Write a brief Introduction why you chose these decisions .

Decision 1

The PMHNP will administer 10 mg of zyprexa orally at bed time and initiate 230mg of invega sustenna through intramuscular, in addition to 156 mg via the same route on day four. A similar dose will be administered within one months’ time. In addition the PMHNP will administer 10mg of Abfility orally at bed time. Expected outcome for this decision is a 25% decrease in the PANSS score (Stahl, 2013). This decision is also expected to alleviate the patient’s psychotic symptoms and achieve normalcy within one month. A slight weight gain is also expected as the drugs are known to increase weight in patients. Because I don’t select the other decisions, the patient is expected to have faster and noticeable changes in psychotic behavior within two weeks of treatment commencement. 

Decision 2

At this point the PMHNP will decide to continue with use of medications selected in decision 1 (Stahl, 2013). However the PMHNP will instruct the administering nurse to begin intramuscular injections of 300mg of Abfility and continue with 10 mg of the same drug in the morning. At this point, PANSS is expected to decrease by 50 % although the patient will also have noticeable weight gain due to use of invega sustenna (Stahl 2014). Because I don’t select other decisions, the patient is expected to have less cardiovascular drug toxicities and experience reduced risks for adverse drug reactions between Invega sustenna and Haldol Deaconoate. 

Decision 3

The decision at this point is to have the patient continue with Invega Sustenna and provide psychological counseling on the effects of the drugs associated with weight gain. It will be essential to explain to the patient that the weight gain from this drug is minimal in comparison with other drugs (Stahl, 2013). The PMHNP will set an appointment follow up date with the patient after one month duration and refer to the nutritionist and physical activity instructor. The difference between expected outcome in decision 3 and results of the decision is Abfility may not be efficacious for more than a period of 6 months given that it does not bind to D 2 receptors in a similar manner as Invega Sustenna. This will necessitate the PMHNP to change to Abfility Maintena because it is easily tolerated by patients on Abfility. 

Because I don’t select the other decisions, the patent will be able to utilize the same drug for the longest possible duration and optimize on their efficacy prior to switching to other types of medication (Stahl, 2013). Since the patient may not have the mental capacity to participate in the decision making process or make autonomous mental health decisions, it is essential to discuss treatment options with the spouse and explain the importance of adherence to treatment (Stein & Giordano, 2015). In addition, the mental health nurse is required to make those decisions which will benefit the patient and also outweigh the risk for adverse health outcomes. 

References

Write a 2 Paragraph response (with 2-3 sources) to this post offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Healthcare system presently is faced with challenges to improving quality of care and controlling costs and according to the Institute of Medicine, electronic health records (EHR) serve as a solution to these challenges (2001). The Health Information Technology for Economic and Clinical Health Act (HITECH) passed by President Barack Obama promotes the adaptation of EHR system by providing health organizations and providers with incentives through Medicare and Medicaid for meaningful utilization of EHR systems (McGonigle&Mastrian, 2017). Technology in nursing has evolved and transformed the way nurses work and continues to grow, along with the role’s nurses play in today’s health care environment (Melissa Wirkus, 2016).For many years the paper chat served as the patient’s primary medical records such as medical histories, medical diagnosis, medications, and other pertinent patient information. In the future, an expected healthcare technology trend in nursing practice will be a significant increase in the use of the Electronic health record (EHR) instead of the traditional paper charting As technology continues to grow so does additional information technology that helps caregivers, engage patients and improve efficiencies and better patient outcomes (Laureate Education, 2018). For example, patients can now have access to their medical health records at their own convenient through online portals and can effectively communicate with their health care provider. In addition, patients are also using social media platforms like Facebook and twitter to get/communicate with others with the same health-related diagnosis.

According to McGonigle & Mastrain “Public health information systems represent a partnership of federal, state, and local public health professionals” (2017). In the present-day majority of health care organizations are embracing the implementation of electronic health records. In the hospital I work, we are making use of the Meditech operating system. Patient medical histories, diagnosis, home medications, and current medications are updated and readily available. During patient’s hospital stay, all health care providers can log in with their personal access codes to document as well as view patients’ labs, patient notes, care plans and so on. More so, one intriguing benefit for the patients is during the patient’s hospital stay and at discharge, patients are educated about our patient portal where they can easily log in to look up their personal medical records.

Potential Risk/ Challenge Associated with data Safety.

A potential risk associated with data and or technology safety is the lack of patient confidentiality. For example, when a nurse who is from a different unit assesses patient medical records they took care of three days before, that is considered a break in patients ‘confidentiality because that nurse has no reason viewing records of a patient who is not assigned to them. At my facility, they monitor nurses who try to access a patient’s chart without proper authorization. This can lead to disciplinary action or termination of employment. The administration has zero tolerance for this behavior. With advancement in information technology patient’s vital information such as test results, labs, and assessments are automatically synched from the operating machine to the appropriate patient’s EMR. This prevents possible errors that can arise with paper documentation. At my current organization, the Meditech EMR system is utilized to its full extent. The EMR system allows a congruent flow inpatient care from providers and clinicians and prevents possible human errors. Informatics has assisted in the incorporation of information technology in healthcare delivery, by providing a haven for patients’ data and making valuable patient data readily available for treatment.

Finally, an inherent risk associated with a legislature that limits telehealth services pertains to reimbursement. State laws and rules regarding reimbursement rates for telehealth services differ, even within the same jurisdiction, for telemedicine profitability are driven primarily by payers, including Medicare, Medicaid, and private insurance companies (Fanburg & Walzman, 2018). Such inconsistency in reimbursement rules for telehealth services can create weak incentives among providers to expand telehealth care. Thus, each provider must be aware of legal policies governing telehealth practice within respective jurisdictions to promote telehealth services successfully.

