse-Directed Blood Glucose Management in the Medical Intensive Care Unit” (Gibbs H, Rowden AM, 2017). is very interesting to me because the management of blood glucose in the medical ICU is organized and if nurses manage it will improve time, planning and prevention of hypoglycemia. I noticed that’s Walden Library has good articles and journals good for patients and family education in blood sugar control. Diabetes problem is growing in our community because of obesity and genetics. There are several ways and material available in different languages to help decrease diabetes. The goal of the research of this article is to decrease risks of hypoglycemia and hyperglycemia. (Critical Care Nurse. 2017;37[3]:30-41).
Complementary Health Implementation by Nurses
The second article I research on is about complementary care such as massages, bone stretching and more implemented by certified nurses. In the article, there is a statement about the increased demands of this care. It is interesting to me because we touch patients all day when caring for them and due to policies and ethical rules we cannot massage or scratch their back when needed. In my opinion, the patient’s dignity is loss immediately they walk in the clinic or Emergency room. This article is good for education with nursing students, nurses, and family. In my current hospital, pet therapy music and art just initiated for patients. (Critical Care Nurse. 2017; 37[3]:60-65).
Watching the video in the Walden University writing center helping me in improving my references and paragraphing formats. Am planning to watch it each time am writing a paper.
References
1.National Center for Complementary and Integrative Health. What complementary and integrative approaches do Americans use? Key findings
2. National Center for Complementary and Integrative Health. NCCAM
Third Strategic Plan: 2011–2015 exploring the science of complement-
tary and alternative medicine. https://nccih.nih.gov/about/plans/2011.
3.Laureate Education, Inc. (Executive Producer). (2012d). Introduction to scholarly writing: Tips for success. Baltimore, MD: Author.
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Post Shannon
/in Uncategorized /by developerRespond to the post bellow, using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Main Post
Music Therapy for Dialysis Patients
The research article that I selected was conducted to see if music therapy was a good non-pharmacological intervention to manage hemodialysis patient’s anxiety, stress, and depression. The researchers recognized that these patients experience anxiety, stress, and depression due to their dire health issue of end-stage renal disease. There were 40 subjects who were receiving dialysis and 20 subjects received music therapy. Blood pressures and pulses were taken before and after music therapy. The randomized control group was given pre-tests, post-tests, and Depression Anxiety Stress Scale Tool (DASS).
Data & Results
The data that was collected that lead to their final conclusion was comparing the vital signs collect before and after music therapy, demographic survey, DASS, pre and post-tests. The researchers completed a paired t-test and design table with the data to determine the effectiveness of the experiment. According to Fernandas & D’silva (2019), “To find the association between depression, anxiety and stress level with selected demographic variables, chi-square test or likelihood ratio test used” (p. 128). Their conclusion stated that the group that received music therapy did have a reduction in anxiety, stress, and depression levels. According to Fernandas & D’silva (2019), “In the present study the investigator made an attempt to relieve stress, anxiety, and depression among haemodialysis patient by providing music therapy and results shows that there was a significant difference in depression, anxiety and stress level among the experimental and control group” (p. 129).
Conclusion & Weakness
The researchers were able to formulate their conclusion by analyzing the data and using careful calculations that they collected from their research. The weakness of the study I believe is that the subjects weren’t select randomly. The participants were selected by assessing if they liked or showed interest in music. The dialysis patients that were interested in music received music therapy.
Additional Research
I do believe that further research should be completed to prove the benefits of music therapy for a dialysis patient. Further studies should be randomized. I also think one-way researchers could add to testing is measuring cortisol in saliva. According to Choi, Kim, & Yang (2014), “Salivary cortisol concentration serves as a biomarker of psychological stress. Cortisol measurements should be carried out in real time”.
References
Choi, S., Kim, S., Yang, J. S., Lee, J.H., Joo, C., & Jung, H. (2014). Real-time measurement of human salivary cortisol for the assessment of psychological stress using a smartphone. Sensing and Bio-Sensing Research., 2, 8-11.
