TO REPLY TO EACH COMMENT WITH APA, CITATION AND REFERENCE ABOVE 2013.

Post 1

Introduction

According to week two, it is clear that the assessment tools used in psychotherapy have two primary purposes. The first purpose is to measure the illness and diagnose clients while the second purpose is to evaluate a client’s response to treatment. There are different types of assessment tools, but in this discussion, I have selected Patient Stress Questionnaire.

The psychometric properties of the Patient Stress Questionnaire as the selected assessment tool

Patient Stress Questionnaire refers to the tool employed in primary care settings to help in screening for the behavioral health symptoms.  The instrument was adapted from the PHQ-9, AUDIT, GAD-7, and PC-PTSD.  Patient Stress Questionnaire is made up of a list of items that efficiently help in identifying the potential behavioral health problems. The tool is a 24-item behavioral health screening tool which is composed of a collection of twelve (12) separate “ultra-brief” screening tools to offer a preliminary mental health and addiction diagnosis. The PHQ-9 is made up of 9 items which represent the criterion symptoms for DSM 5 major depressive disorder. These have questions related to how much sign has bothered the client based on the scale such as  “not at all,” “nearly every day,” and  “several days”. The GAD-7 is made up of seven items with the response similar to PHQ-9 and scored as a continuous variable from 0 to 21 (Kroenke et al. 2016).

When it is appropriate to use Patient Stress Questionnaire

The tool is used when the client is suspected to have depression and anxiety. Several well-validated measures can be used to assess depression and anxiety as separate domains (Flückiger et al 2016), but the advantage of Patient Stress Questionnaire is that it is a measure that offers a single composite score for both the depression and anxiety (Kroenke et al. 2016). The tool is used in assessing depressive symptoms among patients having conditions such as aphasia. The tool is applicable for measuring perceived stress (Laures-Gore et al. 2017).

Furthermore, theoretical and empiric evidence of overarching psychological construct that compromise of distinct but related dimensions of anxiety and depression. Therefore, the intercorrelation between depression and anxiety makes Patient Stress Questionnaire attractive as it provides a composite score.

Based on the efficacy of Patient Stress Questionnaire in evaluating psychopharmacologic medications, psychopharmacological medications aim to manage behavior, stabilize mood, or to treat psychiatric disorders and their associated symptoms. On the other hand, Patient Stress Questionnaire is used to screen for these behavioral health symptoms and therefore, can be used to determine whether the symptoms are reducing or not based on the psychopharmacological medications. The tool can be used to  self-report symptoms and to identify  persistent symptoms of anxiety disorders and even monitor the treatment in clinical practice (Rose & Devine, 2014).

                                                     References

Kroenke, K., Wu, J., Yu, Z., Bair, M. J., Kean, J., Stump, T., & Monahan, P. O. (January 01, 2016). Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials. Psychosomatic Medicine, 78, 6.

Laures-Gore, J. S., Farina, M., Moore, E., & Russell, S. (January 01, 2017). Stress and depression scales in aphasia: Relation between the aphasia depression rating scale, stroke aphasia depression questionnaire-10, and the perceived stress scale. Topics in Stroke Rehabilitation, 24, 2, 114-118.

Rose, M., & Devine, J. (January 01, 2014). Assessment of patient-reported symptoms of anxiety. Dialogues in Clinical Neuroscience, 16, 2, 197-211.

Flückiger, C., Forrer, L., Schnider, B., Bättig, I., Bodenmann, G., & Zinbarg, R. E. (January 01, 2016). A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] — Effects of Three Different Strategies of Impleme

Post 2

psychometric properties of the Screening, brief intervention, and referral to treatment (SBIRT) tool

The SBIRT grant program was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) which provided either brief intervention/treatment or referred to appropriate services for individuals who use alcohol or psychoactive substances, not including tobacco that may not meet criteria for a substance use disorder (Aldridge, Linford, & Bray, 2017).  It begins with a pre-assessment screening which briefly explores substance use.  If a positive pre-screen is evident, the provider should move to the Alcohol use disorders identification test (AUDIT) and/or the Drug abuse screening test (DAST) for more thorough assessment.  If positive brief intervention or treatment is advised (“Clinician Tools – SBIRT for Substance Abuse,” n.d.).  According to Yong, et al. as part of their systematic review, it is unclear whether it is beneficial to utilize brief interventions as part of the SBIRT screened individuals who were not seeking treatment at the time of assessment (2014).  Evaluation of this project indicated that the program was positively correlated with decreased alcohol and/or substance use in this population.  However, it is unclear whether other factors were key (Aldridge et al., 2017).  It was noted however that participants had significantly lower reports of substance use one month after intervention.  However limitations in study design may have impacted the reported results (Aldridge et al., 2017).

Explain when it is appropriate to use SBIRT with clients

Each client should be assessed using a pre-assessment screening tool yearly.  If positive, the client should be assessed using the AUDIT or DAST tools as indicated above (“Clinician Tools – SBIRT for Substance Abuse,” n.d.)

Is the SBIRT tool appropriate to evaluate the efficacy of psychopharmacologic medications

The SBIRT protocol moves to brief intervention or brief treatment as appropriate.  These interventions are focused on psychological treatments 5-60 minutes in length (“Clinician Tools – SBIRT for Substance Abuse,” n.d.)  As such, they would not be involving psychopharmacological substances, at least initially it would not be appropriate for evaluation of medication effectiveness.

