Posts in category: Nursing Papers

DPI Project: Literature Review

DPI Project: Literature Review

NU500-8B-Unit 4 Assignment Theory Evaluation Paper-Critically Evaluate a Middle-Range Nursing Theory

Critically Evaluate a Middle-Range Nursing Theory

Instructions

The purpose of the Theory Evaluation Paper is to help you critically evaluate a middle-range nursing theory. This assignment will be completed using the three stages of the theory evaluation process:  Theory Description, Theory Analysis, and Theory Evaluation.

1. Select a Middle-Range Nursing Theory- Select one specific middle-range nursing theory from your textbook that best suits your area of practice. (Ex. Pender’s Health Promotion Model, Kolcaba’s Comfort Theory, Beck’s Postpartum Depression Theory, etc.)
2. APA Student Title Page– (No Abstract Needed)

• Include the following information on the Student title page in 7th APA format:
  • Assignment name in Bold Font: (Ex. Theory Evaluation Paper: Swanson’s Theory of Caring)
  • Skip a Line
  • Your Name
  • Name of University
  • Course Number and Name
  • Instructor’s Name
  • Date of Submission (Month, Day, Year)

1. Introductory paragraph Capture the reader’s attention (ex. Grabbing statistics) and discuss the rationale for selecting the specific nursing theory for your area of nursing over other nursing theories (Do not write in first person; Include a purpose/thesis statement of what you will describe in the paper as the last sentence of the introductory paragraph.) Next, begin the Body of Paper.
2. Theory Description (Level 1 Header)

• Purpose (Level 2 Header); (Designate as Descriptive, Explanatory, Predictive, or Prescriptive;  Include Scope-middle-range)
• Concepts (Level 2 Header); (Introduce and list main concepts)
• Definitions (Level 2 Header); (Define concepts and other important aspects)
• Relationship (Level 2 Header); (Describe relationship among concepts)
• Structure (Level 2 Header); (Describe; Is there a diagram of structure?)
• Assumptions (Level 2 Header); (beliefs, propositions of the theory)

5.  Theory Analysis (Level 1 Header)

• Theory’s Origin (Level 2 Header); (historical creation and evolution of theory)
• Unique Focus (Level 2 Header); (distinctive views)
• Content (Level 2 Header); (include definitions of metaparadigm concepts of person, environment, health, and nursing)

6.  Theory Evaluation (Level 1 Header)

• Significance (Level 2 Header); (usefulness, social significance, cultural significance)
• Comprehensiveness (Level 2 Header); (of the content, thoroughness, utility)
• Logical Congruence (Level 2 Header); (consistency and clarity of theory; consistent use of concepts throughout the literature)
• Credibility (Level 2 Header); (legitimacy, empirical support through research)
• Contribution to Nursing (Level 2 Header); (usefulness to nursing practice, education, and research)

7.  Conclusion (Level 1 Header) Conclusion paragraph with concluding statements to summarize the content and re-state or re-phrase the purpose/thesis statement.

8.  APA Reference Page- Please be sure to support your paper with in-text citations. Please use 5 peer-reviewed resources.

Additional Instructions: Your assignment should be typed into a Word or other word processing document, formatted in APA style. Paper should be a minimum of 4-5 pages in length, excluding the title and references pages.  You may increase the number of pages of the body of the paper up to 7-8 pages if needed.  This is a scholarly paper and should not be written in first person.  Paragraphs should have a minimum of 3 sentences.  Paraphrasing should be done using in-text citations.  Direct quotes should be rare and used only when the content can be said in no other way. If using direct quotes, you must include page or paragraph number.

Unit 4 Required Resources

• McEwen, M. & Wills, E. (2019). Theoretical basis for nursing (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. ISBN 9781496351203.
  • Chapters 17 and 21
• Chinn, P. & Kramer, M. (2018) Knowledge development in nursing: Theory and process (10th ed.). St. Louis, MO:  Elsevier. ISBN 9780323530613
  • Chapter 8
• Toolshero. (2019). Authentic leadership (Links to an external site.). [Website]. Retrieved from /orders/www.toolshero.com/leadership/authentic-leadership/
• Toolshero. (2019). Leadership (Links to an external site.). [Website]. Retrieved from /orders/www.toolshero.com/leadership/
• Clavelle, J.T., DNP, RN, NEA-BC, FACHE, & Prado-Inzerillo, M., DNP, RN, NEA-BC. (2018, November).  Inspire others through transformational leadership (Links to an external site.).  American Nurse Today, 13(11).  [Website]. Retrieved from /orders/www.americannursetoday.com/inspire-transformational-leadership/
• Greenleaf Center for Servant Leadership.  (2016). What is servant leadership (Links to an external site.)?  [Website]. Retrieved from /orders/www.greenleaf.org/what-is-servant-leadership/

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). /orders/doi.org/10.1037/0000165-000Unit 4 Assignment: Theory Evaluation Paper Rubric (1)

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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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.

• Weekly Participation

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. NU500-8B-Unit 4 Assignment Theory Evaluation Paper

• 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.

• Use of Direct Quotes

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.

• LopesWrite Policy

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.  NU500-8B-Unit 4 Assignment Theory Evaluation Paper

• Late Policy

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

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.

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DNP- 802 PEER RESPONSES

DNP- 802 PEER RESPONSES

DNP Peers’ Posts Needing Responses

I need help responding to the attached peers’ posts in 220 words each, kindly provide references with each post.

Instructions:

1. Make your initial post by 23:59 EST Thursday.

2. Respond to two other classmates’ posts by 23:59 EST Sunday. 

3. Address 2 of the following discussion questions in your post: 

1. Describe the evolution of the doctor of nursing practice curriculum and its potential impact on the future of nursing.  (CO1)

2. Analyze factors in our current healthcare delivery system that is driving the need for nurses prepared as at the doctoral level (CO1)

3. How do you determine the impact of the DNP degree?  What methods should be used to determine the impact of DNP  graduates? See pg 52 of Pritham & White article.  (CO1)

4. What are your thoughts on having a universal standard for APRN entry? 

Jace Sama

Analyze factors in our current healthcare delivery system that is driving the need for nurses prepared as at the doctoral level 

It is common for an individual to hear about the national nursing shortage on the news, or radio. This has become a growing topic since the development of COVID-19. One may also be familiar with the factor of nurse burnout. Schmidt (2020) informs that nearly 62% of nurses working in the United States are affected by some form of burnout. These two factors, including the use of advancing technologies in healthcare drive the need for nurses prepared at the doctoral level.

The doctoral prepared nurse is able to bridge the gap between theory and practice (Rivaz et al., 2021). Throughout this current doctor of nursing practice (DNP) program, students have been taught the ability to conduct research, review its validity and initiate it into practice. The DNP is the terminal degree which thoroughly prepares nurses to make change in the clinical setting. By utilizing the education provided by a DNP program, the nurse is able to understand how to provide effective change or adaptations for nurses affected by staffing shortages, or burnout. They may also be prepared to properly research advancing technologies (charting systems, tools, etc) and prepare nurses for their operation. The DNP prepared nurse displays top leadership, or management qualities based on their education. In times of stress or an ever changing environment, one may seek the expertise of the DNP prepared nurse for their guidance or leadership. Rivas et al. (2021) provide that challenging healthcare systems require nurse leaders that are able to manage unstable environments. This leader is the doctoral prepare nurse. 

What are your thoughts on having a universal standard for APRN entry?

According to McCauley et al. (2020), in 2004 the American Association of Colleges of Nursing (AACN) informed universities to transition to doctoral prepared advanced practice registered nurses (APRNs) programs by the year 2015. It is evident now that the AACN’s wish did not come true. This poses the question if there should be a universal standard for entry into APRN practice. A universal standard would allow equal clinical preparedness for practitioners. If the standard was changed to doctoral prepared nurses only, the education of the practitioner, excluding speciality education, would be similar to that of another APRN. However, one may question if it is wise to require an APRN to spend additional time and money on a degree with the current state of our healthcare system.

McCauley et al. (2020) inform that due to the increase in chronic health conditions and decline in resources, there has been a spike in the need for APRNs. The need for APRNs is crucial as illness and hospital admissions are increasing. This proposes that the APRN standard for entry into practice should remain as timely as possible. One may also argue that APRN candidates may not wish to pursue a doctoral degree or universal standard for entry. Within the last 10 years, doctoral nursing programs for the APRN have increased, however, there has been minimal decrease in the occurrence of master degree prepared APRN entry programs. If a universal standard is set, especially to the AACN’s standards, this may decrease the rate of APRNs into practice, thus minimizing the care provided to the public. This will provide additional strain to the already overwhelmed healthcare population. Although a universal standard for APRN entry seems ideal, the entry of a master degree or doctoral degree prepared APRN will suffice. 