Fernandes, S. T., & D’silva, F. (2019). Effectiveness of Music Therapy on Depression, Anxiety, and Stress among Haemodialysis Patients. International Journal of Nursing Education, 11(1), 124–129. https://doi-org.ezp.waldenulibrary.org/10.5958/0974-9357.2019.00024.2
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Post Sherry Health Assessment
/in Uncategorized /by developerPost a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Main Post
Communication/Interviewing
This is a 40 -year old black man recently migrated from Africa. He is currently uninsured. To begin communicating with this individual, I would make sure he was able to speak English and that we under stand each other. If language is a barrier, I would get an interpreter on the interpretation Line. Communication techniques doesn’t always have to be spoken word, it can be pointing to an area of the body or using pictures. Communicating across language barriers is a challenge for clinicians and health systems. Federal law requires linguistic services for patients with LEP. Title VI of the US Civil Rights Act states that people cannot be discriminated against as a result of their national origin, race, or color, which has been extrapolated to include primary language by the US Office for Civil Rights and Department of Health and Human Services (Karliner, 2018). If the patient can speak some English the target would be to make sure our words mean the same thing and that’s where pointing to items and using hand gestures could come in handy. I would keep the questions fairly short with simple as possible terminology.
Risk Assessment
Being that this patient is newly immigrated to the U.S., I would want to give this patient resources that are free due to not having insurance but certainly would not deny treatment to the patient. I would focus on screening for any diseases that need immunizations, for one. Components of the health assessment for immigrants and refugees include addressing patient health concerns, screening for diseases associated with the country of origin and migration history, initiating age-appropriate immunizations, and routine health care maintenance (Walker, Barnett, & Stauffer, 2019). The question would be “have you had any illness, sicknesses, or hospitalizations that required any type of medications? Any immunizations? Any infections in your body or out breaks on your skin?” I would also ask about the living conditions and the nutritional conditions.
Other Potential Health Risks
Because of the ethnicity, the age and gender, I would certainly screen for any cardiac issue, hypertension, diabetes, and cancer. The acquisition of risk factors for chronic diseases such as coronary artery disease, hypertension, diabetes and cancer is poorly understood among African immigrants. More information must be gathered in the broad categories of chronic disease, health attitudes and health access to better promote the health of African immigrants (Venters & Gany, 2011).
Screening tool
Because of the area from which this patient came from. I would start by screening for infectious disease. I would focus on food and water exposure for things like Giardia or E. Coli, turn to the lungs and check for tuberculosis and so on. These screenings would require blood, urine, and fecal samples and a chest X-ray as most foreign folks get the Bacille Calmette-Guérin immunization and can cause a false positive when given the skin test.
5 Target Questions
I had mentioned some questions earlier but other questions would be
1. Have you had any coughing with bloody sputum,
2. Can you tell me about where you used to live in Africa?
3. Are you married? Are you sexually active with more than one partner?
4. Have you had any infections or illnesses?
5. Any diarrhea, nausea, or vomiting?
References
Karliner, L. S. (2018, April 2018). When Patients and Providers Speak Different Languages. AHRQ. Retrieved from https://psnet.ahrq.gov/webmm/case/440/when-patients-and-providers-speak-different-languagesVenters, H., & Gany, F. (2011, April 13, 2011). African immigrant health. US National Library of Medicine, 333-344. https://doi.org/doi: 10.1007/s10903-009-9243-xWalker, P. F., Barnett, E., & Stauffer, W. (2019). Medical screening of adult immigrants and refugees. Retrieved from https://www.uptodate.com/contents/medical-screening-of-adult-immigrants-and-refugees
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Post Sheryl
/in Uncategorized /by developerRespond to two colleagues in one of the following ways:
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why.
Include additional insights you gained.If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them.
Include resources to support your perspective.
