Post an explanation of how you anticipate enacting personal and professional commitment for advocacy to positively impact your patients, communities, and the profession. Be specific. Then, explain how your role as a DNP-prepared nurse contributes to advocacy for positive social change.

1. 

 My personal and professional commitment to advocacy includes both short and long-term goals within the nursing profession. From a professional standpoint, I am afforded the opportunity to offer input on ways to continuously improve the patient care experience and care delivery. Providing feedback offered directly from patients as well as discussing barriers I experience as a prescriber, including but not limited to coordination with other members of the care team or barriers within technology, will be at the forefront. Openly discussing setbacks provides the opportunity to brainstorm improvements, ultimately improving patient care outcomes.

            Personal commitments to the nursing profession and patient advocacy include the accountability to remaining current within my knowledge of medications and therapies available to treat the mental health population. The formal education provided within the Doctor of Nursing practice (DNP) program provides the structure and skills needed to employ within professional practice. These skills ensuring that the DNP is seeking out and utilizing quality, evidence-based measures to treat patients with interventions supported by adequate science and research (American Association of Colleges of Nursing, 2006). Networking with other mental health professionals both within the nursing field and in other capacities will also expand and enact my commitment to patient advocacy and social change. Learning from other professionals, hearing their perspectives on current events, and in exchange offering my perspective will offer a broad view of treatment approaches and current topics (Hann et al., 2020).

The Doctor of Nursing as a Social Change Agent

            As a DNP, I would like to employ my skills as a social change agent by engaging in educational opportunities within the mental health community, driven by research opportunities. Engaging in the research that guides evidence-based practices improves outcomes for the millions of patients impacted by care delivery and would exercise the practice-based research skills formed in DNP education (Iwama et al., 2023). Utilizing the terminal DNP degree to its utmost while continuing to engage in patient care would combine the aspects I found most rewarding of my MSN-PMHNP career and the completion of the DNP program. Advocating for improved treatment measures within the mental health community, as well as for increased access to appropriate care and diagnostic assessments, are all ways in which I would like to engage in DNP research opportunities. Providing education, facts, and data related to how patients are impacted by lack of access to specialized psychiatric care due to barriers such as telehealth restrictions and lack of full practice authority for nurse practitioners will continue to increase awareness of these topics and lobby for change. The DNP offers specialized insight into these topics as a professional working not only for but within the field, and holds significant weight when discussing these topics with both other professionals as well as non-professionals. 

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Hann, K., Heather Pearson, Campbell, D., Sesay, D., & Eaton, J. (2020). Factors for success in mental health advocacy. Global Health Action, 8(0), 1–9. https://doi.org/10.3402/gha.v8.28791

Iwama, K., Travis, A., Nowlin, S., Souffront, K., Finlayson, C., Gorbenko, K., & Cohen, B. (2023). Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nursing Outlook, 71(5). https://doi.org/10.1016/j.outlook.2023.102031In the nursing profession, advocating for our patients is something that is deeply ingrained in us.  One of the five key areas of the social determinants of health is access to healthcare (Centers for Disease Control and Prevention, 2021).  Unfortunately, approximately one in ten patients do not have health insurance (Berchick et al., 2018).  In the field of mental health, we often see patients who are too disorganized to navigate the health insurance system and experience lapses in insurance.  In Massachusetts, we are required to abide by the Expedited Psychiatric Inpatient Admissions (EPIA) Policy, which mandates that “no individual boarding in an ED waiting placement in a psychiatric hospital will wait more than 96 hours before Department of Mental Health has been notified, regardless of whether the individual is uninsured or has coverage not regulated by Division of Insurance” (Executive Office of Health and Human Services, 2023).  The pressure to decompress emergency rooms and move psychiatric patients out as quickly as possible means that we often receive patients who are uninsured.  In order to help our patients get the services they need, nurses and social workers assist our patients in taking the necessary steps to obtain health insurance.  This often means lengthy phone wait times on phone calls, but as advocates, we do what is necessary to ensure positive outcomes for our patients.   

