Respond 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

                                                     Main Post

The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability (HealthyPeople.gov, 2014). Many people with a variety of mental disorders are disadvantaged because of poor access to health care. Poor access to care can be due to several reasons, and those reasons range from lack of employment and insurance to knowledge deficiencies surrounding mental conditions and the need to get help. Several factors can play into this, such as the behavior of an individual. Individual determinants include stress, coping mechanisms, risk-taking behaviors, and openness. Another factor is social environment determinants. These determinants include access to good education and a supportive network of people, access to employment for income, and community dynamics. A third factor is physical environment. Physical environment determinants include access to parks and safe sidewalks for physical activity to relieve stress, supportive house environment with no violence, residential crowding, home conditions, and exposure to toxins at certain developmental stages. Lastly, genetic factors play a significant role in a person’s susceptibility to mental health issues. Disorders such as depression, schizophrenia, and autism are known to run in families through DNA transmission. 

In overlooking the five population determinants, the ones that most standout when it comes to mental health are access to healthcare and social environment determinants. According to an article in Social Solutions, more than half of Americans living with a mental health condition receive no treatment. These barriers to health access are due to financial burdens, lack of mental health providers, mental health education and awareness, the social stigma that surrounds mental health conditions, and racial barriers. Early screenings, accurate diagnoses, and appropriate treatment for mental illnesses can help to alleviate suffering from both patients and those close to the individual.  

The social determinants of health, defined as those conditions in which people are born, grow, live, work, and age that impact health and well-being are known to have major influences on diverse health outcomes (Shim et al., 2014, p. 23). Prevention at a population level will have the most significant impact. Providing health equity across a populational level regardless of economic or social status will play a crucial role when considering all five determinants of health. 

According to the Centers for Disease Control and Prevention (2012), epidemiologic data provides enough evidence to direct swift and effective public health control and prevention measures. Mental health effects people of all ages. Data in HealthPeople.gov (2014), states that approximately 20% of children are affected within their lifetime and about 83% of adults have some type of mental illness. Epidemiologic data is gathered to analyze the health status of a population living in an environment and then utilize that information to outline potential health impacts and quantify them. This information is then used as a direct link to policy-making decisions. 

References

Centers for Disease Control and Prevention. (2012). Lesson 1: Introduction to epidemiology. 

Retrieved December 17, 2018, from https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section1.html

Gulis, G., & Fujino, Y. (2015). Epidemiology, population health, and health impact assessment. Journal of Epidemiology, 25(3), 179-180. https://doi.org/

HealthyPeople.gov. (2014). Mental health. Retrieved December 17, 2018, from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Mental-Health/determinants

Kindig, D., Asada, Y., & Booske, B. (2008). A population health framework for setting national and state health goals. JAMA, 299(17), 2081–2083. Retrieved from https://jamanetwork-com.ezp.waldenulibrary.org/journals/jama/fullarticle/181830

Laureate Education (Producer). (2012). Population health. Baltimore, MD: Author.

Shim, R., Koplan, C., Langheim, F. J., Manseau, M. W., Powers, R. A., & Compton, M. T. (2014). The social determinants of mental health: An overview and call to action. Psychiatric Annals, 44(1), 22-26. Retrieved from http://m3.wyanokecdn.com/94bb6a43efb278e9eb152cdaf4e17b9a.pdf

Social Solutions. (n.d.). Top 5 barriers to mental healthcare access. Retrieved December 17, 2018, from https://www.socialsolutions.com/blog/barriers-to-mental-healthcare-access/  

 

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Respond 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

EXAMPLE OF A REFERENCE:

If you cannot locate a doi number, this is how the reference should look: 

Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html

                                              Main Post

In order to reform the healthcare system, strong leadership is needed to make that transformation and that leadership needed comes from all levels within an organization. Nurses need leadership skills and to be full partners with other health professionals in the efforts to redesign the health care system. It is crucial for nursing research and practice to develop improvements in care based on best evidence-based practices. Nurse leaders must be able to interpret new research findings and incorporate those into practice and education in order to advocate for policy change. Nurses are vital in identifying problems in the work environment, executing a plan for improvement, tracking it over time, and adjusting as needed to establish the best possible outcomes.  