Main Post
Agonist-to-Antagonist Spectrum of Action
Molecules that bind to receptors are referred to as ligands (“Pharmacology Corner: Agonists and Antagonists”, 2015). Ligands are capable of binding to receptor sites and producing a biological response. These ligands are called agonists (“Pharmacology Corner”, 2015). The opposite effect can also take place. Ligands that block the responses of agonists are referred to as antagonists. An agonist binds to a receptor site, activates it, and causes a signal to be transmitted. This reaction is called a biological response (“Pharmacology Corner,” 2015). Conversely, an antagonist also binds to a receptor site, but blocks binding from any other agonists, thus preventing any biological response (“Pharmacology Corner”, 2015). Several types of agonists exist on a spectrum. Their place on this spectrum is measured by comparing their binding ability versus endogenous agonists already present in the body (“Pharmacology Corner”, 2015). Endogenous agonists are present in the body. Super agonists produce a greater biological response than endogenous agonists. Next on the spectrum are full agonists, which mimic the efficacy of the endogenous agonists. Next in line are the partial agonists, which only exert a partial biological response as their name suggests (“Pharmacology Corner”, 2015). The next group of agonists are the inverse agonists which act in two ways. They inhibit the normal receptor site activity, and exert the opposite pharmacological activity at the same time. Last on the spectrum are the irreversible agonists which permanently bind and activate the receptor site. Since this action is permanent, it only occurs once and results in the destruction of the receptor (“Pharmacology Corner”, 2015).
G-Couple Proteins and Ion-Gated Channels
Receptors called G-protein-coupled receptors (GPCRs) facilitate most physiological responses to neurotransmitters, hormones, and stimulants in the environment. As such, they have great potential to be targeted for the treatment of many diseases (Rosenbaum, Rasmussen, & Kobilka, 2009). GPCRs comprise the largest group of membrane proteins and are responsible for most cellular responses to neurotransmitters and hormones. They also contribute significantly to the human senses of vision, smell, and taste (Rosenbaum et al., 2009). GPCRs are made up of seven alpha-helical segments separated by intracellular and extracellular looped areas (Rosenbaum et al., 2009).
The fastest and least complex of signal pathways occur with signals whose receptors are gated ion channels (Ahern & Rajagopal, 2019). Gated ion channels consist of many transmembrane proteins that create a hole, or a channel in the cell membrane. Each ion channel will allow the passage of a certain ionic species depending on its type. They are called gated because the passage is controlled by a gate which must be opened to allow the ions to pass (Ahern & Rajagopal, 2019). The opening of the gates is controlled by the binding of a signal to the receptor. This causes the immediate passage of millions of ions across the membrane (Ahern & Rajagopal, 2019).
Epigenetics in Pharmacologic Action
Epigenetics refers to genetic information that exists beyond the information contained solely in the individual’s genetic code (Stefanska & MacEwan, 2015). Human diseases can be caused by a single base genetic mutation. Scientists have made great strides in unraveling the genetic code, recording the first complete sequence of the human genome in 2001 (Stafanska & MacEwan, 2015). These advances have prompted scientists to think beyond treating illness through drugs activating receptors, but in a more global fashion. Epigenetic mechanisms are systems that are able to alter or cancel genetic activation, and are present in all genes (Stefanska & MacEwan, 2015). These mechanisms may affect more than one gene or group of proteins, and can even regulate large groups of genes. Cancer is one disease in which the understanding of epigenetics can be key to more effective treatment (Stefanska & MacEwan, 2015).
Specific Client Example
One example of a common client issue is the opioid epidemic. Naloxone (Narcan) is an opioid antagonist that binds to the opioid receptors in the patient’s brain, reversing or blocking the effects of the opioid (“Opioid overdose reversal with naloxone (Narcan, Evzio)”, 2018). This is essential to save the patient’s life who has accidentally or intentionally overdosed on opiate drugs. Naloxone can quickly restore a normal breathing pattern in a person whose respirations have slowed or stopped as a result of the opiate (“Opioid overdose reversal”, 2018). Naloxone (Narcan) can be administered using a pre-filled delivery device that is sprayed into the nostril while the patient lies supine. This device is simple to use and requires no assembly (“Opioid overdose reversal”, 2018).
