Respond  in one or more of the following ways:

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.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

      

                                                             Main Post

 Because evidence-based practice (EBP) stems from scientific research, it is imperative that nurses not only be able to read and interpret the results of research studies; they must also have a sound understanding of the various methodologies utilized to gather, analyze, and interpret the data used within those studies. The design of the study, the number of participants, the data collection methods, all help to determine the relevancy of the research for nursing practice. For example, a large-scale, randomized control trial would more accurately measure the impact of hand-washing on infection control. But, a descriptive qualitative analysis would likely be a more effective research design to determine motivators or deterrents of hand-washing behavior. Polit and Beck (2017) maintain that quantitative nursing research studies primarily aim to establish causality. Philosophically speaking, causality is highly complex because most phenomena cannot be contributed to a single causative factor; rather, they are attributable to multiple, sometimes convoluting variables. Correlation while often compelling, does not equal causation, and a sound research design will be able to distinguish the difference (Polit & Beck, 2017). 

Post-Traumatic Stress Disorder

            Rowe, Sperlich, Cameron, and Seng (2014) maintain that post-traumatic stress disorder (PTSD) is an anxiety disorder which develops after experiencing a psychologically traumatic event. 

It is characterized by intrusive reminders of the event such as nightmares and flashbacks, avoidance of stimuli associated with the event, persistent negative cognitions and numbing of responses, and symptoms of anxiety, including hyper-vigilance, difficulty concentrating, irritability, and sleep disturbances. PTSD is associated with substantial distress and impairment in functioning. (Rowe, Sperlich, Cameron, and Seng para. 8, 2014)

Epidemiological evidence indicates that women are twice as likely to suffer from PTSD than men (Rowe, Sperlich, Cameron, and Seng, 2014). McGovern et al. (2015) assert that PTSD is more likely to affect individuals with co-occurring substance use disorder. Co-morbidity rates are significantly increased when patients suffer from both PTSD and substance use disorder (McGovern et al., 2015). 

Analysis of a Randomized Controlled Design

A randomized control trial (RTC) is an experimental design in which subjects are randomized into distinct groups with the aim of isolating variables to make a comparative analysis and establish the efficacy of each variable. Controlled experiments are considered the gold standard for establishing cause and effect (Polit & Beck, 2017). I selected a single-blind RCT which analyzed treatment modalities for patients with PTSD and co-occurring substance use disorder. The study isolated and analyzed three treatment variables; standard care, integrated cognitive behavioral therapy plus standard care, and individual addiction counseling plus standard care. The results of this RCT determined that cognitive behavioral therapy was most effective for treating symptoms of PTSD. However, cognitive behavioral therapy and individual counseling were similarly effective for treating substance abuse disorder. Both cognitive behavioral therapy and individual counseling combined with standard care were superior to standardized care alone in treating PTSD symptoms and substance abuse (McGovern et al., 2015).

            I believe that the randomized control design was appropriate for this research because the goal was to establish cause and effect of various treatment modalities for PTSD with co-occurring substance abuse. RTCs are well suited to isolate the effects of distinct components of complex interventions, and to measure the effectiveness of the interventions against one another (Polit & Beck, 2017). Moreover, the randomization of participants helped to mitigate variations of genetic, behavioral, and environmental differences amongst the participants. Blinding is a method used to prevent biases which occur from people being aware that they are being observed. To ensure optimal results, the designers of this study did not tell the group of patients receiving the intervention they were being studied, however, the participants administering the interventions were aware of the study. If only one group is unaware of the study, it is referred to as being a single-blind study, as opposed to a double-blind study in which both the group administering the intervention and the group receiving it are unaware of the research (Polit & Beck, 2017). One drawback to this design can be that there is no significant difference between the interventions. This research found no statistical difference between treatment interventions for substance abuse, but did conclude that one intervention was superior for PTSD. Therefore I think the design was well suited and yielded evidentiary treatment recommendations.

Analysis of a Quasi-Experimental Design

            The quasi-experimental design measures an intervention, but lacks randomization, and sometimes even lack a control group. However, its defining characteristic of is the lack of randomization (Polit & Beck, 2017). I examined a quasi-experimental study which aimed to test the effectiveness of a trauma-specific, psycho-educational intervention for pregnant women with a history of abuse-related PTSD on six-intrapartum and post-partum psychological outcomes. This quasi-experimental research employed the nonequivalent control group, pre-test post-test design. Women voluntarily entered the study by responding to an advertisement or accepting a referral from their medical provider. The research concluded that the educational intervention provided clinical benefits including improved labor experience, less post-partum PTSD and post-partum depression, and decreased bonding impairment (Rowe, Sperlich, Cameron, & Seng, 2014). 