References

McCauley, L., Broome, M., Fraizer, L., Hayes, R., Kurth, A., Musil, C., Norman, L., Rideout, K., & Villarruel, A. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing Outlook, 68(4). doi: 10.1016/j.outlook.2020.03.008

Rivaz, M., Shkorollahi, P., Setoodegan, E., & Sharif, F. (2021). Exploring the necessity of establishing a doctor of nursing practice program from experts’ views: A qualitative study.  BMC Medical Education, 21(328). doi: 10.1186/s12909-021-02758-w

Schmidt, A. (2020).  We need to talk about burnout the same way we talk about benefits. American Hospital Association. /orders/www.aha.org/news/blog/2020-10-20-we-need-talk-about-burnout-same-way-we-talk-about-benefits

Nadege Nnamani

The Doctor of Nursing Practice Degree: A Look at the Evolution and Potential Impact on Nursing

The Doctor of Nursing Practice (DNP) is a terminal degree in nursing that prepares nurses for advanced practice roles, such as primary care providers, consultants, and nursing leaders. The DNP curriculum typically includes advanced nursing practice, healthcare policy, leadership, and population health coursework. The DNP degree was developed in response to the growing demand for highly qualified nurses in advanced practice roles. The American Association of Colleges of Nursing (AACN) recognized the need for a practice-focused doctoral degree in nursing. It established the DNP as the terminal degree for advanced practice nursing in 2004 (The American Association of Colleges of Nursing (AACN), 2022). Prior to this, the highest degree in nursing was the Master of Science in Nursing (MSN), which was primarily focused on preparing nurses for research and academia (The American Association of Colleges of Nursing (AACN), 2022). The DNP curriculum has evolved to reflect the healthcare industry’s changing needs and the healthcare system’s increasing complexity (McCauley et al., 2020). The AACN has published guidelines for DNP programs, including coursework in healthcare policy, leadership, and population health, in addition to advanced nursing practice (McCauley et al., 2020). The potential impact of the DNP on the future of nursing is significant. As more nurses earn their DNP, they will be able to take on more advanced roles within the healthcare system and significantly impact patient care (American Association of Nurse Practitioners, 2022. The DNP degree also prepares nurses to be leaders in their field, which can help to shape the future direction of nursing and healthcare.

Factors Driving the Need for Nurses Prepared at the Doctoral Level

Several factors in the current healthcare delivery system drive the need for nurses prepared at the doctoral level. One factor is the increased complexity of healthcare. The healthcare system has become increasingly complex, with advanced technologies, specialized treatments, and complex patient cases (Hajizadeh et al., 2021). This has led to the need for highly trained nurses who can provide advanced levels of care and handle complex situations. Another factor is the shortage of primary care providers. There is a shortage of primary care providers in the United States, which has led to an increased demand for advanced practice nurses who can provide primary care services. The aging population also contributes to the need for nurses prepared at the doctoral level (Hajizadeh et al., 2021). As the population ages, there is an increased demand for healthcare services. Nurses prepared at the doctoral level can provide advanced care to older patients with complex health needs. The prevalence of chronic diseases, such as diabetes and hypertension, is also increasing. Nurses prepared at the doctoral level can provide advanced care and management for patients with chronic conditions. Finally, healthcare reform initiatives, such as the Affordable Care Act, have increased the focus on preventive and primary care services (Rivaz et al., 2021). Nurses prepared at the doctoral level can provide these types of care, which can help to reduce healthcare costs and improve patient outcomes.

Determining the Impact of the Doctor of Nursing Practice Degree

Several methods can be used to determine the impact of DNP graduates. One method is the use of outcome measures. This involves assessing the outcomes of DNP graduates’ practice, such as patient satisfaction, clinical outcomes, and cost savings. Surveys of DNP graduates and their employers can also provide valuable insights into the impact of the DNP degree (Pritham & White, 2016). These surveys can ask about the roles DNP graduates are taking on, their level of responsibility, and their impact on patient care and the healthcare system. Case studies of DNP graduates and their practices can provide a more in-depth understanding of the impact of the DNP degree. These case studies can look at specific projects or initiatives DNP graduates have undertaken and their impact on patient care and the healthcare system (Pritham & White, 2016). Data analysis can also be used to examine trends and patterns in the practice of DNP graduates over time. This could include analysis of administrative data, such as billing records, to assess the types of services DNP graduates are providing and their impact on healthcare utilization and costs. Finally, DNP graduates can contribute to the evidence base through peer-reviewed publications, which can help demonstrate the DNP degree’s impact on nursing practice and healthcare.

The Potential Benefits and Challenges of a Universal Standard for APRN Entry

Having a universal standard for APRN entry could have several benefits. One benefit is that it could increase the consistency and quality of care provided by APRNs (McCauley et al., 2020). A universal standard would ensure that all APRNs have met specific minimum requirements for education, training, and competency, which could improve patient safety and outcomes. Another benefit of a universal standard is that it could help to remove barriers to practice for APRNs. Currently, APRN practice is regulated by each state, and there can be significant variability in the requirements for APRN licensure and certification from one state to another (McCauley et al., 2020). A universal standard would provide a consistent set of requirements for APRN practice across the country, making it easier for APRNs to practice in multiple states and reduce patient care barriers. However, it is essential to consider that a universal standard would also require significant coordination and resources to implement. There would need to be agreement on the specific requirements for APRN practice and a mechanism for enforcing the standard. There could also be challenges in addressing the unique needs and circumstances of different states and regions.

References

The American Association of Colleges of Nursing (AACN). (2022).  DNP position statement. /orders/www.aacnnursing.org/DNP/Position-Statement

The American Association of Colleges of Nursing (AACN). (2022).  AACN fact sheet – DNP. /orders/www.aacnnursing.org/News-Information/Fact-Sheets/DNP-Fact-Sheet

American Association of Nurse Practitioners. (2022).  Discussion paper: Doctor of nursing practice. /orders/www.aanp.org/advocacy/advocacy-resource/position-statements/discussion-paper-doctor-of-nursing-practice

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review.  BMC Nursing,  20(1). /orders/doi.org/10.1186/s12912-021-00648-6

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing Outlook,  68(4), 494–503. /orders/doi.org/10.1016/j.outlook.2020.03.008

Pritham, U. A., & White, P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change.  The Nurse Practitioner,  41(4), 44–53. /orders/doi.org/10.1097/01.npr.0000481509.24736.c8

Rivaz, M., Shokrollahi, P., Setoodegan, E., & Sharif, F. (2021). Exploring the necessity of establishing a doctor of nursing practice program from experts’ views: A qualitative study.  BMC Medical Education,  21(1). /orders/doi.org/10.1186/s12909-021-02758-w

Brandi Ritchie

2. Analyze factors in our current healthcare delivery system that is driving the need for nurses prepared at the doctoral level

We live in complicated times. Healthcare is at a precipice where change must occur if we are to survive. Healthcare will never “die out” or fade away, but healthcare as we currently know it isn’t sustainable. I believe most of us at least toyed with this idea before the pandemic, but COVID has highlighted many of the cracks within the healthcare system and nursing specifically. Nurses are being asked to do more than ever, and not just at the bedside. Over the course of my career I have seen nursing leadership evolve to a place where an entry level bedside nursing degree is no longer sufficient. 

The American Association of Colleges of Nursing (AACN) (2006) reports one of the benefits of doctoral preparation in nursing as being enhanced leadership that fosters strengthened practice and healthcare delivery. Historically nurses have risen to power primarily based on tenure and tenacity. There is no academic preparation at the bachelor (BSN) level or below for a nursing leadership position. It has been my experience that my bachelors degree prepared me to be a clinically competent bedside nurse who could evaluate evidence as it relates to practice at a very basic level. My masters (MSN) degree in nursing executive leadership scratched the surface of the knowledge necessary to lead nursing in today’s healthcare systems and greatly enhanced my ability to translate knowledge into practice. However, I am pursuing my Doctorate of Nursing Practice (DNP) because I know that there is more to be learned before I am truly prepared to tackle an executive leadership role. Through experience and observation it has never been more clear to me that our nursing leaders must be better prepared to fully expand into their roles. The pandemic has acted as a highlighter to the issues of inadequate nursing leadership. An excellent clinical bedside nurse does not always make a great leader and a well educated nurse does not always have what it takes either. My hope for the future of nursing is that the DNP can provide a foundation on which nurse leaders can build more sustainable nursing environments that, undoubtedly, will lead to better patient and nurse outcomes.   

4. What are your thoughts on having a universal standard for APRN entry?

I very distinctly remember hearing about the push to DNP prepared advanced practice registered nurses (APRN) early in my career. My initial thought was something along the lines of “that is ludicrous.” Now, 18 years into my nursing career and 2 years living in a pandemic my thoughts are far more complex. Early in the pandemic I transitioned into a clinical education role and left the bedside. I moved from a large teaching institution that held Magnet nursing status to a much smaller hospital where a majority of the bedside nurses were educated at the associate’s degree (ADN) level. It was a jarring shift in organizational priorities for me to observe. My ADN nurses provide excellent clinical care and I couldn’t differentiate between those with a BSN or ADN on any given day. It was simply very different from the push for BSN and higher education at my previous organization. As the pandemic worsened and nursing saw mass exits into travel assignments or out of the profession altogether, the already invisible line between ADN, BSN, even MSN prepared nurses completely vanished. I saw a resurgence in the hiring of licensed practical nurses. Numerous nurse researchers and nursing organizations have long said that there is a need to better define the clinical proficiencies between nursing degrees (McCauley et al., 2020; Boswell et al., 2021). My experience has made that need very apparent to me. Nursing has fought for autonomy and gained it in many rights, but without role clarification based on education I fear we have come as far as we can. 

