Respond 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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Respond to the Main post bellow offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

Note: the answer should be in a positive way 

                                                    Main Question Post

Nursing Informatics

Nurse informaticists interact with other professionals in my healthcare setting in a variety of ways. One of these ways is through sharing patient information as and when needed. The increased manner in which medical facilities are adopting the use of health information technology means that the nurse informaticists have an integral role that they play in ensuring that patient data is availed when needed (Harrington, 2017). The Nurse informaticists also ensure that patient data is kept accurately and safely so that it can help in proper medical attention of the concerned patients. In so doing, nurse informaticists interact with those who admit patients at the facilities, those in charge of diagnosing and the laboratory technicians to ensure that there is a smooth flow of data from one point to the next (Lee, 2014).

The IT department at my current work place is not physically around or on the floors for night shift, which is when I work. So there isn’t much interaction with the nurse informatistics, but for their physical absence at night there is a contact line that we the employees can access whenever needed. That nurse informatistics has access to mirror what we are seeing on the actual computer screen so that they are able to help in more productive manner. If there is a new feature on the software there will be a super user which are more than likely nurses who have been trained on the new feature to help and aid in the process when needed. For instance, there is a new feature on the software at my work place that involves an innovative way to waste narcotics via the software. Because it has such a huge impact on the hospital they are having an information sessions at various times to accommodate every shift, which will allow a better understanding of the new feature at hand.  

One way of improving these interactions will be by increasing familiarity among team members to the extent that every team member knows the strengths, weaknesses, and idiosyncrasies of all team members (Kalisch & Begeny, 2015). In so doing, it will be possible to take decisive measures on who should handle a particular aspect so that its outcome is the most desirable. Increased familiarity will lead to teamwork, which is likely to enhance the productivity of the nurse informaticists and other segments of the medical facility. 

I believe that the continued evolution of nursing informaticists is likely to eliminate the physical distances among nurses and their facilities, something that will lead to improved patient outcomes. Nursing informaticist is likely to lead to seamless societies where it is possible to interact with other nurses located very many miles from each other and share their experiences or challenges in their line of duty. In so doing, it will be possible to come up with the most desired patient outcomes.  

 

References

Harrington L. (2017). The role of nurse informaticists in the emerging field of clinical 

intelligence. NI 2017: 11th International Congress on Nursing Informatics, June 23-27, 2017, Montreal, Canada. International Congress in Nursing Informatics (11th: 2017: Montreal, Quebec)

Kalisch, B.J. & Begeny, M.J. (2015). Improving nursing teamwork. The Journal of Nursing 

            Administration, 35 (12) pp 550-556. 

Lee, A. (2014). The role of informatics in nursing. Nursing Made Incredibly Easy, 12(4), 55-57. doi:10.1097/01.NME.0000450294.60987.00

 

 

 

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

                                                      Main Post

                        iPhone technology, secure texting, and telehealth

            The hospital that I currently work for piloted the use  of iPhones in addition to our work station on wheels (WoW). We can use  this iPhone technology for charting simple nursing interventions,  receive STAT orders and discharge orders, and communicate with our  colleagues through texting. Our WoWs enable us to do “secure texting” to  a physician, some physicians prefer the secure texting technology some  don’t, but surely there are times that the answering service may fail to  page them in a timely manner and the secure texting technology becomes  very useful. As nurses, we can see through our WoWs as soon as the  physician reads the text message, that way we know they are aware. This  technology saves us some precious time we spend on the phone waiting on  hold just to page a physician for orders, condition and/or results. Our  hospital also offers telehealth services especially for those who are  likely to be readmitted due to chronic diseases. We mostly see a  telehealth order for a patient with cardiac issues.

Risks and benefits

            The biggest threat that I believe healthcare  technology is at risk for is privacy. According to Chaet, Clearfield,  Sabin and Skimming (2017), privacy and confidentiality are just “as  important in the context of telehealth and telemedicine as in hospital  and office settings” (p. 1138). I surmise, organizations providing this  type of technology in healthcare have an incredible security system in  place. The secure texting technology, we are instructed not to use full  names, instead, we use room numbers of the patients.

            The biggest benefit of the use of telehealth and  mobile devices for healthcare is accessibility. Use of the iPhone  technology in our hospital is quick and easy to navigate, we can get in  touch with virtually anybody logged in for that shift in the whole  hospital. From a distance, telehealth helps those patients who are  unable to manage their chronic illnesses very well.

                                                                                    Trends in healthcare technology

            The most promising healthcare technology to me is  virtual visits, mobile health, telehealth, and telemedicine technology.  One can get in touch with a healthcare provider as long as one has a  smartphone and internet access. It could provide access to so many more  patients in need of healthcare that resides in rural areas or have no  means to transport themselves to the physician’s office. It could save  time and money for patients as we all know healthcare can get expensive  very easily and very fast. According to Abuhaimidd, Meetoo and Rylance  (2018), technology in healthcare with the use of mobile devices can  “truly offer the potential to promote healthcare management and health  behaviour change outside formal clinical settings” (p. 1176). This does  not take away the significance of having a physical visit with a  physician, those visits are intended for more complicated health issues,  but I believe this technology has potential to truly help those with  chronic illnesses to be able to manage their health on their own, make  them accountable for their own wellbeing, patients can share data,  interact with clinicians over a mobile device instead of having to go to  the doctor’s office.