I believe that this was an appropriate research design for this study because it facilitated the recruitment and retention of participants from a vulnerable group. The quasi-experimental design was strong in this case because it compared similar patient groups before and after the intervention concluding that differences in outcomes were directly attributable to the intervention. However, this design is vulnerable to selection bias, in that the groups were not comparable before the study (Polit & Beck, 2017). However, because the participants in this study suffered from abuse-related PTSD, this limitation was not applicable to this research.  

Consequences of Inappropriate Research Designs 

            It is imperative to select an appropriate research design because the design of the study has a significant impact on the quality of the results yielded from the research. When the research aims to establish causal relationships, the design is more important than any other methodological factor. Various research designs have distinct strengths and weaknesses, and it is up to the researchers to determine which one is most appropriate for their research question. For therapy questions, experimental designs are the gold standard, while the RCT design is best suited to establish cause and effect. If a researcher chooses a RCT design to answer a therapy question, the quality of the results will suffer, and the question may not even be answered (Polit & Beck, 2017). The goal of the research is to answer questions, but, selecting an inappropriate research design could lead to more questions than answers.

             

References 

McGovern, M. P., Lambert-Harris, C., Xie, H., Meier, A., Mcleman, B., & Saunders, E. (2015). A randomized controlled trial of treatments for co-occurring substance use disorders and post-traumatic stress disorder. Addiction,110(7), 1194-1204. doi:10.1111/add.12943

Polit, D. F., & Beck, C. T. (2017). Nursing research generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer.

Rowe, H., Sperlich, M., Cameron, H., & Seng, J. (2014). A quasi‐experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse‐related posttraumatic stress. Journal of Obstetric, Gynecologic & Neonatal Nursing,43(3), 282-293. doi:10.1111/1552-6909.12312

 

 

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Respond to the post bellow, offering additional/alternative ideas regarding opportunities and risks related to the observations shared. 

 

Initial Post

There  is no doubt that the use of technology is increasing all around us. The  health care field is no different. Technology now plays a major role in  the health care profession. It is almost guaranteed to continue to  develop at a rapid rate (Horn, 2017). From electronic heath records to  patient portals, I have utilized technology since becoming a nurse,  increasing significantly over the last decade. However, at my most  current place of employment, we do not use much technology at all. In  fact, much of technology is prohibited as I work in a prison. After  relying on technology so heavily, it has been a major adjustment to  return to the era of very limited technology use. In fact, the only  technology we utilize is telehealth.

             Telehealth is the “delivery of  health care services, where distance is  a critical factor, by all healthcare professionals using information  and communication technologies for the exchange of valid information for  diagnosis, treatment and prevention of disease and injuries, research  and evaluation, and for the continuing education of health care  providers, all in the interest of advancing the health of individuals  and their communities” (Koivunen, & Saranto, 2018). This method of  health care delivery is seen as a means in which to improve  communication and enhance patient-centered care (Cipriano, 2011; Virji,  Yarnall, Krause, Pollak, Scannell, Gradison, & Ostbye, 2006). As  with all technology, there are both facilitators and barriers present  with the use of telehealth.

According  to the study conducted by Koivunen & Saranto (2018), nurses’ skills  in telehealth application were seen as a facilitator to telehealth  utilization. However, the same study identified some barriers present.  Some of those barriers included nursing’s discomfort with the equipment  utilized with telehealth as well as lack of basic computer skills  present amongst nurses (Koivunen, & Saranto, 2018). In addition,  negative attitudes along with lack of support and training were  identified barriers (Koivunen, & Saranto, 2018). It is obvious that  the change from traditional face-to-face nursing practice to telehealth  requires much support for its users. There is certainly a learning curve  with any new technology with experience and attitudes playing a major  role in the successful implementation. However, if the proper steps are  taken, telehealth can be a  cost-effective way to address health care needs and has been shown to  improve clinical indicators (Shulver, Killington, & Crotty, 2016). 

             In addition to the barriers present, there is also negative attitudes  by some clinicians in regards to telehealth. While some health care  providers believe that telehealth could offer enhanced and expanded  services to many, other clinicians voiced reservations about the  potential safety and suitability of this service (Shulver et al., 2016).  However, in the case of rural patients, many can agree that a service  is better than no service. According to Shulver et al. (2016),  clinicians agreed that any perceived risks associated with telehealth  could be alleviated by having a person “on the ground” with the patient  during telehealth conferences. This is exactly how telehealth is  utilized at my current place of employment. The inmates are seen by a  distance provider as the nurse remains in the room with the patient to  perform any assessments requested and provide information from records  as needed. 