One glaring example of the need for clarification lies within my field of interest, perinatal services. Fullerton et al. (2019) pinpointed some key issues to consider regarding the DNP as the preferred degree for entry to practice amongst midwives. Currently, there are certified nurse midwives who are educated in both nursing and midwifery and certified midwives who lack the nursing education component that are able to obtain the same midwife certification and practice at the same level (Fullerton et al., 2019). The American College of Nurse Midwives (ACNM) is of the opinion that DNP is an option for the practice of midwifery, but should not be required for entry into the field due to a lack of data that suggests that practice quality is improved by the DNP degree (Fullerton et al., 2019). While I wholeheartedly believe that there is a need and a place for the DNP prepared nurse, I’m not entirely convinced that it is necessary for entry into advanced clinical practice. Boswell et al. (2021) looked at the impact of the DNP degree in their geographical area and found both benefits and challenges. DNP prepared nurses displayed improved communication, leadership and influence (Boswell et al., 2021). Unfortunately, they also noted a lack of understanding regarding the role and a lack of recognition for the rigor of their education (Boswell et al., 2021). What can we do to help normalize DNP recognition amongst our peers and colleagues? What is the best and most efficient way to inform others about the benefits of a DNP prepared nurse? If the APRN remains at the clinical level, treating patients, is it imperative that they obtain a DNP?

References

American Association of Colleges of Nursing. (2006). The Essentials of Doctoral Education for Advanced Nursing Practice. Author.

Boswell, C., Mintz-Binder, R., Batcheller, J., Allen, P., & Baker, K. A. (2021). Capturing the impact of the doctor of nursing practice degree on west texas health care.  The Journal of Continuing Education in Nursing,  52(4), 192–197. /orders/doi.org/10.3928/00220124-20210315-08

Fullerton, J. T., Schuiling, K. D., & Sipe, T. A. (2019). The Doctorate of Nursing Practice and entry into midwifery practice: Issues for consideration and debate.  Nurse Education in Practice,  36, 97–100. /orders/doi.org/10.1016/j.nepr.2019.02.001

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing Outlook,  68(4), 494–503. /orders/doi.org/10.1016/j.outlook.2020.03.008

Cassidy Fox ( He/Him)

               The push to require a Doctor of Nursing Practice (DNP) degree as the entry-level to practice as a nurse practitioner has been the subject in the medical community for many years. Similar to the drive for registered nurse programs to become a BSN entry-level and to phase out the two-year associate program, there has also been a push to suspend the Master of Science in Nursing (MSN) nurse practitioner program and make the DNP the entry-level for nurse practitioners. The American Association of Colleges of Nursing first pushed for the phase-out of Advanced Practice Registered Nurses (APRN) MSN programs in 2004 and wanted all MSN programs to be transitioned to DNP programs by 2015 (McCauley et al., 2020). Although the 2015 deadline was not met, many organizations are still pushing for the transition to the DNP as the entry-level. Furthermore, the National Organization for Nurse Practitioner Faculties pledged to transition to a DNP entry-level education for all nurse practitioners by 2025 (Idzik et al., 2021). The organizations proposing the shift to the entry-level degree often detail the everchanging role and requirement of the nurse practitioner and suggest that obtaining a DNP would help better prepare the nurse practitioners for these roles. The aging population is often referenced as one of the driving forces behind the proposal for changing the degree requirements. The idea is that the DNP program will help prepare students for the complex needs of patients and the evolving healthcare environment (Idzik et al., 2021).

              The push for higher education in healthcare is always a great goal in theory, but I fear that this is in direct conflict with the national shortage in nursing concerning registered nurses. Approximately, 275,000 additional nurses will be needed by 2030 to meet the needs of the aging population according to the Bureau of Labor Statistics (Haddad et al., 2022). Registered nurses can complete a program in two years and begin working after the two-year program. The transition to a four-year program would increase the time spent in school and place a strain on the already critical nursing shortage in the United States. The barriers in rural healthcare areas are often a challenge for registered nurses to obtain advanced degrees including distance to programs and lack of financial support from employers (Odahowski et al., 2021).  Although I do not fully agree with the push for the BSN degree as the entry-level for registered nurses, I could more easily adopt the idea of the DNP being the entry-level degree requirement for APRNs.

              In my practice region, the market is inundated with nurse practitioners and nurse practitioner students. Students often have to pay for their clinical rotations so they can secure a site and new nurse practitioners find it difficult to secure a job. I do not feel as though the requirement for the entry-level DNP for APRN practice will have the same impact that the BSN requirement for registered nurses will have on the field of nursing in this area. I do believe that this DNP requirement may make the APRN role less desirable. There are not any current studies, that could be found, regarding the view potential students have regarding the switch from MSN entry-level to a DNP entry-level APRN. The research should focus on the perceptions of potential nurse practitioner students and how this may affect the enrollment of new students into APRN programs.

              Although some areas are inundated with nurse practitioners, some areas have a great need for advanced practice providers. An example of an area with great need is the rural healthcare market. Rural healthcare facilities and primary care practices in rural America continue to have shortages of providers and the academic transition could place greater strain on these regions (Ortiz et al., 2018). One example of an area flooded with students is the Philadelphia, Pennsylvania region. In the Philadelphia area, there are 6 medical schools and 10 nurse practitioner schools that create a strain on the pool of preceptors which makes it difficult for student placement (Todd et al., 2019). Extensive research would need to be completed to fully understand the future healthcare needs and the impact of switching to the DNP as the entry-level for APRNs. First, it is important to understand the future growth of the healthcare field in the next 10 to 20 years and how many nurse practitioner roles will be needed. Additionally, the impact on the future nursing interest in the APRN role should be evaluated regarding the impact of requiring a DNP.

             I would also propose the importance of clear research associating improved patient outcomes with DNP-prepared nurse practitioners. The Institute of Medicine proposed that 80% of working nurses should obtain a BSN by 2020 due to reports of improved patient outcomes in hospitals with a higher proportion of BSN-prepared nurses (Harrison et al., 2019). One study found that hospitals with higher percentages of BSN-prepared nurses along with lower nurse-to-patient ratios were associated with improved patient outcomes after cardiac arrest (Harrison et al., 2019). The push for BSN-prepared nurses is supported by studies that have shown a correlation with improved patient outcomes. The research is quite limited when searching for patient outcomes comparing MSN-prepared nurse practitioners and DNP-prepared nurse practitioners. It is important to understand the impact of the DNP degree and how to measure those impacts. The change is more likely to be accepted when it is supported by improved patient outcomes. One critical area to study is patient outcomes and if the DNP degree has a positive impact, a negative impact, or an overall neutral impact on the outcomes of patients.  

            The impact of the DNP degree is an important area of focus when considering the push to require this degree. It is important to consider how to evaluate the outcomes of the DNP degree and how it affects the delivery of healthcare, the health of individuals, and the overall care of patients (Pritham & White, 2016). We should consider if the requirement of the DNP entry-level for an APRN would negatively or positively impact the care of patients and the delivery of healthcare. It is critical to gauge all the potential outcomes from a transition to the DNP degree as the entry-level for the APRN. Could the requirement negatively impact the access to healthcare for the public? Would this reduce interest in the APRN field as a whole? The overall costs of the programs should also be taken into consideration. The overall benefits of the transition should outweigh the potential detractors. One potential evaluation technique would be to complete outcome studies to better gauge patient-based outcomes (Pritham & White, 2016). If there is a correlation regarding improved patient outcomes when comparing MSN to DNP graduates then this could be the push needed for the transition an entry-level DNP for the APRN role.

            Another consideration is the delivery of healthcare and how it is affected by the proposal. The nurse practitioner role has been able to assist in reducing the healthcare strain in primary care that has been caused by an aging population and high prevalence of chronic health conditions in the United States (Poghosyan et al, 2021). A thorough evaluation would need to be completed regarding the impact this may have on the long-term impact on the APRN field. In the extended outlook, could this reduce the enrollment and graduation of APRNs? The overall strain on healthcare could be detrimental if this reduced the number of registered nurses who return to school for their APRN. Many colleges detail the growing need for advanced practice providers as well as financial constraints as reasons they have not yet transitioned to solely DNP-level programs for APRNs (Martsolf et al., 2015). The current interests and discussions regarding a universal standard will help to drive the necessary research to better understand and gauge the impact this will have on the healthcare field.

References

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In  StatPearls. StatPearls Publishing.

