Case Study:

https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_05/index.html

Examine
 Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

References:

· Stahl, S. M. (2021). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.

· Chapter 8,  “Anxiety, Trauma, and Treatment” (pp. 359-378)

· American Psychiatric Association. (2010a). 

Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder
Links to an external site.
. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/acutestressdisorderptsd.pdf

· American Psychiatric Association. (2010c). 

Practice guideline for the treatment of patients with panic disorder
Links to an external site.
 (2nd ed.). https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf

 Nursing knowledge is classified in a variety of ways, one of which is Carper’s Patterns of Knowing (Carper, 1978). Carper’s framework offers a lens through which the nurse can reflect upon insights acquired through empirical, ethical, personal, and aesthetic knowledge (Carper, 1978). Through intentional reflection using Carper’s Patterns of Knowing, nurses can process experiential learning and knowledge acquired through practice. The purpose of this assignment is to reflect upon a specific practice situation and better understand the professional knowledge and insights obtained through that experience.

Criteria for Content

1. Think of a surprising or challenging practice situation in which you felt underprepared, unprepared, or uncomfortable.
2. Select an important nursing issue/topic that was inherent to the identified situation.
3. Briefly explain the situation.
4. Identify the nursing issue inherent in the identified situation
   1. As a method of refection, use Carper’s Patterns of Knowing to analyze the situation. In your discussion, address ONE of the following Patterns of Knowing:
      1. What do you think was the underlying reason for the situation? (Esthetics)
      2. What were your thoughts and feeling in the situation? (Personal)
      3. What was one personal belief that impacted your actions? (Ethics)
      4. What evidence in nursing literature supports the nursing importance of the identified issue? (Empirical)
5. What new insights did you gain through this reflective practice opportunity? How will this apply to your practice as a nurse practitioner? Be sure to use scholarly literature to support your position.

search for a professional journal article related to a health and aging issue of interest to

the student.  For example, a student who wants to be a Physical Therapist may wish to

research a Physical Therapy journal and gain insight into a recent study on stroke

rehabilitation while a Nursing student may wish to research quality of care in acute care

settings. You are free to choose a journal article on a topic of your choosing that also

relates to health issues among the older population.  will be responsible for the

following:

FRAMING A PRACTICE PROBLEM AS A CRITICAL QUESTION WITH MEASURABLE OUTCOMES

Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the  application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

Respond to  two of your colleagues  by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

PEER #1

Shaunagay Kenney

Week 7 Discussion Main Post

A Critical Question with Measurable Outcomes

Question: Will adding pharmacological interventions to nonpharmacological treatments improve post-traumatic stress disorders in adults?

Article Selection

A total of six articles were discovered and appraised using the “Adapted Rating System for the Hierarchy of Evidence” (Dang & Dearholt, 2017; Fineout-Overholt et al., 2010). The type of article and information that supported the purpose statement were used in the selection process.

Critical Question Explanation

            Post-traumatic stress disorder (PTSD) has long been associated with military members

exposed to combat. Before PTSD was coined, Charles Myers used shell “shock” to describe injured soldiers during World War I (Horwitz, 2018). According to Friedman (2019), PTSD is defined as direct or indirect exposure to a traumatic event where a person is severely traumatized based on that event. According to the National Center for PTSD (2021), 60% of men and 50% of women will experience at least one traumatic event in their lives, 6% of the population will have PTSD at some point in their lives, and about 15 million adults have PTSD during a given year. For most individuals, psychotherapy is a sufficient treatment for PTSD, but not for others. Could pharmacological interventions assist individuals where psychotherapy alone does not work?       

Article Synthesis

            For some individuals, psychotherapy alone does not work. Similarly, pharmacological use alone can be ineffective (Raskind et al., 2018; Rasmusson et al., 2017). However, combining SSRIs or other medications with CBT or other therapies may reduce PTSD symptoms in some individuals (Mithoefer et al., 2019; Wagner et al., 2017). Mithoefer et al. (2019) found that MDMA- assisted psychotherapy effectively treated PTSD. According to Wagner et al. (2017), MDMA increases oxytocin, facilitates openness, and enhances the therapy's effectiveness. In the prolonged exposure and sertraline trial conducted by Rauch et al. (2020), PTSD subjects were given strict instructions on collecting their saliva for testing. They made a ground-breaking discovery about cortisol, finding that cortisol levels were lower in individuals with PTSD than those without PTSD (Rauch et al., 2020). Not only was this discovery made, but following the combination treatment of sertraline and prolonged exposure, significant improvements were noted for one year (Rauch et al., 2019). While combining psychotherapy with some drugs improved PTSD symptoms, others did not.