                                                                                                  Telehealth rules

            According to Mastrian and McGonigle (2017), nurses who  participate in telehealth must be “licensed to practice in all of the  states in which they provide telehealth services by directly interacting  with patients” (p. 381). This can be challenging as states have  different rules and regulations regarding licensure, continuing  education requirements are different as well as fees and renewal  process.                                          

References

Abuhaimid, H. A., Meetoo, D., & Rylance, R. (2018). Health  care in a technological world. British Journal of Nursing, 27(20).  1172-1177.

Barreto, E. A., Cohen, A. B., Donelan, K., Estrada, J. J.,  Michael, C., Schwamm, L. H., … Wozniak, J. (2019). Patient and clinician  experiences with telehealth for patient follow-up care. American  Journal of Managed Care, 25(1), 40-44.

Chaet, D., Clearfield, R., Sabin, J. E., & Skimming, K.  (2017). Ethical practice in telehealth and telemedicine. Journal of  General Internal Medicine, 32(10), 1136-1140.

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

 

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Respond to the Main post bellow offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

Note: the answer should be in a positive way 

                                                             Main Post

Nurse informatics

            According to Sipes (2016), The American Nurses Association (ANA) defines nurse informatics as “the specialty that integrates nursing science with information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice” (p.252). The nursing profession indeed has come a long way. As new technology in healthcare improves so will the nursing process. Nurse informaticists use technology to connect healthcare workers to the collected data wherein information is readily available for nurses to postulate interventions to deliver the best outcome.

Interaction between bedside nurses and nurse informaticists

In my experience as a bedside nurse, I don’t normally interact with the nurse informaticists of the organization I work for. Perhaps a few minutes every now and again when there is a new process that was just introduced or when they need to follow up and ask about how the staff nurses are doing with the new technology that came along. As a staff nurse, I get to interact more with the “super users” of the new technology that comes along. They are the ones that teach us bedside nurses about the new equipment, process change, charting on and of the new technology and how to navigate the new system. Given these new iphones that we now use, piloted in February of this year, the super users were the ones that are in attendance in the unit, available for any questions or difficulty we may face. Prior to the initiation of the said process, we had to attend an hour-long training about it and complete online training as well. This is not to say that we cannot call the nurse informaticists if we get into major issues. However for times as such, we go through the chain of command and if no one is knowledgeable to fix the issue, we call the experts. More often we call the service desk and they fix the issues we encounter on the system (EHR) over the phone. 

                                                         Opportunities for improvement

Nursing is a continuous learning experience. It constantly evolves. From paper charting, now we have electronic charting, and from here, I’m quite sure we will see more interesting changes in the near future. EHR is really a marvelous technology, with the use of EHR, we can go back months, even years of patient history and we are able to compare from presentation or baseline even without having seen the patient first, we can pretty much formulate a good picture. My only comment about this is that human interaction is missing. My suggestion is that nurse informaticists should hold meetings probably, if feasible, at least every quarter, to check on the system’s strengths and weaknesses coming from the bedside nurses, the ones that use the technology day in and day out. I think, in that way, we, as bedside nurses at least can feel their palpable support. Additionally, nurse informaticists should work on possibly reducing redundancy in charting. The current EHR system we use at the organization I work for has so many redundant charting that I feel as though, it takes away from nurse to patient interaction. Moreover, honestly, I don’t even know the name of our organization’s nurse informaticists. Although I’m sure I can find it on the intranet and perhaps the one we see in the unit asking about any system issues is one of them, or maybe she is just another superuser, I honestly don’t know. I think we, as a people, are so in awe of new technology that we forget that human interaction is just as important. 

References

Adams, E., Hussey, P., & Shaffer, F. A. (2015). Nursing informatics and leadership, an essential competency for a global priority: eHealth. Nurse Leader, 13(5), 52-57.

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

Sipes, C. (2016). Project Management: Essential skill of nurse informaticists. Studies in Health Technology and Informatics, 255, 252-256.

 

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Assignment Description

Power in Organizations

Have you ever been involved in union organizing, collective bargaining, or worked in a union shop? If so, share your experience. If not, locate a scholarly journal article that describes collective bargaining and describe how it works within an organization.

Have you ever worked in a healthcare facility that had Magnet accreditation, or had experience with shared governance? If so, share your experience. If not, locate a scholarly journal article that describes shared governance and explain how it could be implemented in your current facility.

Assignment Expectations:

Length: 1000 – 1250 words

Structure: Include a title page and reference page in APA format. These do not count towards the minimum word count for this assignment. Your essay must include an introduction and a conclusion.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. At least two (2) scholarly sources should be utilized in this assignment

 

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