Harrison, J. M., Aiken, L. H., Sloane, D. M., Brooks Carthon, J. M., Merchant, R. M., Berg, R. A., McHugh, M. D., & American Heart Association’s Get With the Guidelines–Resuscitation Investigators (2019). In hospitals with more nurses who have baccalaureate degrees, better outcomes for patients after cardiac arrest.  Health affairs (Project Hope),  38(7), 1087–1094. /orders/doi.org/10.1377/hlthaff.2018.05064

Idzik, S., Buchholz, S. W., Kelly-Weeder, S., Finnegan, L., & Bigley, M. B. (2021). Strategies to move entry-level nurse practitioner education to the doctor of nursing practice degree by 2025.  Nurse educator,  46(6), 336–341. /orders/doi.org/10.1097/NNE.0000000000001129

Martsolf, G. R., Auerbach, D. I., Spetz, J., Pearson, M. L., & Muchow, A. N. (2015). Doctor of nursing practice by 2015: An examination of nursing schools’ decisions to offer a doctor of nursing practice degree.  Nursing outlook,  63(2), 219–226. /orders/doi.org/10.1016/j.outlook.2015.01.002

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track.  Nursing outlook,  68(4), 494–503. /orders/doi.org/10.1016/j.outlook.2020.03.008

Odahowski, C. L., Crouch, E. L., Zahnd, W. E., Probst, J. C., McKinney, S. H., & Abshire, D. A. (2021). Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce.  Journal of professional nursing, 37(2), 404–410. /orders/doi.org/10.1016/j.profnurs.2020.04.008

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes.  Healthcare,  6(2), 65. /orders/doi.org/10.3390/healthcare6020065

Poghosyan, L., Norful, A. A., & Martsolf, G. R. (2017). Primary care nurse practitioner practice characteristics: Barriers and opportunities for interprofessional teamwork.  The Journal of ambulatory care management,  40(1), 77–86. /orders/doi.org/10.1097/JAC.0000000000000156

Pritham, U. A., & White, P. (2016). Assessing DNP impact using program evaluations to capture healthcare system change.  The Nurse practitioner,  41(4), 44–53. /orders/doi.org/10.1097/01.NPR.0000481509.24736.c8

Todd, B. A., Brom, H., Blunt, E., Dillon, P., Doherty, C., Drayton-Brooks, S., Hung, I., Montgomery, K., Peoples, L., Powell, M., Vanacore, D., Whalen, D., & Aiken, L. (2019). Precepting nurse practitioner students in the graduate nurse education demonstration: A cross-sectional analysis of the preceptor experience.  Journal of the American Association of Nurse Practitioners,  31(11), 648–656. /orders/doi.org/10.1097/JXX.0000000000000301

DNP-810A Peers’ Posts Needing Responses

Abiodun Kolawole

Posted Date

The news story chosen for analysis is entitled “Dwarfism drug aims to boost healthy growth.” According to the article, achondroplasia is one of the most common types of dwarfism, which affects one individual in every 25,000 people (Roberts, 2019). Achondroplasia is a genetic disorder caused by the mutation of a gene that limits the growth of bones in the skull base, the limbs, and the spine (Pauli, 2019). The author describes the typical case of an achondroplasia-affected child named Sam with short legs and arms. However, researchers have developed a new type of medication known as vosoritide that promotes healthy growth among children born with dwarfism. The drug’s effectiveness can be proven by comparing the growth of Sam before and after the injection before he joined the study. Sam grew 3cm (1in) after the injection and another 6cm in the first year after treatment (Roberts, 2019). In terms of ethics, RNs or APRNs are concerned about whether the drug can prevent growth-related complications. In terms of societal implications, the approval of the medication would change dwarfism. However, there is still uncertainty about whether individuals with the disorder would support the intervention. Because vosoritide has not yet gained FDA approval, RNs and APRNs cannot prescribe the drug to their patients at this time. Culture can influence how disability is understood and how individuals with disabilities are treated. As a result of media narratives that inaccurately portray disability, societal beliefs become dominant (Haller, 2010). However, the effect of these beliefs on dwarfs in the community has been largely ignored. Dwarfs are often subjected to unwanted attention due to their appearance, including staring and verbal abuse, which can be considered a social disability.

References

Haller, B.A. (2010) Representing Disability in an Abelist World. Louisville: The Avocado Press.

Roberts, M. (2019). Dwarfism drug aims to boost healthy growth. Retrieved May 12, 2022, from /orders/www.ncbi.nlm.nih.gov/search/research-news/3265/

Pauli RM. Achondroplasia: a comprehensive clinical review. Orphanet J Rare Dis. 2019 Jan 3;14(1):1. /orders/ doi.org/ 10.1186/s13023-018-0972-6.

Solomon, S. (2020) Dwarf Pride’ Was Hard Won. Will a Growth Drug Undermine It. Retrieved May 12, 2022, from /orders/www.ncbi.nlm.nih.gov/search/research-news/11271/

Kristen Williams

Ribonucleic acid (RNA) plays an essential role in messenger Ribonucleic acid (mRNA) translating and decoding (D’Ascenzo et al., 2022). Advancements in technology have improved scientists’ ability to sequence RNA leading to the development of medication and targeted therapies. Advances in RNA sequences have led to biotech companies’ billions in investments (Wang et al., 2020). The potential impact on the pharmaceutical industry from targeted drug development is massive and has the potential to save millions of lives. Although the potential to save lives is vast many ethical, fiscal, and social issues arise. Many uncertainness surrounds the role of genomics in the prognosis and management of diseases (Newson et al., 2016). 

The advancements in RNA have led to more advanced medication development. Although improvements are taking place in the effect of medications, access continues to be a problem. Prescription medicines are not assessable to many due to financial causes. Social and ethical dilemmas currently reside around increasing access to medication as this technology advances. As billions are poured into developing new medicines and treatments, society needs to ensure they are accessible to those who need them. For developing technology to be accessible, a shift must occur in our culture surrounding healthcare. Currently, access to healthcare is a privilege and not a right. There is potential that as technology advances, a cultural shift will occur, and healthcare will be viewed as a right and expanded to those in need. 

References

D’Ascenzo, L., Popova, A. M., Abernathy, S., Sheng, K., Limbach, P. A., & Williamson, J. R. (2022). Pytheas: A software package for the automated analysis of RNA sequences and modifications via tandem mass spectrometry. Nature Communications, 13(1).  /orders/doi.org/10.1038/s41467-022-30057-5

Newson, A. J., Leonard, S. J., Hall, A., & Gaff, C. L. (2016). Known unknowns: Building an ethics of uncertainty into genomic medicine. BMC Medical Genomics, 9(1).  /orders/doi.org/10.1186/s12920-016-0219-0

Wang, F., Zuroske, T., & Watts, J. K. (2020). Rna therapeutics on the rise. Nature Reviews Drug Discovery, 19(7), 441–442.  /orders/doi.org/10.1038/d41573-020-00078-0

Yu, A.-M., Choi, Y., & Tu, M.-J. (2020). Rna drugs and RNA targets for small molecules: Principles, progress, and challenges. Pharmacological Reviews, 72(4), 862–898.  /orders/doi.org/10.1124/pr.120.019554

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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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.

• Weekly Participation

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.

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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.

• Use of Direct Quotes

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.

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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. DNP- 802 PEER RESPONSES

• Late Policy

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.

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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.

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Week 2: Therapy for Pediatric Clients With Mood Disorders

Week 2: Therapy for Pediatric Clients With Mood Disorders

Assessing And Treating Pediatric Clients With Mood Disorders

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.
Photo Credit: GettyLicense_185239711.jpg
 
Assignment: Assessing and Treating Pediatric Clients With Mood Disorders
When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.
Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
Learning Objectives
Students will:
· Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
· Evaluate efficacy of treatment plans
· Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter      6, “Mood Disorders”
• Chapter      7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Review the following medications:

• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine
• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

 Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
Note: Retrieved from Walden Library databases.
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Note: Retrieved from Walden Library databases.
Required Media
Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
Optional Resources
El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655
Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497
To prepare for this Assignment:
· Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.
The Assignment
Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
· At each decision point stop to complete the following:
o Decision #1
§ Which decision did you select?
§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.
§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
§ Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
o Decision #2
§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.
§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
§ Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
o Decision #3
§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.
§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
§ Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
· Also include how ethical considerations might impact your treatment plan and communication with clients.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

NURS 6660 – Week 9 Assignment: Early-Onset Schizophrenia

NURS 6660 – Week 9 Assignment: Early-Onset Schizophrenia

The Assignment (2 pages):
Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.
Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues
Week 9: Early-Onset Schizophrenia
“I can’t believe he is speaking to me! I have always liked his music, but now here he is on TV speaking directly to me! When I started following him on social media, he must have seen my profile. I know he loves me. He cannot love that model I saw with him in the picture. She must be the person following me to school. I have not seen her, but I know she is there. She does not want me being with him, but I will be with him. He loves me as much as I love him.”
Kaitlyn, age 17
Early-onset schizophrenia is a rare and severe mental illness in which children interpret reality abnormally. There are a range of problems with cognitive functioning, behavior, and emotions. Perceptions may be distorted and children or their parents may report that they have difficulty distinguishing reality. This is a diagnosis that is difficult to confirm in the early stages.
This week, you compare evidence-based treatment plans for adults versus children diagnosed with schizophrenia. You analyze the legal and ethical issues involved with forcing patients with early-onset schizophrenia to take medications for the disorder. You also complete a Decision Tree concerning children with psychotic disorders.
 
