How can the knowledge of economic theory be utilized by advanced practice nurses? How can economic theory be applied in analysis of interventions?
In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in this course and potentially solving an identified practice problem.
General Guidelines: Use the following information to ensure successful completion of the assignment:
- This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
- Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
- This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
- You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
DNP 815 Discussions and Assignments GCU Construct a 2,500-3,000 wor
Directions:
d (approximately 10-12 pages) case report that includes a problem or situation consistent with a DNP area of practice. Requirements:
- Use a minimum of any two theories discussed in the course to develop the case report.
- Apply one or more theories to describe understanding of the problem or situation of focus.
- Apply one or more theories to the recommended intervention or solution being proposed.
- Develop the case report across the entire scenario from the identified clinical or health care problem through proposing an intervention, implementation, and evaluation using an appropriate research instrument.
- Describe the evaluation of the selected research instrument in the case report.
- Lastly, explain in full the tenets, rationale for selection (empirical evidence), and clear application using the language of the theory within the case report.
In addition, your case report must include the following:
- Introduction with a problem statement.
- Brief literature review.
- Description of the case/situation/conditions explained from a theoretical perspective.
- Discussion that includes a detailed explanation of the synthesized literature findings.
- Summary of the case.
- Proposed solutions to remedy gaps, inefficiencies, or other issues from a theoretical approach.
- Identification of a research instrument to evaluate the proposed solution along with a description of how the instrument could be evaluated.
- Conclusion.
Portfolio Practice Hours: It may be possible to earn Portfolio Practice hours for this assignment. Enter the following after the references section of your paper:
Practice Hours Completion Statement DNP-815 I, (INSERT NAME), verify that I have completed (NUMBER OF) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.
SAMPLE SOLUTION FOR WEEK 7 CASE REPORT
Case eport: Application of Theory Grand Canyon University: DNP-815
Suicide in Adolescence
Suicide in adolescence is the second most cause of death between the ages of 14-17 (Centers for Disease Control and Prevention (n.d.). With the development of technology and the increase of social media, bullying can take many forms. It does not necessarily have to be confined in face-to-face situations; social media has opened the door to innovative ways of bullying through the Internet. Social media also can influence the young minds of adolescents. Because of this, depression has increased throughout the years, resulting in more suicides (Centers for Disease Control and Prevention (n.d.). The purpose of this case report is to address the problem of depression in adolescence and increasing suicide rates, by discussing how to assess for depression and provide treatment options and/or resources.
Literature Review
The following resources helped introduce the assessment of depression process with the use of an established questionnaire. Allgaier, Pietsch, Frühe, Sigl-Glöckner, & Schulte-Körne (2012), in Screening for depression in adolescents: Validity of the patient health questionnaire in pediatric care, researches the appropriateness and validity of the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-2 (PHQ-2) that is traditionally used to assess depression in adults, to be used to assess adolescents with depression. The study states that the PHQ-9, which was derived from the Primary Care Evaluation of Mental Disorders interview, is the gold standard for assessing Depressive Disorders in adults. The results confirmed the appropriateness of the PHQ-9 and PHQ-2 to be used to assess depression in adolescents. This was validated with results, charts, and data, which showed that PHQ-9 was more specific and sensitive to the detection of depression, as opposed to the PHQ-2. Arroll, et al. (2010), in Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population, further looked at the validity of the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-2 (PHQ-2) to be used in the Primary Care setting. The intention is to identify depression earlier than seeing a Psychiatrist or Psychologist.