From the information in box 7.3, “Research Priorities for Transforming Nursing Leadership,” one of the topics is the identification of skills and knowledge most critical to leaders of healthcare organizations.  This is important to me as I further my education to pursue a career in advanced nurse practitioner. The unique position that advanced nurse practitioners are in is they still posses the qualities of a nurse such as communication skills, attention to detail, empathy, emotional stability, problem-solving skills, and respect but are specialized to diagnose illnesses and conditions, interpret diagnostic tests, provide counseling, and prescribe medication as needed. According to the article in the Journal of Professional Nursing, Reforming health care means fixing escalating costs, providing accessibility and quality care to patients, and addressing personnel shortages in various health disciplines. Nurse practitioners are in a position to utilize their skills and knowledge to increase those shortcomings in various health disciplines and to provide high-quality more cost-effective care. 

It is essential for nurses to possess leadership skills to be able to contribute to patient safety and quality of care effectively. These skill sets include being able to work in a team, knowledge of the healthcare delivery system, and holding themselves and others accountable. Collaboration amongst all levels within an organization has been proven to demonstrate more significant results with patient outcomes, cost, and job satisfaction. Education and self-confidence are essential attributions in a leader to advocate for needed changes in health care. 

References

Archibald, M. M., & Fraser, K. (2013). The Potential for Nurse Practitioners in Health Care Reform. ScienceDirect, 29(5), 270-275. Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S8755722312001883?

Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2016, May 13). Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical Practices. Medical Care Research and Review, 74(4). Retrieved from https://journals-sagepub-com.ezp.waldenulibrary.org/doi/full/10.1177/1077558716649109?

Shaughnessy, M., Griffin, M. Q., Bhattacharya, A., & Fitzpatrick, J. J. (2018, November). Transformational leadership practices and work engagement among nurse leaders. The Journal of Nursing Administration, 48(11), 574-579. https://doi.org/10.1097/NNA.0000000000000682

 

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Hello everyone, my name is Rajwinder Gill, I go by Raj. I’m originally from India. I moved to the states with my parents when I was 21 years old. Currently, I live in California. I moved to US in Dec 1999, and got my RN degree in 2003. I joined Sutter Hospital as a new grad in 2004, and have been working there since then. I work in telemetry department as a night shift charge nurse. I like the hospital, my coworkers and the management team. It feels like home while I’m at work, that’s the main reason I haven’t changed my job in 15 years.

I’m married to a very loving and supportive husband, and we have two beautiful girls. They are 11 and 13. We love traveling as a family and try to spend as much time together as possible. That’s one of the main reasons I work night shift so I can attend to all their needs and wants during the day. One of my daughter is type 1 diabetic since she was 3 years old. I have been trying my best to manage all of that while working and supporting my other daughter. Now, since she is 11 and getting independent in taking care of her diabetes, I have more time for myself. I always wanted to go into management or teaching in nursing. This is my first step towards my future goals. I chose GCU so I can have the independence of studying from home. Nothing can beat not having to go the classroom and still be able to finish school.

 

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Respond  on two different days who selected different factors than you, in the following ways:

Share insights on how your colleague’s factors impact the pathophysiology of pain.

Suggest alternative diagnoses and treatment options for acute, chronic, and referred pain.

                                                               Main Post

Pain is both an easy and complex symptom to diagnose and treat due to its subjective nature. As future practitioners, we are diagnosing pain in the era of the opioid crisis will only add to the complexity of analyzing all of the signs and symptoms while trying to provide comfort to our patients. Pain confronts us with basic questions such as the tension between an objective and a subjective approach, the concept of brain disease, human consciousness, and the relationship between body and mind (Dekkers, 2017).

Pain

According to the National Library of Medicine (2018), pain is a signal activated within the nervous system signaling to an individual that something may be wrong; it is an unpleasant feeling that can be described as burning, stinging, aching, tingling, etc. It ranges from dull to severe, can be treated in a variety of ways, or can dissipate on its own. Every individual reacts differently to pain; pain can present differently in genders despite being the same disease process.  

Acute Pain

Acute pain is brief and can last several seconds or up to three months; acute pain occurs in an attempt to protect the body from harm by causing withdrawal from painful stimuli and encourages individuals to avoid painful stimuli in the future (Huether & McCance, 2017). The damage to the tissue is usually easily seen, with the naked eye or imaging that can reveal the source. Acute pain also involves biological functions that protect against further injury. For example, pain produces protective reflexes, including an unconscious withdrawal from the noxious stimulus, muscle spasms, and other autonomic reactions such as flight (Rodriguez, 2015). Noxious stimulation in the periphery leads to activation of nociceptors and the transmission of signals to the central nervous system, which will lead to the perception of acute pain (Berger & Zelman, 2016). 