Assignment 1: Early Onset Schizophrenia
Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest.
In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia.
 
To Prepare for this Assignment:
Review the Learning Resources concerning early-onset schizophrenia.
 
The Assignment (2 pages):
Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.
 
Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.
 
Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.
Learning Resources
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
· Standard 10 “Quality of Practice” (pages 73-74)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
· Chapter 31, “Child Psychiatry” (pp. 1268–1283)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
· “Schizophrenia Spectrum and Other Psychotic Disorders”
Note: You will access this book from the Walden Library databases.
 
McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf
 
Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011
Note: You will access this article from the Walden Library databases.
 
Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872
Note: You will access this article from the Walden Library databases.
 
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
 
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.
· Chapter 57, “Schizophrenia and Psychosis” (pp. 774–794)
 
Review the following medications:

Childhood-onset schizophrenia is a syndrome that consist of positive and negative symptoms of psychosis and can impact the child’s development and social functioning. The etiology of this disease is not fully known, but because it affects structural brain abnormality and genetic risk factors, it is important to diagnose it early and then initiate treatment to limit its morbidity (Rapoport & Gogtay, 2011). This discussion will focus on comparing two evidence based treatment plans used to treat schizophrenia in adults versus one that is used in treating children and adolescent, the legal and ethical consideration to consider when the child or adolescent has to be forced to take medication against their wish or desire will also be addressed.

The ultimate goal of treating schizophrenia is to treat the symptoms thereby preventing relapse, and improve patient functioning (Patel, Cherian,ohil,&Atkinson,2014).Pharmacological drugs can be used to treat the schizophrenia, but sometimes patient still have residual symptoms when on medications therefore other interventions like psychotherapy is useful (Patel et al, 2014). Evidence has proven that medication administration and cognitive behavior therapy can greatly reduce symptoms in adult. In cases where non- compliance with by mouth medication is prevalent, the client should be encouraged to take a long acting medication by injectionlike Invega sustena, risperidone consta or if first generation medication is working for them Haldol decanoate or prolixin decanoate should be considered.

Research has shown that in adults with schizophrenia 2nd generation antipsychotics should be used because they have less side effects (Patel et al, 2014). The use of medications along with cognitive behavior therapy can lead to better treatment outcome (Patel et al.,2014). Children with schizophrenia should be started on low dose medications, depending on the age of the child. The treatment should also include cognitive behavior therapy, cognitive enhancement therapy and vocation skill training and parental education and support.

When treating schizophrenia in the adolescent and adult population, 2nd generation antipsychotic has proven to work better with less side effects (Patel et al, 2014). Risperidone, aripiprazole, quetiapine, paliperidone, and olanzapine are medications that have been approved by the FDA for treatment of schizophrenia in patients 13 years and older (McClellan & Stock, 2013).

The use of Psychosocial intervention has proven to be an effective treatment of schizophrenia in children as well as adults. Cognitive behavior therapy can be used alone to treat schizophrenia especially in cases where the patient will not take medications (Frankenburg,2018) CBT done by a skilled therapist can reduce symptom severity and improve social functioning capability (Frankenburg, 2018). In children and adolescent however, CBT adapted for psychosis has proven to help children think and adapt to responding to hallucinations and delusions in a manner that does not greatly affect their daily lives (Milller, 2016). Family education and counseling is very essential when treating children. Parental education on what to expect from treatment is vital.

Legal and ethical consideration.

The patient needs to be educated on why it is important to take medication and what medications that they are taking. Parental consent should be obtained prior to children being started on medications. Parents should be educated on the benefits and risk of any medication intervention

and the child diagnosis. They should also be informed that in cases where the child or adolescent is a danger to themselves or medications will have to administered forcefully.it is the duty of the PMHNP to carefully assess the patient and determine the best course to follow with an understanding of legal and ethical principles guiding the provision of care of children. PMHNP should start children with the lowest dose of medications and then gradually increase the dose if needed. Medication should also be given at different intervals since children metabolize medications faster than adults. The child’s age, weight should be taken into consideration when prescribing medications.

References

Frankenburg, F. R. (2018, July 11). Schizophrenia Treatment & Management: Approach Considerations, Antipsychotic Pharmacotherapy, Other Pharmacotherapy. Retrieved from /orders/emedicine.medscape.com/article/288259-treatment#d11

McClellan, J., & Stock, S. (2013). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976-990. doi:10.1016/j.jaac.2013.02.008

Miller, C. (2016, July 26). How Does CBT Help People With Psychosis?. Retrieved from /orders/childmind.org/article/cbt-help-people-psychosis/

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014, September). Schizophrenia: Overview and Treatment Options. Retrieved from /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC4159061/

Rapoport, J.L.Gogtay,N. Childhood onset schizophrenia: Support for a progressive

Neurodevelopmental disorder.Int. J Dev Neurosci 2011:29:251.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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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.

• Weekly Participation

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.

• Use of Direct Quotes

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. NURS 6660 – Week 9 Assignment: Early-Onset Schizophrenia

• LopesWrite Policy

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.

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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.

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NURS 3333 Assignment 2 – Week 4 Practicum: Decision Tree

NURS 3333 Assignment 2 – Week 4 Practicum: Decision Tree

Practicum: Decision Tree
For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.
Note:  For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.
                                                              The Assignment:
Examine Case 1. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)
At each Decision Point, stop to complete the following:
· Decision #1: Differential Diagnosis
o Which Decision did you select?
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
· Decision #2: Treatment Plan for Psychotherapy
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
· Decision #3: Treatment Plan for Psychopharmacology
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
· Also include how ethical considerations might impact your treatment plan and communication with clients and their families.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Case #1: A young girl with difficulties in school
                                                                               BACKGROUND
In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.
For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.
When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.
Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.
To start, consider what assessment tools you might need to evaluate Katie.
· Child Behavior Check List
· Conners’ Teacher Rating Scale
The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” (Available at: http://www.doctorrudy.com/files/teacher_add_adhd_short.pdf). This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess.
When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.
 
SUBJECTIVE
You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”
Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.
Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.
 
                                                                  MENTAL STATUS EXAM
The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
 
299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder
315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics
314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation
ANSWER CHOOSEN: Attention Deficit Hyperactivity Disorder, 
predominantly inattentive presentation 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation
RESULTS OF DECISION POINT ONE
·  Client returns to clinic in four weeks
·  You selected Attention deficit hyperactivity disorder, predominantly inattentive presentation. Based on this choice, outline the remainder of the diagnostic evaluation that you will conduct on this child and their parents. Be sure to include standardized assessment instruments that you would administer
· Decision Point Two

· BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

·  Wellbutrin 75 mg orally daily
·
·  Strattera 25 mg orally daily
·
·  Adderall XR 10 mg orally daily
ANSWER CHOOSEN: Adderall XR 10 mg orally daily
 RESULTS OF DECISION POINT TWO
·  Client returns to clinic in four weeks
·  Katie’s parents seem absolutely delighted upon their return stating that Katie is paying more attention in school, but note that there is still room for improvement, particularly in the afternoon
·  They report that Katie’s teacher has reported that Katie is able to maintain her attention throughout the morning classes but come afternoon, she “daydreams.”
·  Katie’s parents are also concerned about her decrease in appetite since starting the medication.
Decision Point Three
BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.
 Katie’s parents that weight loss is common with stimulant medications 
used to treat ADHD
 medication with family thearpy
 a small dose of immediate release Adderall in the early afternoon
ANSWER CHOOSEN: Add a small dose of immediate release Adderall in the 
early afternoon
                                             Guidance to Student
Whereas weight loss is common with stimulant medication, this option does not address Katie’s parents’ concerns about the return of symptoms in the afternoon.
Augmentation with family therapy is also a good idea as it can help Katie with her symptoms and further help her parents to understand the unique challenges that Katie experiences, as well as ways that they can help her with symptoms, however, this option does not address the return of inattentive symptoms in the afternoon.
Adding a small dose of immediate relate Adderall in the afternoon can help Katie to maintain attention throughout the afternoon and into the early evening when she must do homework. This would be the best option.
                                                  Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 3, “Contributions of the Sociocultural      Sciences” (pp. 131–150)
• Chapter      31, “Child Psychiatry” (pp. 1152–1181, 1244–1253)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Neurodevelopmental Disorders”

o “Intellectual Disabilities”
o “Communication Disorders”

• “Disruptive, Impulse-Control, and Conduct Disorders”

Volkmar, F., Siegel, M., Woodbury-Smith, M., King, B., McCracken, J., & State, M. (2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 237–257. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00819-8/pdf 
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
 
                                                       Required Media
Laureate Education (Producer). (2017b). A young girl with difficulties in school [Multimedia file]. Baltimore, MD: Author. (SEE THE ATTACHED CASE STUDY SAMPLE WITH ANSWER)
                                               Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