References
Ahern, K., & Rajagopal, I. (2019). Ligand-gated Ion Channel Receptors. Retrieved from https://bio.libretexts.org/Bookshelves/Biochemistry/Book:_Biochemistry_Free_and_Easy_(Ahern_and_Rajagopal)/08:_Signaling/8.2:_Ligand- gated_Ion_Channel_Receptors.Opioid overdose reversal with naloxone (Narcan, Evzio). (2018). Retrieved from drugabuse.gov.Pharmacology Corner: Agonists and Antagonists. (2015). Retrieved from aegislabs.com/agonistsRosenbaum, D.M., Rasmussen, S.G.F., & Kobilka, B.K. (2009). The structure and function of G-protein-coupled receptors. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967846/#_ffn_sectitle.Stefanska, B., & MacEwan, D.J. (2015). Epigenetics and pharmacology. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439868/#_ffn_sectitle.
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Post Starr 19492611
/in Uncategorized /by developerRespond to at least two of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
NOTE: Positive comment
Main Post
Case Study: Volume 2, Case #21 focuses on the treatment of an adult client diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Questions
Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?
Rationale: The client may have additional stress due to broken relationships and this could be due to his disorder. “Emotional dysregulation is increasingly recognized as a core feature of ADHD” (Stralen, 2016). Signs of ADHD include low frustration tolerance and explosive behavior (Stralen, 2016).
Question 2:
What causes you the most anxiety?
It is important to determine the triggers of the anxiety to help the patient prepare for times when he is likely to be in high stress situations. Planning a response when feeling overwhelmed can help the patient remain in control of his emotions and allow the patient to monitor his behavior.
Question 3:
You stated that your father was abusive, was this physical or verbal abuse or both? Do you contribute some of your anxiety from previous issues with your father?
It is important for the provider to understand the client’s point of view in regards to his upbringing. He realizes it has affected in him in some way, as he has obtained psychotherapy in the past. I would want to know if he has ever spoken to his father about this and if his father has ever apologized for his actions.
Questions for family
I would want to talk with his mother to ask her how he did as a child in school and at home in regards to schoolwork, chores and would want to know if he had friends. Although social problems are not part of the diagnostic criteria for ADHD, the peer relationship difficulties faced by youth with this disorder are profound (Hoza, 2007)
Diagnostics & Exams
A full psychiatric evaluation which would include the Adult Self-Report Scale (ASRS). ASRS was been developed by the World Health Organization to determine if an individual (adult) may have ADHD. The scale is made up of 6 questions, and if a client has at least 4 of 6 symptoms, there may need to be a diagnosis of ADHD made by a professional (ADDA, 2018). Seay et al. (2009) suggests the PMHNP should utilize intelligence test, broad-spectrum scales, tests of specific abilities, and brain scans to confirm the diagnosis and to rule out other disabilities, autism, auditory processing disorders or mood disorders. In addition, a full medical work-up by a PCP in order to rule out other medical conditions that could present similarly to ADHD.
Differential DX
General Anxiety Disorder: The patient exhibits symptoms of generalized anxiety disorder, DSM-5 300.02 (F14.1). He has had the symptoms for greater than six months with the symptoms being severe enough to interfere with the patient’s daily functioning. The patient complains of feels of worry that is difficult to control, irritability, restlessness, difficulty concentrating and feeling on edge. The patient symptoms have not been linked to a physical condition or to substance use (Reynolds & Kamphaus,2013).
ADHD: client consistently complains of feeling tense, irritable, and anxious (Stahl Online, 2019). Questions arise once the general anxiety symptoms are resolved and the client is left feeling hyperactive, inattentive, and the inability to focus (Stahl Online).
Post-Traumatic Stress Disorder: The client’s diagnosis of anxiety may have been related to underlying issues related to a traumatic event that he experienced as a child. The client’s father was verbally abusive to him and was an alcoholic. It is a possibility that the client’s issues could have some relations to previous exposure as a child. Post-Traumatic Stress Disorder is a serious condition that can occur in clients who have experienced various incidents including abuse (PTSD, 2018).
Medications
The case states by year six the client has failed to achieve remission on an SSRI, a 5-HT1A receptor partial agonist, an antihistamine anxiolytic and an SGRI (Stahl Online, 2019).