Chronic Pain

Chronic pain persists for at least three months or greater, despite intervention to relieve the injury, surgical, holistic, or medicinal, when the treatment does not control the original issue. Chronic pain is disruptive to sleep patterns and activities of daily living, and as a pain syndrome, it serves no protective or adaptive function (Rodriguez, 2015). Anwar (2016) acknowledges that there are three ascending pathways: the first-order neuron; start from the periphery (skin, bone, ligaments, muscles, and other viscera) travels through the peripheral nerve reaches the dorsal horn of the spinal cord, second-order neuron: start at the dorsal horn cross over to the contralateral side and then ascend in the spinal cord to the thalamus, and other brain areas like dorsolateral pons and third order neuron: starts at the thalamus and then terminates in the cerebral cortex. The descending pathway begins in multiple areas of the brain, sending signals across nerve fibers. 

Referred Pain

Referred pain is felt in an area removed or distant from its point of origin-the area of referred pain is supplied by the same spinal segment as the actual site of pain (Huether & McCance, 2017). Making the diagnosis difficult for practitioners, referred pain also presents differently in men and women. It is fairly common in some conditions, such as heart attacks and osteoarthritis (Ungvarsky, 2019). Impulses from many cutaneous and visceral neurons converge on the same ascending neuron, and the brain cannot distinguish between the different sources of pain (Huether & McCance, 2017). 

Impact of Gender and Age on Pain

Focusing on the factors of age and gender and the effects on the experience of pain showed the importance of understanding different factors relating to pain. Persistent pain affects the elderly disproportionally, occurring in 50 % of elderly community-dwelling patients and 80 % of aged care residents (Veal & Peterson, 2015). In the United States, the fastest growing population is the baby boomers generation, and in ten years they will represent one out of five citizens. Pain is also increasingly difficult to manage in the elderly patient population as drug interactions, absorption rates and drug clearances begin varying as a result of the aging process. With the opportunity of placing a high fall risk population in even more danger, dosing for the elderly population can become difficult for a  practitioner. Petrini, Matthiesen, and Arendt-Nielsen (2015) acknowledged that the experience of pain in the elderly may differ from the experience in younger populations on multiple dimensions (sensory, affective, and cognitive). As the body physically wears down, so does the nervous system. In many patients seeking pain relief, the number of neurotransmitter cell receptors decreases with age-associated cortical and subcortical atrophy of brain tissue (Kaye et al., 2014). The practitioner must take into account all of the aging population’s comorbidities plus, fully assess the patient to determine if they are accurately representing their pain description. 

Females have always been associated with a higher threshold for pain, and I can attest to this as I would gladly take an open heart female patient over a male patient but, this is not fair to assume those female patients have a higher tolerance for pain. Practitioners must still assess their patients, monitor their vital signs, and ask questions that can reveal answers that patient may not know themselves until the question is asked. Women do have more difficulty when attempting to have their pain managed. The tendency to underdiagnose and undertreat the pain of certain groups of patients, especially women, is greater when patients present with symptoms that are less objective and more grounded in complaints of pain (coronary artery disease, collagen vascular disease, nonspecific abdominal or pelvic pain) (Becker & Mcgregor, 2017). While pain does not differentiate between genders, male masculinity has taught generations of men to accept pain as normal while at the same time, women who complain of pain are frequently underdiagnosed. 

Conclusion

Pain can be acute or chronic, and it can be referred or direct, practitioners must take into account all the factors that can mask or enhance the pain experience of their patients. Understanding the role the pain experience has can vary due to age or gender and pain is whatever the individual states it is or in some cases, fail to state. High-quality physical assessments and asking the appropriate questions can help practitioners manage their pain, taking into account the aging process and comorbidities that present throughout life. 

 

                                                                                                                               References

Anwar, K. (2016). Pathophysiology of pain. Disease-a-Month, 62(9), 324–329. https://doi-org.ezp.waldenulibrary.org/10.1016/j.disamonth.2016.05.015

Becker, B., & Mcgregor, A. J. (2017). Article Commentary: Men, Women, and Pain. Gender and the Genome, 1(1), 46-50. https://doi-org.ezp.waldenulibrary.org/10.1089/gg.2017.0002

Dekkers, W. (2017). Pain as a Subjective and Objective Phenomenon. Handbook of the Philosophy of Medicine, 1-15. doi:10.1007/978-94-017-8706-2_8-1