References

Dang, D., & Dearholt, S. (2017). 
Johns Hopkins nursing evidence-based practice: Model and     guidelines (3rd ed.). Sigma Theta Tau International.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B. & Williamson, K. M. (2010). Critical   

           appraisal of the evidence: Part I. 
American Journal of Nursing, 110(7), 47-52. 

https://doi.org/10.1097/01.NAJ.0000366056.06605.d2Links to an external site.

Friedman, M. J. (2019, October 14). 
PTSD History and Overview. U.S. Department of Veterans Affairs. 

https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.aspLinks to an external site.

Horwitz, A. (2018). 
PTSD: A short history. Johns Hopkins University Press

Mithoefer, M. C., Feduccia, A. A., Jerome, L., Mithoefer, A., Wagner, M., Walsh, Z., Hamilton,     S., Yaza-Klosinski, B., Emerson, A., & Doblin, R. (2019). MDMA-assisted psychotherapy for treatment of PTSD: Study design and rationale for phase 3 trials based   on pooled analysis of six phase 2 randomized controlled trials. 
Psychopharmacology,            236(9), 2735-2745. 

https://doi.org/10.1007/s00213-019-05249-5Links to an external site.

PTSD: National Center for PTSD. (2021, September 10). 
How common is PTSD in adults? U.S.       Department of Veterans Affairs.        

https://www.ptsd.va.gov/understand/common/common_adults.aspLinks to an external site.

Raskind, M. A., Peskind, E. R., Chow, BB., Harris, C., Davis-Karim, A., Holmes, H. A., Hart, K.    L., McFall, M., Mellman, T. A., Reist, C., Romesser, J., Rosenheck, R., Shih, M. C.,           Stein, M. B., Swift, R., Gleason, T., Lu, Y., & Huang, G. D. (2018). Trial of prazosin for     post-traumatic stress disorder in military veterans. 
The New England Journal of         Medicine, 378(6), 507-517. 

https://doi.org/10.1056/NEJMoa1507598Links to an external site.

Rasmusson, A. M., Marx, C. E., Jain, S., Farfel, G. M., Tsai, J., Sun, X., Geracioti, T. D.,    Hamner, M. B., Lohr, J., Rosse, R., Summerall, L., Naylor, J. C., Cusin, C., Lang, A. J.,         Raman, R., & Stein, M. B. (2017). A randomized controlled trial of ganaxolone in   post-traumatic stress disorder
. Psychopharmacology, 234(15), 2245-2257.            

https://doi.org/10.1007/s00213-017-4649-yLinks to an external site.
 

Rauch, S. A. M., Kim, M., Powell, C., Tuerk, P. W., Simon, N. M., Acern, R., Allard, C. B.,         Norman, S. B., Venners, M. R., Rothbaum, B. O., Stein M. B., Porter, K., Martis, B.,            King, A. P., Liberzon, I., Luan Phan, K., & Hoge, C. W. (2019). Efficacy of prolonged        exposure therapy, sertraline hydrochloride, and their combination among combat veterans             with post-traumatic stress disorder. 
JAMA Psychiatry, 76(2), 117-126.             

https://doi.org/10.1001/jamapsychiatry.2018.3412Links to an external site.

Rauch, S. A. M., King, A., Kim, H. M., Powell, C., Rajaram, N., Venners, M., Simon, N. M.,   Hamner, M., & Liberzon, I. (2020). Cortisol awakening response in PTSD treatment:     Predictor or mechanism of change. 
Psychoneuroendocrinology, 118, 1-16.             

https://doi.org/10.1016/j.psyneuen.2020.104714Links to an external site.

Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-      Klosinski, B., & Doblin, R. (2017). Therapeutic effect of increased openness:  Investigating mechanism of action in MDMA-assisted psychotherapy. 
Journal of  Psychopharmacology, 31(8), 967-974. 

https://doi.org/10.1177%2F0269881117711712Links to an external site.

PEER # 2

Samir Moneer Nawaf Hamed

 

Critical Question: Nursing burnout and its impact on nurses and patient care.