Based on the pharmacological agents, I would select either Cymbalta 60mg or Effexor XR 150mg. Cymbalta did illicit a response, but side effects prevented the escalation of the dosage. Augmenting with guanfacine an alpha-adrenergic agonist proved to be the therapy that elicited remission for this client.
Lessons Learned
I learned to always consider additional differential diagnosis and evaluate and re-evaluate every situation separately to be sure of the correct diagnosis. Patient’s often have comorbid diagnosis and treating both is vital to a successful outcome for the patient. Symptoms of mental illness change overtime making continued care necessary for the patient. The provider must always be approachable and helpful for the client to feel comfortable in his/her presence.
References
Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/
Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.
Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
Applications (4th ed.). New York, NY: Cambridge University Press.
Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.
Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/
Hoza B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology. 2005b;73:411–423.
Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:
www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_
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Post Starr
/in Uncategorized /by developerRespond to at least two of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
NOTE: Positive comment
Main Post
Case Study: Volume 2, Case #21 focuses on the treatment of an adult client diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Questions
Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?
Rationale: The client may have additional stress due to broken relationships and this could be due to his disorder. “Emotional dysregulation is increasingly recognized as a core feature of ADHD” (Stralen, 2016). Signs of ADHD include low frustration tolerance and explosive behavior (Stralen, 2016).
Question 2:
What causes you the most anxiety?
It is important to determine the triggers of the anxiety to help the patient prepare for times when he is likely to be in high stress situations. Planning a response when feeling overwhelmed can help the patient remain in control of his emotions and allow the patient to monitor his behavior.
Question 3:
You stated that your father was abusive, was this physical or verbal abuse or both? Do you contribute some of your anxiety from previous issues with your father?
It is important for the provider to understand the client’s point of view in regards to his upbringing. He realizes it has affected in him in some way, as he has obtained psychotherapy in the past. I would want to know if he has ever spoken to his father about this and if his father has ever apologized for his actions.
Questions for family
I would want to talk with his mother to ask her how he did as a child in school and at home in regards to schoolwork, chores and would want to know if he had friends. Although social problems are not part of the diagnostic criteria for ADHD, the peer relationship difficulties faced by youth with this disorder are profound (Hoza, 2007)
Diagnostics & Exams
A full psychiatric evaluation which would include the Adult Self-Report Scale (ASRS). ASRS was been developed by the World Health Organization to determine if an individual (adult) may have ADHD. The scale is made up of 6 questions, and if a client has at least 4 of 6 symptoms, there may need to be a diagnosis of ADHD made by a professional (ADDA, 2018). Seay et al. (2009) suggests the PMHNP should utilize intelligence test, broad-spectrum scales, tests of specific abilities, and brain scans to confirm the diagnosis and to rule out other disabilities, autism, auditory processing disorders or mood disorders. In addition, a full medical work-up by a PCP in order to rule out other medical conditions that could present similarly to ADHD.
Differential DX
General Anxiety Disorder: The patient exhibits symptoms of generalized anxiety disorder, DSM-5 300.02 (F14.1). He has had the symptoms for greater than six months with the symptoms being severe enough to interfere with the patient’s daily functioning. The patient complains of feels of worry that is difficult to control, irritability, restlessness, difficulty concentrating and feeling on edge. The patient symptoms have not been linked to a physical condition or to substance use (Reynolds & Kamphaus,2013).
ADHD: client consistently complains of feeling tense, irritable, and anxious (Stahl Online, 2019). Questions arise once the general anxiety symptoms are resolved and the client is left feeling hyperactive, inattentive, and the inability to focus (Stahl Online).
Post-Traumatic Stress Disorder: The client’s diagnosis of anxiety may have been related to underlying issues related to a traumatic event that he experienced as a child. The client’s father was verbally abusive to him and was an alcoholic. It is a possibility that the client’s issues could have some relations to previous exposure as a child. Post-Traumatic Stress Disorder is a serious condition that can occur in clients who have experienced various incidents including abuse (PTSD, 2018).
Medications
The case states by year six the client has failed to achieve remission on an SSRI, a 5-HT1A receptor partial agonist, an antihistamine anxiolytic and an SGRI (Stahl Online, 2019).