The study shares that about 50% of primary care providers miss the diagnosis of depression without the proper screening tool. The study utilized a 3-arm randomized controlled population. Sensitivity and specificity were calculated comparing the results of the screening tests with a reference standard. The results concluded that using the PHQ-9 determined depression diagnosis with much more sensitivity than the PHQ-2. The study provided data and tables to illustrate the findings. Furthermore, Lowe, Lipps, Gibson, Jules, & Kutcher (2018: DNP 815 Week 6 DQ 1 and 2), published Validation of the Kutcher adolescent depression scale in a Caribbean student sample, which addresses the reliability of the Kutcher Adolescent Depression Rating Scale (KADS) because adolescent depression detection has been limited within the Caribbean adolescent population. This study was completed with a sample from elementary schools in Jamaica and Barbados. Not only was KADS used for the study, but also the Adolescent Depression Rating Scale (ADRS), the Revised Children’s Anxiety and Depression Scale (RCADS), and state and trait anxiety visual analogue scales, as references to compare. ADRS and RCADS is currently the gold standard and more widely accepted in the Caribbean because it has been proven to have consistent validity and reliability. The study suggested that the KADS assessment had an acceptable range of concurrent validity, and it correlated with the ADRS and RCADS. The study included flow charts, data, and tables to illustrate the effectiveness of KADS.
Case Description with Applied Theories
Adolescent depression has increased in the past years. According to the National Institute of Mental Health (NIMH) (n.d.), in 2016, an estimated 3.1 million adolescents aged 12 to 17 in the United States had at least one major depressive episode. This number represented 12.8% of the U.S. population aged 12 to 17. And according to the Centers for Disease Control and Prevention (n.d.), the second leading cause of death in adolescents (aged 15-19), is suicide. The NIMH continues to add that 19% received treatment with a therapist, 19% received treatment with a therapist along with medication, only 2% received medication treatment alone, and an overwhelming 60% of adolescents did not receive any treatment at all. Knowing that adolescents are at school majority of their weekday time, it might be best to have depression being assessed at the school level by a school nurse and assist in having treatment options offered and delivered earlier than seeking help at a doctor’s office. Applying Watson’s Theory of Caring would assist in understanding the role of the school nurse to the adolescent student. Watson’s theory focused on the human and nursing paradigm, where the goal is to balance and bring harmony between health and illness experiences.
This holistic approach to caring would prove beneficial to those dealing with depression. While assessing a student on their possible depressive state, the school nurse can employ the Theory of Caring by assisting the student in recognizing their own emotional state of being and thereby giving the student a sense of capacity for actual self-healing (Ozan, Okumuş, & Lash, 2015: DNP 815 Week 6 DQ 1 and 2). Furthering the relationship between school nurse and adolescent student, the use of Hildegard Peplau’s Theory of Interpersonal Relationships. Peplau’s theory focuses on the three relationship stages of the school nurse and the adolescent student: (1) orientation, (2) working, and (3) termination. Within orientation, the school nurse and the student are just getting to know and understand each other. This is when the assessment of depression occurs and whether or not the student should be followed in regards to receiving possible treatment for depression. If the student has been deemed to be in a depressive state, that is when the working relationship occurs. The school nurse and the student begin to build a relationship built on trust, honesty, and openness. The student should feel that their emotional situation is recognized but at the same time understand that there are ways to assist in this emotional state. During termination, the student has been given management skills and coping mechanisms, tools to deal with situations in school, life, family, and anything that might disrupt the progress of growth and healthy living mentally (Delaney, Shattell, & Johnson, 2017).
Synthesized Literature Findings
When creating a program that will help identify adolescent students at risk for depression and suicide, utilizing several nursing theories can be used to accomplish this goal. Beginning with Watson’s Theory of Caring, the nurse becomes involved with the student to begin defining the relationship of school nurse and student. With Peplau’s Theory of Interpersonal Relationships, the relationship begins with assessing the student’s risk of depression. Using the Patient Health Questionnaire-9 (PHQ-9) as an assessment tool to be used with adolescents was shown to have a sensitivity of 85.0% and specificity of 79.4% (Allgaier, Pietsch, Frühe, Sigl-Glöckner, & Schulte-Körne, 2012).