Nursing burnout is a state of emotional, physical, and mental exhaustion resulting from prolonged and intense stress in the nursing profession. It significantly impacts nurses by causing increased job dissatisfaction, higher turnover rates, and adverse mental and physical health effects (Mudallal et al., 2017). Moreover, burnout has a direct and detrimental impact on patient care, leading to decreased quality, increased medical errors, and reduced patient satisfaction due to compromised nurse-patient interactions and reduced attention to detail (Garcia et al., 2019). Addressing nursing burnout is crucial for maintaining a resilient nursing workforce and ensuring high-quality patient care outcomes.

Synthesis of Scholarly Articles

1. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis

This study comprehensively analyzed existing research and found compelling evidence that burnout among healthcare professionals significantly impairs patient safety. The meta-analysis synthesized data from multiple studies, revealing a strong association between burnout and increased risks of medical errors, compromised quality of care, and adverse patient outcomes, highlighting the critical importance of addressing burnout as a crucial factor in ensuring patient safety in healthcare settings (Garcia et al., 2019).

2. Relationship between nurse burnout, patient and organizational outcomes: Systematic review

This study examined a broad range of studies and revealed a clear and intricate relationship between nurse burnout, patient outcomes, and organizational effects. It found that higher levels of nurse burnout are consistently linked to adverse patient outcomes such as increased mortality rates, longer hospital stays, and decreased patient satisfaction. Additionally, burnout has detrimental organizational consequences, including higher nurse turnover and lower overall workplace performance. This study underscores the interconnectedness of nurse well-being, patient care quality, and organizational success, emphasizing the urgency of addressing burnout to improve healthcare outcomes and workplace environments (Jun et al., 2021).

3. Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries

This study conducted a comprehensive cross-national analysis and identified a consistent and alarming pattern: nurse burnout substantially negatively impacts the quality of patient care across different healthcare systems and countries. The study's findings highlighted that high levels of nurse burnout were associated with lower perceptions of care quality among both nurses themselves and patients. This suggests that addressing nurse burnout is imperative not only for the well-being of healthcare professionals but also for maintaining and improving the quality of care delivered in diverse healthcare settings globally (Poghosyan et al., 2021).

4. Association of resident fatigue and distress with perceived medical errors

This study demonstrates a significant correlation between resident physician fatigue and distress levels and the perception of medical errors. The research findings suggest that higher levels of resident fatigue and distress are associated with increased instances of perceived medical errors. This indicates that addressing the well-being and mental health of healthcare providers, including reducing fatigue and distress, can play a crucial role in improving patient safety and reducing the likelihood of medical errors in healthcare settings, emphasizing the need for interventions and policies aimed at mitigating these factors to enhance patient care quality. (West, 2019)

Value for Stakeholders

Addressing nursing burnout is a moral imperative and a strategic quality improvement initiative. The identified articles provide compelling evidence that nurse burnout directly impacts patient satisfaction, healthcare outcomes, and organizational effectiveness (Mudallal et al., 2017). By investing in interventions to reduce burnout, healthcare organizations can enhance patient care quality, increase staff retention, reduce medical errors, and ultimately improve their bottom line. Moreover, addressing nursing burnout aligns with the mission of healthcare organizations to deliver safe, effective, and patient-centered care, enhancing their reputation and competitiveness in the healthcare industry (Jun et al., 2021).

 

References

Garcia, C. de L., Abreu, L. C. de, Ramos, J. L. S., Castro, C. F. D. de, Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019, August 30). Influence of burnout on Patient Safety: Systematic Review and meta-analysis. Medicina (Kaunas, Lithuania). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780563/

Jun, J., Ojemeni, M., Kalamani, R., Crecelius , M., & Tong , J. (2021, March 26). Relationship between Nurse Burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies. https://www.sciencedirect.com/science/article/abs/pii/S0020748921000742

Mudallal, R. H., Othman, W. M., & Al Hassan, N. F. (2017, January 1). Nurses’ burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry : a journal of medical care organization, provision and financing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/

Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2021, August). Nurse Burnout and quality of care: Cross-national investigation in six countries. Research in nursing & health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908908/#:~:text=Across%20countries%2C%20higher%20levels%20of,quality%20of%20care%20in%20hospitals.

West, C. (2019, September 23). Association of resident fatigue and distress with perceived medical errors. JAMA. https://jamanetwork.com/journals/jama/article-abstract/184625