As stated above, a current and future trend that has evolved and still evolving is the introduction of social media and telehealth. Currently, telehealth is trending I have seen many health-related groups on Facebook where patients with the same diagnoses communicate, ask questions, and even get healthcare provider recommendations. Telehealth, on the other hand, is the use of electronic information and telecommunications technologies to assist and promote long-distance clinical health care systems (McGonigle&Mastrian, 2017). For example, individuals who are looking for quick answers to their health problems, and maybe have no means of transportation, telehealth is beneficial for them in the comfort of their homes. Services like this offer patient immediate healthcare consult/answers and refrains patient from going to the emergency room and sitting there for several hours before being attended to. This impacts nursing practice positively. Telehealth nursing can be done anywhere. Nurses can make use of technology to conduct telehealth sessions in their homes, at doctor’s offices, in prisons, and in clinics and hospitals. Basically, any place where the proper technology is available is a suitable place for telehealth nursing. For example, in emergencies, nurses from around the world can participate in telephone triage set-ups. Wherever nursing is done in a telehealth setting, nurses can monitor a patient’s oxygen levels, heart rate, respiration, blood glucose and more. In addition, patients contact their nurses through the telehealth system to get help. In non-emergency situations, they can get the nurse to take their blood pressure readings or glucose readings, for instance. Nurses can instruct patients as to how to dress a wound or treat a minor burn. The patients usually find their telehealth nurses through their managed health care organization. Nurses must be overseen there to regulate patient access to the system. Most of the time, the goal is to reduce the number of trips patients make to the ER.

These are the sources you used for my post. You can use these or any others you want. I trust your judgement

Baniasadi, T., Kalhori, S.R., Ayyoubzadeh, S.M., Zakerabasali, S., & Pourmohamadkhan, M. (2018). Study of challenges to utilize mobile-based health care monitoring systems: A descriptive literature review. Journal of Telemedicine and Telecare, 24(10), 661–668. DOI: 10.1177/1357633X18804747

Naseribooriabadi, T., & Sheikhtaheri, A. (2015). Social media and health care: Necessity of facing their challenges. Iranian Journal of Public Health, 44(4), 596–597. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441977/

University of Saint Mary. (n.d.). Five exciting technologies that are changing nursing practice. Retrieved from https://online.stmary.edu/msn/resources/five-technologies-changing-nursing-practice

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32. doi:10.3390/informatics4030032

 Respond to at least two of your colleagues’ posts by offering suggestions/strategies for working with this database from your own experience, or offering ideas for using alternative resources.

at least 2 references in each peer responses! 

  Clinical documentation improvement seems to be a very gray area of nursing and in the medical field, in general. Most times, nurses working in this field find ourselves educating physicians and hospital administration about the importance of our program and how it impacts quality outcomes for the hospital. Most hospital administrations and physicians like to think of our department as dealing with hospital reimbursement. While part of this may have been true when the programs were created with most CDI program falling under a revenue cycle department, programs are now quality driven. Clinical documentation affects patient outcomes by showing the severity of illness and case mix index of a specific DRG while capturing all of the comorbid conditions that also affect a stay, such as diabetes with hyperglycemia. Finding peer reviewed articles, like the ones below, provide evidence of how a CDI program helps to improve everything from length of stays and better outcomes for patients and families. 

I was honestly very surprised to find so many articles in the ScienceDirect area of the Walden Library. I have been looking for articles such as these to help support our program in Tampa with our physicians. Ongoing education and support is something that I am always striving to bring to our physicians. It is very difficult to show the worth of your program to physicians and administration without discussing dollars and cents. I would definitely love to share this information with my colleagues, both nurses and physicians. Sometimes, physicians need additional resources to help them understand. Nurses working in this field can always use more resources to help better assist them in explaining and using evidence to explain and validate why our program is so important. 

Respond to at least two of your colleagues’ posts by offering suggestions/strategies for working with this database from your own experience, or offering ideas for using alternative resources.

at least 2 references in each peer responses! 

To craft research papers, the research to support the topic must be research articles should be quality, peer-reviewed from a credible source. Above is an example of a research article that meets criteria to be incorporated into a graduate-level body of work. To obtain the peer-reviewed article above, I utilized the Walden Library database search. The article titled “Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit” comes from Academic Pediatrics, which is a peer-reviewed publication. The research presented in this article used a cross-sectional survey to identify patterns of mental health-related visits of youth populations to pediatric emergency departments (Rodean et al., 2019). A cross-sectional survey is a qualitative study that aims to identify patterns, behaviors, actions, and experiences with the use of self-administered interviews (Smith, 2009, p. 7). Since I plan to focus on the pediatric population once I obtain my Psychiatric Mental Health Nurse Practitioner (PMHNP), this journal article is relevant to my career path. Using the Walden library search has been advantageous as it is user-friendly and had many choices to choose from when I searched for “pediatric mental health.”

Because of the reasons mentioned above, I did not find it difficult to find related material to my subject of choice. I believe because of the ease of use and the ability to use the “ask a librarian” tool to help find resources, the Thoreau search through Walden University Library is a collection of databases that would be useful to my colleagues. Overall, I would recommend the Thoreau search through the Walden University Library, as it has an expansive variety of peer-reviewed, reputable resources and articles as it searches many databases all in one place (Walden University, n.d.). Incorporating articles and resources that are reputable and peer-reviewed is essential when creating bodies of work that are credible (Laureate Education, 2018). By evaluating resources this week, I am gaining a better understanding of what resources to utilize to create reliable resources that are full of integrity.