Telehealth  is only one of many promising trends in health care that offer many  benefits. Other up-and-coming health technology trends include  artificial intelligence, Internet of Medical Things (IoMT),  blockchains, and virtual/augmented reality. These trends have many  benefits to offer. For example, artificial intelligence is now capable  of diagnosing skin cancer more accurately and more efficiently than a  board-certified dermatologist (Rigby, 2019). But, as previously  mentioned, all technology can bring added risks. Such use of technology  has the potential to threaten patient safety, preference, and privacy  (Rigby, 2019). Informed consent remains of utmost importance, as with  any medical procedure, when utilizing technology in providing health  care to patients. All the risks associated with the technology must  remain transparent to the patient. 

             Technology has already advanced quickly all around us and its use in  health care is no exception. By utilizing technology, the practice of  medicine is revolutionized, transforming the patients’ experiences and  the providers’ daily routines. These up-and-coming health care trends  are aimed at preventative care while enhancing patient experiences,  lowered expenses, and big data processing. Cutting-edge technology is  being utilized by many providers to assist their patients. We can only  expect the current trend to continue with more amazing discoveries to  come.

References

Cipriano P. (2011). The future of nursing and health IT: the quality elixir. Nursing Economics, 29(5), 286–90. Retrieved from https://www.researchgate.net/publication/221868226_The_Future_of_Nursing_and_Health_IT_The_Quality_Elixir

Horn, H. (2017). Predicting the Future of Healthcare Technology. Biomedical Instrumentation & Technology, 51(3), 203. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.2345/0899-8205-51.3.203

Koivunen,  M., & Saranto, K. (2018). Nursing professionals’ experiences of the  facilitators and barriers to the use of telehealth applications: a  systematic review of qualitative studies. Scandinavian Journal of Caring Sciences, 32(1), 24–44. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1111/scs.12445

Rigby, M.J. (2019). Ethical Dimensions of Using Artificial Intelligence in Health Care. AMA Journal of Ethics, 21(2), 121–124. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1001/amajethics.2019.121

Shulver,  W., Killington, M., & Crotty, M. (2016). “Massive potential” or  “safety risk”? Health worker views on telehealth in the care of older  people and implications for successful normalization. BMC Medical Informatics And Decision Making, 16(1),  131. Retrieved from  https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=27733195&site=eds-live&scope=site

Virji,  A., Yarnall, K., Krause, K., Pollak, K., Scannell, M., Gradison, M.,  & Ostbye ,T. (2006). Use of email in a family practice setting:  opportunities and challenges in patient- and physician-initiated  communication. BMC Med, 4(18), 1-7. Retrieved from https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-4-18

 

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 Read a selection of your colleagues’ responses and respond  on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. 

        

                                            Main Post

 

Diabetes is an all too common endocrine disorder. Creating an effective treatment plan is essential to delay long term effects of the disease. This post explores the differences between types of diabetes with a focus on details of type two diabetes, one drug used to treat it, dietary considerations, and short-term and long-term impact.

There are several types of diabetes include type two, gestational, juvenile, and type two. This list is not all-inclusive, but for purposes of simplicity, I will focus on these four. Type one diabetes is related to an autoimmune response that destroys the beta cells in the pancreas. The beta cells produce insulin for the body, and insulin is a hormone that draws glucose into the cells for fuel. When the beta cells no longer exist, no insulin production occurs, and the glucose remains in the bloodstream leading to hyperglycemia and cell starvation. Juvenile diabetes is the old name for type one diabetes and received the name because it often appeared during this time in the life span. Gestational diabetes appears in a pregnant patient and subsides quickly after delivery of the child. Type two diabetes is the most prevalent form as 90 to 95 percent of diabetics have this type (Rosenthal & Burchum, 2018). It is insidious and often appears after age 40. Type two is related to inappropriate production of insulin and insulin resistance. The cells become intolerant to insulin and do not uptake it, or the beta cells do not produce enough insulin, rendering it ineffective to control blood sugar. There is a familial association which suggests it is hereditary, but the etiology remains unknown. 

I chose Metformin as it is appropriate for the initial treatment of type two diabetes. It is a biguanide that works by decreasing glucose production in the liver and increasing tissue response to insulin. This mechanism of action is essential to understand because it prevents a sharp increase in blood sugar after a meal but does not actively control blood sugar. The provider should order Metformin at 500 mg twice a day with meals as the initial starting dose (Epocrates, 2019). There is no particular food to avoid with Metformin, and common side effects include gastrointestinal disturbances. The recommended diet should be low in carbohydrates, including sugar, low in fried foods, low in salt, and high in protein (National Insititute of Diabetes and Digestive and Kidney Diseases, 2016).

Lastly, the short-term effects of diabetes include medication, diet changes, adding exercise, and routine follow-up with the provider. The long-term effects include all of the above as well as retinopathy, nephropathy, peripheral neuropathy, and shorter life span related to these long-term effects of the disease. Metformin is relatively safe but can cause vitamin B12 and folic acid deficiencies and lactic acidosis, which is rare.  