                                                                     Advocacy in my Community

As an agent of positive change, I will advocate at the community level for residents who suffer from mental illness.  In spite of the “growing recognition of the burden associated with mental illnesses and the availability of cost-effective treatments, they are not yet afforded the same policy or program priority as comparably disabling physical conditions” (Stuart, 2017).  I aim to increase access to mental health services by expanding my organization’s service lines to include outpatient services for mental health and substance use disorders.  In order to gain buy-in from the community, I plan to attend town meetings to advocate for increased services as well as partnering with local Emergency Departments to educate them about the mental health services that my organization offers.  I plan to seek meetings with local politicians to advocate that resources be invested into increasing services for mental health and substance use disorder services. 

                                                                     Advocacy in my Profession

            According to a recent survey conducted by the American Psychiatric Nurses Association (APNA), “only 4% of licensed registered nurses (RNs) work in psychiatric-mental health, If that percentage is still consistent, then there are approximately 154,000 RNs working in psychiatric-mental health, which is not nearly enough to meet the demand” (APNA, 2018).  As a doctorally prepared nurse, it is critical that I take steps now to increase the number of nurses who specialize in mental health.  I aim to do this on the local level by partnering with local nursing schools to invite them into my organization for their psychiatric clinical rotations.  Additionally, I will attend local universities’ career fairs so that I can provide information to nursing students about the advantages of working in the field of mental health.

                                                                          Advocacy and Social Change

As a doctorally prepared nurse, I aim to help close the gaps in the inequities of access in the field of mental health.  To do so, I must first identify opportunities to advocate for my own patients by assisting them in obtaining health insurance so that they are able to have access to outpatient services.  At the community level, I aim to increase access to mental health services by expanding my organization’s service lines to include more outpatient services for psychiatry and substance use disorders.  With regard to the profession of nursing, specifically psychiatric nursing, it is imperative that I identify ways to increase interest for newly graduated RNs to join the field by promoting the field at local nursing schools.  By acting as an advocate on all three levels, I will be able to effect positive social change in the field of psychiatric nursing.

                                                                                   References

American Psychiatric Nurses Association. (2018). Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey. https://journals.sagepub.com/doi/abs/10.1177/1078390318777873?journalCode=japa

Berchick, E.R., Hood, E., & Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdfLinks to an external site. [PDF – 1.4 MB]

Centers for Disease Control and Prevention. (2021). Social determinants of health: Know what affects health. https://www.cdc.gov/socialdeterminants/index.htmLinks to an external site.

Executive Office of Health and Human Services. (2023). Expedited Psychiatric Inpatient Admissions (EPIA) Policy. https://www.mass.gov/info-details/expedited-psychiatric-inpatient-admissions-epia-policyLinks to an external site.

Stuart, H. (2017). Reducing the Stigma of Mental Illness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314742/

2. 

 My personal and professional commitment to advocacy includes both short and long-term goals within the nursing profession. From a professional standpoint, I am afforded the opportunity to offer input on ways to continuously improve the patient care experience and care delivery. Providing feedback offered directly from patients as well as discussing barriers I experience as a prescriber, including but not limited to coordination with other members of the care team or barriers within technology, will be at the forefront. Openly discussing setbacks provides the opportunity to brainstorm improvements, ultimately improving patient care outcomes.

            Personal commitments to the nursing profession and patient advocacy include the accountability to remaining current within my knowledge of medications and therapies available to treat the mental health population. The formal education provided within the Doctor of Nursing practice (DNP) program provides the structure and skills needed to employ within professional practice. These skills ensuring that the DNP is seeking out and utilizing quality, evidence-based measures to treat patients with interventions supported by adequate science and research (American Association of Colleges of Nursing, 2006). Networking with other mental health professionals both within the nursing field and in other capacities will also expand and enact my commitment to patient advocacy and social change. Learning from other professionals, hearing their perspectives on current events, and in exchange offering my perspective will offer a broad view of treatment approaches and current topics (Hann et al., 2020).