This was further solidified with Arroll, et al. (2010), who also used the PHQ-9 which resulted with 74% sensitivity and 91% specificity. In both studies, the PHQ-9 was proven to be the better assessment tool for depression than the PHQ-2. Because the PHQ-2 was limited to just 2 questions, details involving further assessment was found with the PHQ-9 that would not be discovered otherwise. Allgaier, Pietsch, Frühe, Sigl-Glöckner, & Schulte-Körne (2012), continue to discuss that the PHQ-9 was determined to have a Cronbach’s alpha coefficient of .82. This reliability shows that this questionnaire can be utilized not only in primary care for adults, but also with adolescents.
Case Summary
Adolescent depression will only increase with the age of technology. Bullying is far more easier to reach than just the arm length of a swinging fist. A student can emotionally scar another student with just a simple click on a keyboard and social media post that can disseminate like wild fire to the masses. School staff, especially nurses, can assist in identifying these students who are possible victims of bullying or at risk for depression or emotional assistance.
With over 60% of adolescents with depression not receiving any type of support whether psychological or pharmaceutical, is a staggering percentage that needs to be addressed (Centers for Disease Control and Prevention, n.d.). School nurses are with adolescents almost every day and some visit the nurse office often. Signs and symptoms of depression in adolescents can take many shapes or forms. Thus, using a depression assessment tool when a student comes into the office despite for what reason, can possibly clue in to students who may need help and are unable to really voice it or recognize they need the help.
Intervention
A useful intervention for most mood disorders is the utilization of cognitive based therapies. Cognitive theory basically suggests that automatic thoughts of negative affect and depressed mood are what the mind cognitively distorts (Rnic, Dozois, & Martin, 2016: DNP 815 Week 6 DQ 1 and 2). Cognitive behavior therapy (CBT) is a type of psychotherapy that addresses emotional problems by boosting the person’s self-worth and happiness by modifying the initial negative thoughts, emotions, and/or behaviors. For example, when this author sees a rose, the hurtful memory of being forced into the bushes to take a picture and receiving several minor nicks on arms and legs from the thorns becomes apparent.
With CBT, this author can now change that negative thought process and remember that roses are beautiful and fragrant. Keles & Idsoe (2018) did a meta analysis of group cognitive behavior therapy interventions for adolescents and had remarkable results. It showed that the randomized controlled trials supported group CBT is effective for treating depression among adolescents. It was also noted that it is more cost effective because it is group therapy and that it can be utilized outside of the clinic (Keles & Idsoe, 2018).
Implementation
Knowing that the PHQ-9 would be the most effective at detecting depression in adolescents, this questionnaire would be the basis of educating school nurses on how to use the tool. Educating school nurses on (1) what is deemed to be a high-risk score, (2) address the specific issues that the student might consider the factors that lead them to be emotionally vulnerable, and then (3) to begin the process of cognitive behavior therapy. School nurses will be educated on how to assess, address issues, begin teachings of cognitive behavior therapy and then also refer to the school psychologist and social worker to give more added emotional support and guidance. Additional resources for adolescents with depression will give those students more options on how to address their issues and with who is most compatible.
Evaluation
Evaluating whether the proposed case review is effective, it would be best to test it against Kolcaba’s Theory of Comfort. Because Kolcaba’s theory is holistic, addressing the pain of a patient (whether it is physical or emotional) is in regards to the three types of comfort: relief, ease, and transcendence. And these 3 types of comfort are addressed in the four contexts of the holistic experience of: physical, psycho spiritual, socio cultural, and environmental. In order to fully evaluate the effectiveness of cognitive behavior therapy as an effective intervention for students who are at risk for depression and/or suicide, it is best to address Kolcaba’s Theory of Comfort within the three types of comfort themselves.
Relief. Assessing comfort of with the use of observation charts or comfort scoring. Physical addresses the mood swings, any heart issues or breathing issues induced by depression or anxiety. Psycho spiritual addressed anxiety and fear. Socio Cultural addressed relief from feeling alienated. And environmental addressed relief from environmental stressors such as social media contact. This area of comfort could be evaluated with an observational checklist that included comfort level scoring and qualitative data retrieved from the patient.