Based on the pharmacological agents, I would select either Cymbalta 60mg or Effexor XR 150mg. Cymbalta did illicit a response, but side effects prevented the escalation of the dosage. Augmenting with guanfacine an alpha-adrenergic agonist proved to be the therapy that elicited remission for this client.
Lessons Learned
I learned to always consider additional differential diagnosis and evaluate and re-evaluate every situation separately to be sure of the correct diagnosis. Patient’s often have comorbid diagnosis and treating both is vital to a successful outcome for the patient. Symptoms of mental illness change overtime making continued care necessary for the patient. The provider must always be approachable and helpful for the client to feel comfortable in his/her presence.
References
Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/
Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd
Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.
Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
Applications (4th ed.). New York, NY: Cambridge University Press.
Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.
Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/
Hoza B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al. What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology. 2005b;73:411–423.
Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:
www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_
Diagnostic-Criteria_GeneralizedAnxietyDisorder.pdf.
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Post Stephanie Fg
/in Uncategorized /by developerRespond to this post with a positive response :
Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Use references
Critical Thinking in the Workplace
While there is no clear definition of critical thinking, it can often be associated with the terms “evaluation”, “analysis”, and “higher-thinking” (Horvath & Forte, 2011, pg. 1). Critical thinking can be described as the process in which one uses logic and reason to determine a solution to a problem. As nurses, we develop critical thinking skills through our practices and expansion of knowledge. To critically think one must assess the problem, determine solutions, and apply them to the current situation. Critical thinking is a sought out skill that improves one’s ability to make reasonable decisions in and out of the workplace.
Critical thinking is an essential part in the delivery of high-quality patient care. In the Emergency Department (ED) for example, patients are triaged and treated based on their level of acuity. Let’s say that two patients present to the ED. The first patient is a 58 year old female who presents with chest pain and productive cough that started three days ago. The second patient is a 69 year old male who presents with sudden 10/10 “tearing” pain in his upper abdomen and chest. Based on signs and symptoms the nurse would use critical thinking to prioritize and determine which patient needs immediate treatment. In this circumstance, patient number two would be evaluated first; this is due to the high possibility of aortic dissection. Prioritization and critical thinking are not only used in the ED but as well as other healthcare settings. Critical thinking skills are essential in the nursing field because they allow nurses to prioritize and make key decisions that can save lives (Nurse Journal, 2005-2018, para. 1).
Strategies to Critical Thinking
In recent years there has been emphasis placed on the quality of care provided by nurses. To ensure the delivery of high quality patient care, it is essential that nurses maintain a high level of competence to respond effectively to complex clinical situations (Carvalho et al., 2017, pg. 103-107). Two strategies that are often used to encourage the development of critical thinking include problem-based learning (PBL) and simulations.
PBL is a student-centered learning method that focuses on applying theory to real life situations. The use of open-ended questions in PBL allows students to think critically and provide feedback. Simulation labs are mock scenarios that allow health care professionals to practice in a controlled environment. Simulation labs are found to be highly effective as they allow students to critique their skills until competent. While there are several strategies used to develop critical thinking, it is essential to determine which strategies works best for each individual to promote adequate learning.
Critical Thinking, Nursing Practice, and Scholarship
Critical thinking is an essential part of one’s nursing practice as it helps to build confidence and competency in the delivery of patient-directed care. With continued education and practical application nurses can develop skills needed to practice at a scholarly level. To continue to advance in one’s nursing practice nurses must evaluate strategies essential for the development of critical thinking skills.
Resources
Carvalho, D. P., Azevedo, I. C., Cruz, G. K., Mafra, G. A., Rego, A. L, Vitor, A. F., . . .Junior, M. A. (2017). Strategies Used for the Promotion of Critical Thinking in Nursing Undergraduate Education: A Systematic Review. Nurse Education Today, 57, 103-107. Doi10.1016/j.nedt.2017.07.010
Horvath, C. P., & Forte, J.M. (2011). Education in a Competitive and Globalizing World: Critical Thinking: Retrieved December, 31, 2018, from https://ebook.central.proquest.com/lib/waldenu/reader.action?docID=3021945&ppg=155.