The Doctor of Nursing as a Social Change Agent

            As a DNP, I would like to employ my skills as a social change agent by engaging in educational opportunities within the mental health community, driven by research opportunities. Engaging in the research that guides evidence-based practices improves outcomes for the millions of patients impacted by care delivery and would exercise the practice-based research skills formed in DNP education (Iwama et al., 2023). Utilizing the terminal DNP degree to its utmost while continuing to engage in patient care would combine the aspects I found most rewarding of my MSN-PMHNP career and the completion of the DNP program. Advocating for improved treatment measures within the mental health community, as well as for increased access to appropriate care and diagnostic assessments, are all ways in which I would like to engage in DNP research opportunities. Providing education, facts, and data related to how patients are impacted by lack of access to specialized psychiatric care due to barriers such as telehealth restrictions and lack of full practice authority for nurse practitioners will continue to increase awareness of these topics and lobby for change. The DNP offers specialized insight into these topics as a professional working not only for but within the field, and holds significant weight when discussing these topics with both other professionals as well as non-professionals. 

References

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Hann, K., Heather Pearson, Campbell, D., Sesay, D., & Eaton, J. (2020). Factors for success in mental health advocacy. Global Health Action, 8(0), 1–9. https://doi.org/10.3402/gha.v8.28791

Iwama, K., Travis, A., Nowlin, S., Souffront, K., Finlayson, C., Gorbenko, K., & Cohen, B. (2023). Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research. Nursing Outlook, 71(5). https://doi.org/10.1016/j.outlook.2023.102031

TOPIC : NURSING SHORTAGE

Decision-Making Process 

Instructions

In this assignment, you will be writing a 6-pages identifying, comparing and contrasting at least 3 DIFFERENT DECISION MAKING APPROACHES SOF CARE from a multidisciplinary perspective using a pertinent and significant topic ( NURSING SHORTAGE).

You are required to use APA 7th edition format and the page count does not include title page or reference page. Reflect on your own decision-making practices and the implications this will have regarding differing approaches taken of nursing leaders and staff nurses/clinical practitioners in decision making within to issues in practice. To complete this assignment, do the following:

1. Select and describe an issue in nursing that impacts nurses at all levels from bedside to advanced practice. Make sure to provide an adequate background and its significance to all levels of nursing using a strong review of the literature. Additionally, this should include a thorough literature review that provides a good understanding of what the cause of this problem is; what is suggested to address this problem. Essentially, this review must support your choices of the decision-making models and this needs to include how all levels of nursing practice (the bedside nurse to the APN are impacted by the problem).
2. Identify how you would expect a nurse leader/manager, a bedside/staff nurse and an Advanced practice nurse (CNO or NP) to address your selected issue using at least 3different decision-making approaches which are clearly supported by the literature review. This must first include aa detailed analysis/overview of the selected decision making models and how they are used in practice. Then a detailed analysis of how these decision-making approaches/models would address the problem/along with a detailed analysis of how each of the three selected models would be applied to address the selected issue/problem making sure to incorporate this at all levels of practice. One of the decision-making models may be more applicable to the bedside nurse; whereas the other more applicable to the APN; however, all levels of nursing practice need to be addressed with at least one of the chosen 3 decision-making models. However, this does not mean that each decision-making model will apply to all levels of practice only that in this discussion needs to include how each level of nursing practice would utilize the decision-making model to address the problem. For instance,one decision making model may apply to the bedside nurse; the second decision making model may be more applicable at the level of APN (CNO, NP, etc) and the other decision-making model may be best applied to the nurse manager. This section should be detailed; meaning specific, well thought out, realistic solutions of how the nurse (at the level identified; this may include more than one level for the same decision-making model or not) would address the problem using the decision-making model is provided and well supported by the literature. of the benefits and limitations of various decision-making approaches that are applied appropriately to the level of nursing practice to address the selected issue/problem. This is informed from course readings,literature, clinical scenarios and other evidence-based and scholarly sources.
3. Prioritize the best decision-making approach/model to address the selected problem that is grounded in best practice. This should provide a well-supported rationale for this choice that includes a good comparison and contrasting of the 3 chosen decision-making models that clearly illustrates why the choice was made, that is consistent with the decision making model and how it would address the chosen topic or problem.
4. Identify a possible funding source that would addresses your approach to solving the problem. For instance, if the best approach to solving the nurse-to-patient ratio problem is through the use of SDM and shared governance, perhaps you may seek a local funding source to provide you with funding to implement a small EBP or research project that would be funded by a local nursing organization such as Sigma Theta Tau or perhaps if it was geared more towards assessing the value of this model towards NP in practice than seeking a local organization that supports funding for projects being implemented by practicing NP? If seeking money for research this would need to be overseen by a nurse with a DNP or a PhD or someone with the credentials to do so that are part of their scope of practice. Consider looking at federal, state,or local organizations. For example: There are many grants available through the CDC,HRSA, etc. Again, this need to be specifically applied with sufficient details
5. Use at least 10 references other than your main text.Uses APA 7th edition formatting. At least 5 of these need to be within the past five years.