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Kaye, A. D., Baluch, A. R., Kaye, R. J., Niaz, R. S., Kaye, A. J., Liu, H., & Fox, C. J. (2014). Geriatric pain management, pharmacological and nonpharmacological considerations. Psychology & Neuroscience, 7(1), 15–26. https://doi-org.ezp.waldenulibrary.org/10.3922/j.psns.2014.1.04

National Library of Medicine – National Institutes of Health. (2018). Retrieved June 7, 2019, from https://www.nlm.nih.gov/

Petrini, L., Matthiesen, S. T., & Arendt-Nielsen, L. (2015). The Effect of Age and Gender on Pressure Pain Thresholds and Suprathreshold Stimuli. Perception, 44(5), 587–596. https://doi-org.ezp.waldenulibrary.org/10.1068/p7847

Rodriguez, L. (2015). Pathophysiology of Pain: Implications for Perioperative Nursing. AORN Journal, 101(3), 338–344. https://doi-org.ezp.waldenulibrary.org/10.1016/j.aorn.2014.12.008

Ungvarsky, J. (2019). Referred pain (reflective pain). Salem Press Encyclopedia of Health. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=ers&AN=133861288&site=eds-live&scope=site

Veal, F., & Peterson, G. (2015). Pain in the Frail or Elderly Patient: Does Tapentadol Have a Role? Drugs & Aging, 32(6), 419–426. https://doi-org.ezp.waldenulibrary.org/10.1007/s40266-015-0268-7

 

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                        Respond 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

                                                  Main Post 

Throughout my years as an ICU nurse, critical thinking has become a skill that I utilize on a daily basis in my clinical practice. Not only are critical thinking skills a part of my daily practice, but I also observe my colleagues putting their critical thinking skills to use in their every day clinical practice. One example of critical thinking skills being used in ICU clinical practice is when multiple drips are being titrated on a patient that is extremely ill. As an ICU nurse, it is essential and vital that you utilize critical thinking skills when choosing which drip to titrate up or down or which drip to start or stop. Another instance where I have observed critical thinking skills being used in the ICU is when I would attend a rapid response on one of the medical floors. As the critical care nurse, I must use my critical thinking skills to choose the right lab tests to run, determine what might be going on with the patient that is in distress, and choose the right treatment pathway.

 

I try to improve my clinical competence in every way I can, especially by employing my critical thinking strategies. Some of the strategies I use most often include listening, continuing to learn every chance I get, and explaining to my colleagues why I came to a specific conclusion. I use the strategy of listening to improve my clinical competence because it helps me find new solutions to everyday problems that I might face in the ICU. Learning helps improve my clinical competence because it makes me a better ICU nurse. The more I learn, the more proficient I can become. I like to explain my rationale for the conclusion I came to because another colleague might have something important to add that would aid in solving the problem at hand. 

 

Clinical scholarship is defined as an approach that enables evidence-based nursing and the development of best practices to meet the needs of clients efficiently and effectively (Stanley et al., 1999). 

Critical thinking is defined as the objective analysis and evaluation of an issue in order to form a judgment (Benner, Hughes, & Stuphen, 2008, p. [Page 120]). 

Clinical practice is defined as either the field of principal professional clinical activity (Wilkes, Mannix, & Jackson, 2013).

 

After reviewing the definitions of clinical scholarship, critical thinking, and clinical practice I was able to see how each term is interconnected. In order to have a clinical scholarship like approach in clinical practice, it is essential that critical thinking tools be utilized. The development of the best practices in clinical nursing practice will not occur if there is no critical thinking involved in the process (Wilkes, Mannix, & Jackson, 2013).

These three terms should be looked at as a single unit; one cannot exist without the other. 

 

 

 

Benner, P., Hughes, R. G., & Stuphen, M. (2008). Patient Safety and Quality: An 

 

               Evidence-Based Handbook for Nurses.Rockville, MD. 

 

Stanley, J., PhD, Keating, S. B., EdD, Edwardson, S., PhD, Easley, C. E., PhD, Alichnie, 

 

               C., PhD, & Edwards, J., PhD. (1999, March 15). Defining Scholarship for the 

               

               Discipline of Nursing. Retrieved December 31, 2018, from

 

               https://www.aacnnursing.org/News-Information/Position-Statements-White-

 

               Papers/Defining-Scholarship 

 

Wilkes, L., Mannix, J., & Jackson, D. (2013). Practicing nurses perspectives of clinical 

 

scholarship: a qualitative study. BMC nursing, 12(1), 21. doi:10.1186/1472-6955-

 

 

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