Ease. Physical addressed ease in pain and distressing symptoms. Psycho spiritual addressed ease of fear and depression. Socio cultural addressed ease in alienated feeling. And environmental addressed ease from environmental stressors not being around the bullies or in contact with bullies via in person or web. This can be evaluated by the patient verbalizing ease and contentment, and lack of fear or visual reduced anxious behavior.
Transcendence. Physical addressed rising above pain and distressing symptoms. Psycho spiritual addressed crying, fear, and depression. Socio cultural addressed need for rising above the feeling of alienation, and need for support from family or significant other. Environmental addressed the need to rise above the level of environmental stressors (Chandra, Raman, & Kolcaba, 2016). This can be evaluated by overall level of depression of the patient was reduced and vocalizing tools in order to overcome emotional obstacles. Comfort scores and observation checklist can also be utilized by seeing the student motivated to participate in activities, able to commit to active daily living activities, and the student is able to adjust to being alienated and feeling more confidence and self-worth in an otherwise very unwelcoming environment (Chandra, Raman, & Kolcaba, 2016). Kolcaba’s theory of comfort is significant. It truly does address comfort in most, if not all, aspects nursing. The need for comfort to be approached in the holistic manner is expressed, and the use of a taxonomic structure to address all constructs of the theory as a whole. Kolcaba’s theory of comfort is parsimonious, meaning simple at best. It is all containing and addresses issues thoroughly without use of much resources if any.
Conclusion
Writing this conclusion is very difficult. Just today, I just read an article of a student who was found dead by the custodian in his middle school at 6:30am (Vargas, 2019), apparently from a suicide. Students are shocked, mourning, and grieving. There has to be signs some say. Within the article, counselors state that parents should look for signs of depression, changes in behavior, lack of appetite. But, most times, adolescents don’t confide in their parents, they usually turn to their friends, but even that can be vague. Some may come into a school nurse office stating they just don’t feel good. Seems benign, the school nurse does a cursory assessment with vitals and find nothing out of the ordinary. And sends that student back to class after 20 minutes of rest. What if the school nurse had a simple tool to ask sensitive questions that might not ever get asked? The student is there, in the nurse office, the nurse can easily hand the student a questionnaire such as PHQ-9.
Most students will pass over the PHQ-9 without understanding the gravity of it, but there might be just student that might actually answer it truthfully and a school nurse will be able to assist that student in receiving services and much needed assistance. Thus, a school nurse can be armed with the necessary tools to assess an adolescent in an open and non-clinical manner for possible depression. If a student was found to be at risk for depression, the school nurse will again have the tools to assist that student in developing their own personal cognitive behavior therapy tools. With the increasing rate of depression and suicide in adolescents, one more added advantage for those students to find help is to have it within the place they are located most of their waking hours like school. School nurses have the education, compassion, and necessary capacity to be that bridge to help in the mental health of adolescents.
References
Allgaier, A., Pietsch, K., Frühe, B., Sigl-Glöckner, J., & Schulte-Körne, G. (2012). Screening for depression in adolescents: Validity of the patient health questionnaire in pediatric care. Depression & Anxiety (1091-4269), 29(10), 906. doi:10.1002/da.21971
Arroll, B., Goodyear-Smith, F., Crengle, S., Gunn, J., Kerse, N., Fishman, T., & … Hatcher, S. (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine, (4). 348. Centers for Disease Control and Prevention (n.d.). National center for health statistics: Adolescent health. Retrieved from https://www.cdc.gov/nchs/fastats/adolescent-health.htm
Chandra, S. M., Raman, K., & Kolcaba, K. (2016). Application of Katharine Kolcaba Comfort Theory in Post Operative Child: Delivering Integrative Comfort Care Intervention by using Theory of Comfort. International Journal of Science and Research (IJSR),5(6), 1714-1720. doi:10.21275/v5i6.nov164670 DNP 815 Week 6 DQ 1 and 2
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- Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.
Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
- APA Format and Writing Quality
Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.
I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.
For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.
The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. DNP 815 Week 6 DQ 1 and 2
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