NO PLAGIARISM MORE THAN 10 5 ALLOWED, ATTACH PLAGIARISM REPORT

GO FROM POINT 1 TO 5 , DON’T MISS ANY SECTION

CHECK YOUR GRAMMAR, MUST BE GOOD AND PROPER

RUBRIC ATTACHED

NO LATER THAN OCTOBER 12 , 2023

PLEASE REFER TO THE TOPIC NURSING SHORTAGE, FOCUS ON THAT TOPIC, NO OTHER TOPIC. 

Nicole Washington 

        Explain the agonist-to-antagonist spectrum of action of  psychopharmacologic agents, including how partial and inverse agonist  functionality may impact the efficacy of psychopharmacologic treatments.

Neurotransmitters and some drugs that stimulate receptors are  called agonists. Agonists stimulate receptors to their fullest signal  transduction. Drugs that act as agonists are useful in patients who lack  or are deficient in agonist neurotransmitters. In situations where the  actions of a full agonist or partial agonists are undesirable, an  antagonist is required to revert the receptor back to the state where no  agonist exists, back to neutral. Partial agonists act as they sound,  and produce a conformational change of a receptor that is halfway  between the changes of a full agonist and the baseline conformation of  that receptor. An antagonist can also reverse the effects of inverse  agonists to the receptors baseline. An inverse agonist acts to change  the conformation of a receptor to completely inactivate it and remove  the baseline constitutive activity. 

Compare and contrast the actions of g coupled proteins and ion gated channels.

Both G protein coupled receptors and Ion gated channels are a  form of signal transduction cascades in the brain. They are both  triggered by neurotransmitters, and many of the psychotropic drugs used  today affect one of these two cascades. They both perform when an  extracellular first messenger passes a message to an intracellular  second messenger. However, G protein’s second messenger is a chemical,  such as adenosine monophosphate, while the ion channel second messenger  can be an ion, such as calcium. There are two classes of ion channels,  Ligand gated and voltage sensitive ion channels. The ligand gated ion  channels act similar to g protein receptors because they use the agonist  spectrum. Voltage sensitive ion channels are opened and closed based on  the voltage charge across the membrane.

Explain how the role of epigenetics may contribute to pharmacologic action.

Epigenetics determines if inherited genes are expressed or not  expressed into proteins that make up the story of any one person. The  mechanism of epigenetics turns genes on or off by modifying chromatin.  These modifications are regulated by neurotransmitters, drugs and the  environment. So drugs introduced to patients can affect a person’s  epigenetics.

Explain how this information may impact the way you prescribe  medications to patients. Include a specific example of a situation or  case with a patient in which the psychiatric mental health nurse  practitioner must be aware of the medication’s action.

Understanding the way medications will affect patients based on  their genetic makeup, their current medications, the condition being  treated, what causes the imbalance, is all important when prescribing  medications. For example imipramine, a tricyclic antidepressant,  inhibits the reuptake of serotonin and norepinephrine, elevating these  neurotransmitters in the brain. It is important to understand if this is  the cause of the patients depression before prescribing this medication  because if incorrectly prescribed it could alter the patients  epigenetic mechanisms in an inverse way (Boks, et al. 2012). 

due 11-15-23 @10am