Chapter      51, “Autism Spectrum Disorder” (pp. 665–682)FINANCIAL ANALYSIS REPORT 2
 

Decision Tree: Personality Disorders

Frank Jones Sam’s University
Nurs 3333: PMHNP Role IV
Dr. Joe Mark
October 20 , 2010 
 
Decision Tree: Personality Disorders
As described by the American Psychiatric Association (APA) (2013), ‘‘personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment’’. There are different types of personality disorders classified into three clusters. Cluster A individuals are described as the odd or eccentric, cluster B as the dramatic, emotional, or erratic and cluster C as the anxious or fearful. The purpose of this paper is to discuss the case study of a young woman with personality disorder. This paper will explore threes decisions relating to differential diagnosis, psychotherapy and psychopharmacology based on the presented clinical manifestations.
Decision One
The clinical manifestation presented in the case study are indicative of more than one personality disorder, specifically borderline personality disorder (BPD) and antisocial personality disorder (ASPD). Patients exhibits a fear of abandonment which aligns with BPD. The patient mentioned an interpersonal relationship involvement which she exhibited idolization for the man of her interest, and now is devaluing the man. This is also evident in BPD as outlined by diagnostic criteria set forth by the APA (2013).
My diagnosis for this patient is ASPD, because the client exhibits clinical manifestations of ASPD than BPD. One of the reasons that led me to the diagnosis of ASPD is the client’s lack of remorse. The client stole from a friend, instead of being sorry, client’s blames friend instead. Client exhibits lack of respect for social norm and failure to comply with the law as evidenced by more than one record of arrest. The client fails to upholding financial obligation and is deceitful. Client shows irresponsibility evidenced by inability to keep a job. These presentations are evident in clients with ASPD as outlined in the DSM-5.
The two personality disorders which are classified as cluster B personality disorders by the APA (2013) have clinical manifestations which overlap, thus needs to be ruled out as differential diagnoses for each other. As described on the DSM-5 diagnostic criteria, BPD and ASD have similar features of impulsivity, aggression and manipulative behaviors, which client exhibits in the case study. The differing manifestation between the two is that in BPD, clients seek out interpersonal relationship, while ASPD client is unable to form any attachment to relationship. Clients with BPD exhibit self-mutilating behaviors and self-aggression, while in ASPD, aggression is directed on others. In ASPD clients are egocentric (also seen in narcisstic personality disorder), while BPD clients have a poor image of self.
Decision Two
Since the client exhibits symptoms which are synonymous with one more than personality disorder, specifically borderline and antisocial; the best decision is to opt to conduct a psychological testing. This will to further help the practitioner to decipher between the two diagnoses or conclude that patient indeed has the two personality disorders which is a possible occurrence. Psychological testing can be in the form of rating scales which includes questionnaires, checklists e.t c. According to Sadock, Sadock and Ruiz (2014), these scales are useful for monitoring patient overtime or to provide a comprehensive assessment information that was not obtained during a routine clinical interview.
There is limited evidence from existing literatures on the effectiveness of medications to target the core symptoms of ASPD. Khalifa et al. (2010) mentions that pharmacological interventions are not to be considered as monotherapy but as adjunctive intervention to target associated symptoms of ASPD such as depression, aggression etc. The option of Haldol, an antipsychotic medication can be used to address aggression but does not treat the core features of the disorder such as lack of remorse, deceitfulness. Furthermore, the plethora of side effects known to be caused by the medication can increase noncompliance. Psychotherapy can be beneficial, but psychodynamic is not appropriate for this patient because it may require patient to address emotional states. According to Hesse (2010), probing about ‘feeling states’ is unhelpful because the ASPD client may have difficulty accessing such state and may become aggressive when made to confront personal shortcoming.
Decision Three
In decision three, the recommendation is for a group-based cognitive therapy. Latuda an antipsychotic can be used to treat aggression but not the core symptoms of ASPD. Dialectical behavioral therapy will be more appropriate in the client with BPD than in ASPD. The most cited effective psychotherapeutic approach used in ASPD is cognitive behavioral therapy (CBT). This approach helps the client address distorted beliefs about self, others and the world. CBT can be used to enhance social and intrapersonal functioning.
A group setting may be beneficial for these clients as they may be able to learn from others experience or information shared about self. Psychotherapy for ASPD should be met with skepticism, but Hesse (2010) suggested that approaches that includes employing moral reasoning, cognitive behavioral approach, applying a social information processing approach, and planning for relapse prevention should be used. Additionally, the clients need a high level of external structure that includes supervision of the patient and reinforcement of positive social behaviors to yield increased outcomes for ASPD clients (Hesse, 2010).
 
Ethical and Legal Considerations
Due to the clinical manifestation of ASPD, some clinicians believe that it is hopeless to treat ASPD clients due to their clinical manifestation of aggression, deceitfulness and manipulation. Clients tends to be noncompliant, fueling the clinician’s pessimism. Existence of pessimism can hinder practitioners from upholding the ethical principles to do no harm and to do the best for the patient to full capacity. Hatchet (2015), implores clinicians to turn to published studies to become more aware of treatment options and to avoid expert opinions or clinical myths in regards to treating clients with ASPD. For these clients, autonomy may be purposely compromised to prevent harm to the patient and to others. This is seen in cases where patient refuse to comply with treatment plan or ordered into treatment and remain in treatment until deemed fit to come out of treatment.
Conclusion
It is essential for the practitioner to be knowledgeable about personality s disorder to effectively care for the patient. The practitioner should explore various options of medication, used to target accompanied symptoms. Psychotherapy, even though some might argue of its effectiveness, should not be ruled out. Assessment tools should be used to guide the clinicians, in diagnosing, especially with disorders that have overlapping symptoms.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Khalifa, N., Duggan, C., Stoffers, J., Huband, N., Völlm, B. A., Ferriter, M., & Lieb, K. (2010). Pharmacological interventions for antisocial personality disorder. The cochrane database of systematic Reviews, (8). Doi: 10.1002/14651858.CD007667.pub2
Hatchett, G. T. (2015). Treatment guidelines for clients with antisocial personality disorder. Journal of mental health counseling, 37(1). Retrieved from Walden University Database
Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? Biomed central medicine, 8(66). DOI: 10.1186/1741-7015-8-66
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction

Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction

The Assignment

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction
Impulsivity and compulsivity have a wide range of clinical presentations and often overlap with many other psychiatric disorders. Some individuals act without forethought and have difficulty saying “no” to certain things such as using illicit drugs or spending money, whereas other individuals engage in compulsive behaviors with undesirable consequences. In some cases, these impulsive and compulsive behaviors also fuel issues with addiction. To effectively assess and treat clients, you must understand how these disorders differ, as well as how their symptoms impact clients and their families.
This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of clients with these disorders. You also consider ethical and legal implications of these therapies.
Photo Credit: [Apolinar B. Fonseca]/[Moment]/Getty Images
 
Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction
Impulsivity, compulsivity, and addiction are challenging disorders for clients across the lifespan. These disorders often manifest as negative behaviors, resulting in adverse outcomes for clients. In your role as the psychiatric mental health nurse practitioner, you have the opportunity to help clients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.
Learning Objectives
Students will:
· Assess client factors and history to develop personalized therapy plans for clients with impulsivity, compulsivity, and addiction
· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction
· Evaluate efficacy of treatment plans
· Analyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addiction
Learning Resources
Note:  To access this week’s required library resources, please click on the link to the Course Readings List, found in the  Course Materials  section of your Syllabus.
Required Readings
 
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
 
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
 
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
· Chapter 14, “Impulsivity, Compulsivity, and Addiction”
Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.
 
To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.
· Chapter 10, “Disorders of Impulsivity and Compulsivity”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
 
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
 
Review the following medications:
For insomnia
For obsessive-compulsive disorder
· Citalopram
· clomipramine
· escitalopram
· fluoxetine
· fluvoxamine
· paroxetine
· sertraline
· venlafaxine
· vilazodone
 
For alcohol withdrawal
· chlordiazepoxide
· clonidine
· clorazepate
· diazepam
· lorazepam
· oxazepam
 
For bulimia nervosa and binge eating
· fluoxetine
· topiramate
· zonisamide
For alcohol abstinence
· acamprosate
· disulfiram
 
For alcohol dependence
· nalmefene
· naltrexone
 
For opioid dependence
· buprenorphine
· naltrexone
For nicotine addiction
· bupropion
· varenicline
 
Book Excerpt: Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol Series, No. 32. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/
· Chapter 1, “Substance Use Among Adolescents”
· Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
· Chapter 7, “Youths with Distinctive Treatment Needs”
University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from /orders/www.sciencedaily.com/releases/2016/01/160120201324.htm
Note: Retrieved from Walden Library databases.
Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x
Note: Retrieved from Walden Library databases.
Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. doi:10.3928/00989134-20160314-04
Note: Retrieved from Walden Library databases.
Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439
Note: Retrieved from Walden Library databases.
Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018
Note: Retrieved from Walden Library databases.
Required Media
 
Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
 
To prepare for this Assignment:
· Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment
Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
· Decision #1
· Which decision did you select?
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
· Decision #2
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
· Decision #3
· Why did you select this decision? Support your response with evidence and references to the Learning Resources.
· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Note:  Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Co-morbid Addiction (ETOH and Gambling)  53-year-old Puerto Rican Female
 
BACKGROUND
Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”
 
SUBJECTIVE
Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.
She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.
Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.
 