Nurse Journal. (2005-2018). The Value of Critical Thinking in Nursing & Examples. Retrieved from https://nursejournal.org/community/the-value-of-critical-thinking-in-nursing/ [Accessed 31 Dec. 2018].
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Post Tami 19205257
/in Uncategorized /by developerRespond by offering additional thoughts regarding the examples shared, Systems Development Life Cycle SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
Main Post
Systems Development Life Cycle
The systems development life cycle (SDLC) is a process whereby a company or entity determines the need for the implementation of new technology. SDLC provides information systems that are effective at incorporating the company’s business plan (McGonigle & Garver Mastrian, 2018). It is essential that a working knowledge of the problems or issues are understood. In the case of healthcare organizations, this means establishing an assessment that discovers the needs of each department (McGonigle & Garver Mastrian, 2018). Most of the time when analyzing these needs an outside company is brought in to assess, interview, and determine the type of system that would benefit the company.
Consequences of Lack of Inclusion of Nurses
In the application of any new technology or policy, it is essential to trial it with the individuals that will be using it. When considering an update or new system in the healthcare setting, it is beneficial to involve nurses in the decision-making process. The Agency for Healthcare and Research (n.d.a) report that it is important to consult with nurses in the preliminary period of development. By incorporating nurses into the initial design, the researchers learn nursing processes, possible new tasks, effect the technology will have on patient care, staffing needs, and usability of the design. This analysis of workflow is used to determine the best use of technology (McGonigle & Garver Mastrian, 2018). Including nurses in this process opens routes for discussion and collaboration that will benefit the designers and users.
Failure to include nurses in the planning stages of technology design is detrimental to the intended use of the new system. A researcher or computer designer could miss critical elements of the nursing process due to their lack of knowledge regarding nursing procedures. McGonigle & Mastrian (2018) state, “nursing informatics professionals should always be included in these activities to represent the needs of clinicians and to serve as a liaison for technological solutions to process problems” (p. 250). The role of the informatics nurse and a nurse, in general, can play in designing technology is critical. Their contribution to the analysis of workflow and clinical implications is invaluable information needed for the formation of a system that will be used to its potential.
An Example of Collaboration
A study was done in Canada to determine the impact of the initiation of computerized order entries for medications on nursing workflow and reduction of medication errors. Registered nurses participated in a study where interviews and observations were used to study the effects of digital technology on the nursing process (Vito, Borycki, Kushniruk, & Schneider, 2017). The researchers spent considerable time observing and recording how the technology affected nurses and the influence it made on time spent with patients. This study is one example of the impact that nurses can have on the design and implementation of technology in the healthcare setting.
Current Healthcare Facility
When our facility transitioned to electronic health records (EHR) as an ER nurse, I was not involved in the planning. The nurse informaticist I assume worked with the company to create templates that are in use today. Within the ER portion of the EHR, there have been changes made because of nursing input. As a unit, we have asked for an ED narrator to be developed with our order sets, documentation narrators, and medication administration policies. Recently we asked for changes to our trauma narrator to include additional documentation options for different trauma levels. As a group we have also discussed missing pieces of data that is beneficial for everyday use and discussed this with our leaders. The leaders take this information to the information technology (IT) individuals that work directly with the EHR company and changes are then made. There are times when the nurse’s input is not embraced due to financial constraints or leadership ability to see the need. The size of the healthcare organization plays a significant role in the inclusion of nurses in decision-making practices. Many variables exist to modification of technology in healthcare. In an ideal setting, it would be ideal to include nurses throughout the design process.
References
Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide. Retrieved April 17, 2019, from https://healthit.ahrq.gov/sites/default/files/docs/page/impact-of-hit-on-nurses-quick-reference-guide.pdf
McGonigle, D., & Garver Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.
Vito, R., Borycki, E., Kushniruk, A., & Schneider, T. (2017). The impact of computerized provider order entries on nursing practice. Studies in Health Technology and Informatics, 234, 364-369. doi:/10.3233/978-1-61499-742-9-364
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