References

Epocrates. (2019). Metformin Adult Dosing. Retrieved from https://online.epocrates.com/drugs/787/metformin

National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Diabetes Diet, Eating, & Physical Activity.

        Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO:

        Elsevier.

 

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Respond on two different days who selected different disorders or factors than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the pathophysiology of the disorder your colleague selected.

Offer alternative diagnoses and prescription of treatment options for the disorder your colleague selected.

Validate an idea with your own experience and additional research.

                                       Main Post

Disorders of the Reproductive Systems

The reproductive system is essential to the continuation of the human race. Proper functioning is necessary for optimal physical and psychosocial well being. This post will explore two reproductive disorders, including similarities and differences and the impact of behavior on the conditions. Phimosis is a disorder of the male reproductive system that prevents retraction of the foreskin over the glans penis. It is a non-issue in males under the age of three, as the glans and foreskin are one under normal physiological conditions (Huether & McCance, 2017). After age three, the foreskin begins to separate from the glans penis naturally. Phimosis can happen at any age in uncircumcised males. It often occurs as a result of chronic infection, but treatment is unnecessary unless balanitis or posthitis occur. Common symptoms include tenderness, edema, erythema, or purulent discharge. If the condition is pathological, treatment includes circumcision or a preputioplasty which widens the hole for the glans to pass through properly preserving the foreskin (McPhee & McKay, 2019).Paraphimosis is a disorder of the male reproductive system where the foreskin becomes trapped behind the corona of the glans. This condition is considered a urologic emergency and requires rapid treatment. If left untreated, the glans becomes strangulated, leading to vascular compromise, edema, and necrosis (Bragg & Leslie, 2019). Paraphimosis often occurs when retracting the foreskin for cleaning, physical examination, or placement of a catheter. Common symptoms include erythema, swelling, and pain. Treatment for uncomplicated paraphimosis includes manual reduction using a small amount of lubricant and moderate pressure to advanced the foreskin back over the glans. Complicated paraphimosis requires analgesia and surgical incision to correct.

 Similarities and Differences

One similarity between the two disorders is the involvement of the foreskin. In one condition, the foreskin does not retract, and in the other, it does not return to cover the glans penis. One difference is that paraphimosis is most common in adolescents, while phimosis can happen at any age. Also, paraphimosis can occur in circumcised males too if there is enough skin present after a circumcision. 

Behavior

Cleanliness is essential in the prevention of phimosis. Regular hygiene prevents many cases of this condition. Self-inflicted injuries are a significant cause for paraphimosis. However, merely retracting the foreskin can trigger the problem

                                               References

Bragg, B. N., & Leslie, S. W. (2019). Paraphimosis. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books          /NBK448067/ Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.McPhee, A. S., & McKay, A. C. (2019). Phimosis. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books        /NBK448067/

 

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Respond by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.

                                                                   Main Post

Organization Policies and Practices to Support Healthcare Issues

Competing needs of the workforce may have an impact on the development of organization policy. A shortage of providers may institute organizational or legislative change to increase workforce capacity. In this post, I will discuss how the need of the workforce impacts policy as it relates to the national issue of the scope of practice for the nurse practitioner (NP).

Estimates project that two-thirds of new practitioners added to the workforce will be NPs between 2016 and 2030 (Auerbach, Staiger, & Buerhaus, 2018). This information shifts the conversation towards the NP workforce and the policies that affect it. Poghosyan, Liu, Shang, D’Aunno (2017) found that NPs were more likely to be satisfied with their jobs and less likely to have the intent to leave if their organization supported NP practice. This finding could have a direct impact on workforce capacity and patient care as a result. Organizations located in areas where the effect of a deficit is minimal tend to restrict NPs using policy, and this may be affecting their internal workforce. Organizations must adopt a plan that is supportive NPs in their daily practice. Ricketts & Fraher (2013) highlight that workforce policy is a result of the demands of different professions and not about the needs of patients. A vital obligation of a healthcare institution is to ensure patients receive the care they need. Outdated policy or one that is non-reflective of the needs of the community does not meet this obligation. New York is an example of government policy that is not beneficial to the residents of the state via the NP scope of practice. NPs must work under the supervision of a physician, which inhibits how many patients they can manage as well as the physicians patient load. I imagine this is an example of professions shaping policy versus patient needs. Changes in policy can have a dramatic impact on workforce capacity and patient care. 

References

Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358–2360. doi:10.1056/NEJMp1801869

Poghosyan, L., Liu, J., Shang, J., & D’Aunno, T. (2017). Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity. Health Care Management Review, 42(2), 162–171. Retrieved from https://doi org.ezp.waldenulibrary.org/10.1097/HMR.0000000000000094 

 

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