MENTAL STATUS EXAM
The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.
Diagnosis: Gambling disorder, alcohol use disorder
Decision Point One
Select what the PMHNP should do:
Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
 
Antabuse (Disulfiram) 250 mg orally daily
 
Campral (Acamprosate) 666 mg orally three times/day
 
Co-morbid Addiction (ETOH and Gambling)  53-year-old Puerto Rican Female
 
Decision Point One
 
Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
RESULTS OF DECISION POINT ONE
·  Client returns to clinic in four weeks
·  Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection
·  Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)
·  Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned
Decision Point Two
Refer to a counselor to address gambling issues
 
RESULTS OF DECISION POINT TWO
·  Client returns to clinic in four weeks
·  Client reports that the anxiety that she had been experiencing is gone
·  Client reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous. She stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group
Decision Point Three
 
Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings
 
Guidance to Student
Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, four weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As you will learn in future courses, ruptures and the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA approved treatments for gambling addiction, and the mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the gamblers anonymous meetings, she should be encouraged to continue her participation with this group.
The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

• 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.

• Weekly Participation

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.

• Use of Direct Quotes

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.

• LopesWrite Policy

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. Therapy for Clients With Impulsivity, Compulsivity, and Addiction

• Late Policy

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

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.

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

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NURS 6630 Week 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

NURS 6630 Week 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, but they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.

To prepare for this Assignment:

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.

The QUESTION: 5 pages

Examine Case Study: An African American Child Suffering From Depression

1. Make three decisions concerning the medication to prescribe to this patient. 

2. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

3. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. 

4. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. 

5. 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.

Note:  Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

MEDICATION RESOURCES

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. /orders/www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – NURS 6630 Week 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

• 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.

• Weekly Participation

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.

• Use of Direct Quotes

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.

• LopesWrite Policy

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. Assessing and Treating Pediatric Patients With Mood Disorders

• Late Policy

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. NURS 6630 Week 4 Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

• Communication

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. Assessing and Treating Pediatric Patients With Mood Disorders

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

Looking for a Similar Assignment? Order a custom-written, affordable, plagiarism-free paper

Week 2 Discussion NURS 6630

Week 2 Discussion NURS 6630

Discussion: Foundational Neuroscience

As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Discussion Instructions

Post a response to each of the following:

1. 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.

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

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

4. 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.

5. At least 5 references

Instructions:

Respond to your colleague in one of the following ways:

· If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

· If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

Ozichukwu Awusah 

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.

 In order to be effective, drugs must be able to reach their intended cells and attach to the appropriate receptors on those cells. It will be easier to explain how partial and inverse agonist function affects the effectiveness of therapies if you understand the distinction between the agonist and antagonist spectrum of action in relation to psychopharmacologic medicines. This receptor binding alters the activity or behavior of the cell by agonizing or antagonizing the cell’s normal reaction, depending on the situation. Agonists are medications that function by activating the receptors in the body. The antagonist binds to the receptor without activating it, preventing the receptor from being triggered by additional agonists in the future. Full agonists give the greatest possible reaction since they bind to all of the accessible receptors. Partially agonists only bind to a subset of receptors, resulting in a reduced response even at larger concentrations of the agonist. Agonists constantly stimulate the receptors to produce a certain natural reaction, while the antagonist attempts to displace the agonist by blocking the agonist’s route to the receptors and preventing it from reaching the receptors. Inverse agonists have the opposite effect of their agonist counterparts. According to pharmacological definition, an inverse agonist is a substance that binds to the same receptor as an agonist but produces the pharmacological response that is the inverse of the reaction produced by the agonist.

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

 Both the G coupled protein receptors (GCPR) and the ion gated channels allow our cells to communicate with extracellular contents via specific integral receptors embedded into the cell membrane. When ligands bind to the receptor on an ion gated channel, there is a conversion of a chemical signal into an electrical one. As the channel opens it allows K+, Na+, Cl+, and Ca+ to move through the cell membrane and change its electrical properties. Thus, the ion gated channels produce a faster signal than the GCPRs. G-protein coupled receptors compromise the largest family of transmembrane proteins. They convey signals across the membrane in response to the binding of a particular ligand, resulting in the initiation of a cellular signaling cascade and the generation of an intracellular reaction. While the G protein is not the actual receptor, it is a protein that is connected to the receptor and that is activated by a particular ligand that binds to the receptor in order to transmit the activity inside the cell. The activation of an intracellular signaling cascade is induced by GCPRs.

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

It has long been understood that both environmental and genetic variables influence gene expression in different ways. It is the theory of epigenetics that genes may be activated or silenced depending on the presence or absence of certain chemical changes. The nucleotide sequence of the gene is not altered as a result of these variations in gene function. Epigenetics is a study that untangles the clues that suggested gene function and sequences that can be related to illnesses, behaviors, and other health indicators (Anderson et al.,2019). This includes an understanding of the influence of the phenotype of the DNA sequence. This research has found epigenetic mechanisms that are linked to cancers, cognitive dysfunction, respiratory, cardiovascular, reproductive, autoimmune, and neurobehavioral illnesses (Anderson et al.,2019). With this knowledge, pharmacologic action related to diseases linked with epigenetics can be created to regulate epigenetic mechanisms for the management of patients.

 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.

Each mental disease and its relationship to psychopharmacology should be understood by psychiatric mental health nurse practitioners (PMHNP). A patient with a bipolar illness diagnosis should be extensively assessed in terms of family history, behaviors, and patient history. In terms of parents passing down this condition, family history plays a part in bipolar disorder. According to research, clinical differences between manic and depressive episodes may allow for the discovery of biomarkers that influence mood-stabilizers on the epigenome (Legrand, et. al., 2021). Although this has been detected, no precise indicators have been discovered, and further study is required. Patient behaviors should be examined in light of neurotransmitter abnormalities associated with the condition. Neurotransmitters such as serotonin, norepinephrine, dopamine, and GABA have been linked to bipolar illness. The lack of two neurotransmitters, serotonin, and norepinephrine, has been related to depression. Shi et al. (2008) Furthermore, dopamine agonists have been demonstrated to cause manic or severe depressive episodes while alleviating manic or depressed symptoms (Shi, et. al, 2008). GABA deficiencies have been associated with bipolar depressive episodes and stress-related depression behaviors in animal studies (Shi, et. al., 2008).

 References

 Anderson, E. M., Penrod, R. D., Barry, S. M., Hughes, B. W., Taniguchi, M., & Cowan, C. W. (2019). It

                  is a complex issue: emerging connections between epigenetic regulators in drug addiction?  

                 The European Journal of Neuroscience, 50(3), 2477–2491 

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into

              clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.),

              Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 1–19).

 Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. British Journal of

               Pharmacology, 172(11), 2701–2704. /orders/doiorg.ezp.waldenulibrary.org/10.1111/bph.13136

 Legrand, A., Iftimovici, A., Khayachi, A., & Chaumette, B. (2021). Epigenetics in bipolar disorder: a

               critical review of the literature. Psychiatric genetics, 31(1), 1– 12

             /orders/doi.org/10.1097/YPG.0000000000000267

 Shi, J., Badner, J. A., Hattori, E., Potash, J. B., Willour, V. L., McMahon, F. J., Gershon, E. S., & Liu, C.

              (2008). Neurotransmission and bipolar disorder: a systematic family-based association study.

              American journal of medical genetics. Part B, Neuropsychiatric genetics: the official publication

Please Repond to Mackenzie Gray

Week 2 Discussion Agonist-to-Antagonist Spectrum

Assignment: Position Paper On Health Policy

Now that you have analyzed many different aspects of health care policy, you are better able to form a comprehensive evidence-based opinion on its effectiveness. The policy you chose to focus on, like all policy, as you now well know, is a conglomeration of many different facets. Each of those facets is integral to the policy’s success, efficiency, and value.

As a nursing professional and advocate for change, having an all-inclusive understanding of health care policy is extremely important. Nurses have a tremendous amount of untapped power to make positive changes. Your knowledge of policy is just a first step. With this new process of breaking down and analyzing each of the pieces of health care policy, you have added another tool to your toolkit.
To complete this Assignment, consider all of your findings from the Discussion in Week 1 and the Assignments in Weeks 2 and 3. Analyze your research on the policy, including costs, quality, and/or safety issues.
Address the following:

1. Introduce the topic by drawing from your previous work. Introduce the policy by providing an overview of the suggested or implemented policy: background of the topic, including main elements of the policy, costs, and quality/safety. Assert your main thesis statement.
2. Offer an evidence-based, informed opinion in support of the suggested or implemented policy. Describe at least two major contributions that this policy makes to health care, nursing, or health outcomes. Provide support with at least three sources of evidence.
3. Discuss at least one opposing opinion to the suggested or implemented policy. Provide evidence and/or data to support the counterargument.
4. Present a final position on the policy. Support the final defensible argument with current literature.
5. Conclusion:
   A. Restate your argument.
   B. Provide a plan of action, but do not introduce new information. In total, your paper will be 4–5 pages in length, not including the title page or reference page.

Assignment: Addressing Patient Safety and Quality of Care through Policy

NURS 4105: Advocacy through Healthcare Policy
Maria Pribe
Walden University
September 15, 2019
Addressing Patient Safety and Quality of Care through Policy
The legalization of the policy relating to the use of Marijuana in Michigan for adults aged 21 years and older removes criminal and monetary penalties for the possession, use, and supply of the drug for recreational purposes (Todd, 2018). The Michigan Medical Marihuana Act legalized the growth, possession, and use of marijuana. A 21 year and older will be allowed to possess 2.5 ounces of marijuana and grow up to 12 plants in an enclosed area (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). The aim of writing this paper is to address patient safety and quality of care through policy.
Ways that the Policy Addresses Safety, Quality, and its Implications Triple Aim Initiative
Medical cannabis products acquired from dispensaries and state programs follow the specified Michigan requirements of growing, formulation, manufacturing, marketing, and distribution (Thomas & ElSohly, 2016). In the United States (US), there is an increase in errors in the chemical content and inaccuracies in the labeling of products purchased from medical cannabis markets. According to Thomas and ElSohly (2016), an analysis of the tetrahydrocannabinol (THC) content on 75 products from 47 brands indicated that 17% were accurately labeled, 23% had inadequate descriptions, and 60% had an increase in classifications. Additionally, the FDA reported that in the US, firms were marketing cannabidiol-containing drugs that had not been approved thus indicating a decrease in quality control measures. Also, edibles that resemble sugars may increase intoxication or unintentional consumption. Therefore, the risk of overdosing is exacerbated by the absence of appropriate labeling and the lack of an FDA-approved antagonist that reverses the effects of the drug (Thomas & ElSohly, 2016).
States that have legalized the use of marijuana have laws requiring product safety testing for contaminants, pesticides, and cannabinoids before selling (Klieger et al., 2017). Consequently, the labeling rules outline the need to indicate the health risks, the strain of marijuana used, product potency, and proof of contaminant testing. Due to the concerns of accidental ingestions of edibles by children, manufacturers are required to have child-resistant packaging and labeling (Pacula & Smart, 2017).
To address safety and quality, the state of Michigan has regulations that outline the standards of testing, packaging, and labeling of products (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). It is also a requirement that for marihuana-infused products, the maximum level of THC and the amount of marihuana concentrate is specified on the product label. Also, a sample of the product needs to be tested by a marihuana safety compliance facility before distribution (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). Consequently, restrictions have been made on advertising, marketing, and display of marihuana to protect adolescents and children from early exposure to the drug.
The Institute for Healthcare Improvement (IHI) developed a framework that illustrates the efficient approach to optimizing health system performance (The IHI Triple Aim Initiative, n.d.). The objective of IHI Triple Aim is to improve the quality and experience of care offered to the patient, enhance the health of the population, and reduce the per capita cost of accessing health care. Communities that accomplish the Triple Aim have populations with improved health because of designing policies that identify healthcare problems and provide solutions to them.
The medical cannabis programs achieve the objectives of the IHI Triple Aim because the interdisciplinary services of medical cannabis programs improve the patient healthcare experience. Furthermore, medical cannabis was found to be effective in managing cancer and opioid addiction, therefore, it improves the health of the population because patients are offered coordinated care that decreases the illness (The IHI Triple Aim Initiative, n.d.). Additionally, economic benefits have been observed in states with medical cannabis programs such as reduced Medicare Part D spending and increased taxation profits. Hence, a reduction in the per capita cost of care for populations reduces publicly funded health care budgets.
The Effectiveness of the Policy on Improved Outcomes of Care for Patients
States that have legalized the use of medical marijuana to treat chronic pain have reduced opioid overdose deaths and untreated use disorder (Lucas & Walsh, 2017; Todd, 2018). In states that have legalized medical marijuana, the overdose death rates reduced by 25%. Legal access to marijuana has also caused a reduction in opioids dependence or hospitalization because of abusing the drug by 23% (Todd, 2018). Studies show that patients use marijuana to reduce the use of opioids for mental health and pain-related conditions (Todd, 2018). The increased rate of substitution for prescription drugs among the patients suggests that medical cannabis may be an effective treatment for the conditions (Lucas & Walsh, 2017).
Cannabinoids regulate crucial cell signaling pathways that are involved in its survival, angiogenesis, invasion, and metastasis. A research conducted by Orellana-Serradell et al. (2015) detected the presence of cannabinoid receptors on prostatic cancer and then assessed the effects of the in vitro use of synthetic cannabis analogs. The study established that there is a presence of a dose-dependent inhibitory effect that included an increase in the levels of activated caspase-3 and a decrease of Bcl-2, confirming the activation of apoptosis. The researchers also observed an endocannabinoid-modulated activation of the ERK path-way and a concurrent reduction in the AKT pathway activation. This observation suggests that endocannabinoids may impact the treatment of prostate cancer (Orellana-Serradell, 2015).
Role of the Nurse in Addressing the Quality and Safety Standards within the Policy
In the United States, the federal government classifies cannabis as a schedule 1 controlled substance with increased chances for abuse and no accepted medical value. Nurses are important in providing quality care in the health care system because of their frequent interactions with patients (Mason, Gardner, Outlaw, & O’Grady, 2016). Therefore, nurses may influence practice standards and processes to ensure the quality of care through policy work. Nurses are required to have practical information to effectively care for the increasing number of patients using cannabis through the medical marijuana program and those who self-administer the drug for recreational purposes or treatment of different conditions (National Council of State Boards of Nursing [NCSBN], 2018).
A nurse requires to know the current state of legalization and the jurisdiction of medical and recreational cannabis (NCSBN, 2018). An understanding of the endocannabinoid system, cannabinoid receptors, pharmacology, and the research associated with the medical use of cannabis. Additionally, nurses need to identify the safety considerations for patient use of cannabis to treat the patient without judging their choice of treatment (NCSBN, 2018). These principles provide the nurse with the essential knowledge for providing safety and quality care for the patients using medical or recreational marijuana.
Opinion about the Policy
I support the policy on the legalization of Marijuana in Michigan state for adults 21 years and older because of its therapeutic benefits. Studies show that cannabinoid-based medications are effective in the treatment and management of chronic pain and cancer (Orellana-Serradell, 2015; Lucas & Walsh, 2017). However, nurses lack evidence-based resources when caring for patients who use medical or recreational marijuana because of its classification as a schedule 1 controlled substance (NCSBN, 2018).
References
Klieger, S. B., Gutman, A., Allen, L., Pacula, R. L., Ibrahim, J. K., & Burris, S. (2017). Mapping medical marijuana: State laws regulating patients, product safety, supply chains and dispensaries. Addiction, 112(12), 2206–2216. doi:10.1111/add.13910
Lucas, P., & Walsh, Z. (2017). Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. International Journal of Drug Policy, 42, 30–35. doi:10.1016/j.drugpo.2017.01.011
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier.
Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1 (2018). Retrieved from /orders/www.legislature.mi.gov/(S(r03jnxzfjaqkfrcvnkpajhxx))/documents/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf
National Council of State Boards of Nursing (2018). The NCSBN national nursing guidelines for medical marijuana. Journal of Nursing Regulation, 9(2). Retrieved from /orders/www.ncsbn.org/The_NCSBN_National_Nursing_Guidelines_for_Medical_Marijuana_JNR_July_2018.pdf
Orellana-Serradell, O., Poblete, C. E., Sanchez, C., Castellón, E. A., Gallegos, I., Huidobro, C., . . . Contreras, H. R. (2015). Proapoptotic effect of endocannabinoids in prostate cancer cells. Oncology Reports, 33(4), 1599–1608. doi:10.3892/or.2015.3746
Pacula, R. L., & Smart, R. (2017). Medical marijuana and marijuana legalization. Annual Review of Clinical Psychology, 13(1), 397–419. doi:10.1146/annurev-clinpsy-032816-045128
Institute for Healthcare Improvement. (n.d.). Retrieved from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx
Thomas, B. F., & ElSohly, M. A. (2016). The Analytical Chemistry of Cannabis: Quality Assessment, Assurance, and Regulation of Medicinal Marijuana and Cannabinoid Preparations (pp.83–99). St. Louis, MO: Elsevier. http://dx.doi.org/10.1016/B978-0-12-804646-3.00005-9
Todd, T. (2018). The benefits of marijuana legalization and regulation. Berkeley Journal of Criminal Law, 23(1), Article 6. /orders/doi.org/10.15779/Z38NK3652D

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