References

Aldridge, A., Linford, R., & Bray, J. (2017). Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT). Addiction, 112, 43–53. https://doi.org/10.1111/add.13651

Clinician Tools – SBIRT for Substance Abuse. (n.d.). Retrieved September 5, 2018, from http://www.sbirt.care/tools.aspx

Young, M. M., Stevens, A., Galipeau, J., Pirie, T., Garritty, C., Singh, K., … Moher, D. (2014). Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Systematic Reviews, 3, 50. https://doi.org/10.1186/2046-4053-3-50

Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussio

Jessica, a baccalaureate prepared registered nurse, has been practicing for 8 years. Throughout her nursing career, she has worked in pediatric, surgical, and emergency departments. She worked as a floor nurse, a charge nurse, and she was recently offered a position in Nursing Administration. A stipulation for becoming a nurse administrator is that Jessica must attain a Master of Science in Nursing degree within 2 years of accepting the position. The offer prompted Jessica to contemplate her career. She is interested in returning to college, and wants to have greater impact on patient care but isn’t sure she will find that in an Administrative role, nor is she sure is ready for the responsibility of becoming a Nurse Practitioner. Jessica has decided to explore the advance practice roles available in nursing in order to determine the best MSN track for her. Jessica must choose one role (CNP, CRNA, CNS, CNM) and apply to a program, but she is unsure about the different roles and their individual scopes of practice. One colleague states, “You know, Jessica, working as an NP is great because you can diagnose and write prescriptions, and the accountability will fall on the physician you are working with.”

Discussion questions:

• Is Jessica’s colleague right? Why or why not?
• Explore the four APN roles, and compare and contrast the pros and cons of each role against each other in order to determine the best choice for Jessica. Consider issues such as work environment, level of accountability, patient population, salary, and scope of practice. Include each role of the APN on the list, and be certain to provide appropriate rationales and citations.

reference not older than 5 years. 300 words minimum 

1-Qualitative data are words, instead of numbers. According to Burns, Gray and Grove (2015) “Qualitative research is a systematic approach used to describe experiences and situations from the perspective of the person in the situation. The researcher analyzes the words of the participant, finds meaning in the words, and provides a description of the experience that promotes deeper understanding of the experience”. Initially you want to state the purpose of the study. In a Qualitative study there are different types of perspectives that can be associated with a qualitative study.  Phenomenological, grounded theory, ethnographic, exploratory-descriptive, qualitative and historical are types of research (Grove, 2015).  To assist with the management of the study, according to White, Oleke, and Friesen (2012) they had eight recommendation as follow

• Have      one person manages and organize the study.
• Provide      a through documentation collection and analysis details
• Strict      timeline for data collection, coding and analysis
• Use      of iterative process for data collection and analysis
• Comprehensive      internal audits
• communications      among all members of the team
• resources      are to be utilized to meet dead line
• re-assess      and determine if any changes need to be made.

According to Burns, Gray and Grove (2015) when collecting research, a way to manage the data is by organizing the information into themes and subthemes to form meaning from the data. Data analysis and interpretation allows the researcher to place the findings into the correct category, finding correlation or the non-correlation of the data being obtained.  They must be consistent with the method and the philosophy of the study, allow the data and meaning to be revealed, thus demonstrating the rigor of the study.

Reference

Grove, S., Gray, J., Burns, N., (2015). Understanding Nursing Research, 6th Edition. Retrieved from https://viewer.gcu.edu/DPBXHG

White, D., Oleke, N., & Friesen, S. (2012, July). “Qualitative Data Has Been Described As Voluminous And Sometimes Overwhelming To The Researcher In What Ways Could A Researcher Manage And Organize The Data” Essays and Research Papers. Retrieved from https://doi.org/10.1177/160940691201100305

2-Qualitative data can be difficult to process and analyze if not organized properly but the organizing itself is often a difficult task because qualitative data by its very meaning has no numerical data that can be placed in any order or sorted. For this very reason, the data almost always has to be separated and sorted by a human being rather than a computer system that would have to be programed to search for a numerical characteristic that doesn’t exist. In the place of these numerical characteristics, the researcher would need to sort their data into themes based around patterns found in their work. These patterns would differ based on the nature of their research. Once these patterns were decided upon they would be used to create groupings for the data.

References

Grove, Susan, Jennifer Gray, Nancy Burns.(2015). Understanding Nursing Research, 6th Edition. Saunders, VitalBook file.

3-“Qualitative research is multimethod in focus, involving an interpretive, naturalistic approach to its subject matter. This means that qualitative researchers study things in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them” (Mcleod, 2008). What this means is that the point of qualitative research is to understand the reality of the subject matter and participants that are being studied, which is why these test subjects are studied in their natural setting. I agree that qualitative data can be voluminous and overwhelming, so organizing large amounts of data in to smaller groups would be preferable. One way you could start would be to divide up the data into the different environments in which they are being studied. For example, if you are assessing fall risks in the elderly in the healthcare setting, there are three different categories you can divide into in themselves. To further break down the data, you could organize any of these groups into different facilities, such as assisted living facilities, hospital, nursing homes, rehabilitation facilities, and adult foster homes. The division of data is all dependent on what the focus of your study is and what end goal you are attempting to achieve. If you are seeking safe staffing ratios, you  could begin by dividing fall risk patients by facilities with higher staffing ratios than those with lower ones to compare and contrast. There really is no “exact answer” on how to organize the data. The development of technology is very helpful in the organization of data in recent years. I believe that professor Mcdonald made a comment earlier about a study that she was once involved in that did not use computers for the organization of data. It would definitely speed up the process of sifting through the information you have for the information that can be used. When it comes to organization, in any capacity, I find that lists and spreadsheets help me to focus my mind and not leave out any important information. This method may not work for everyone, but if I don’t write something down, chances are, it will get forgotten in the end.

References:

Mcleod, S. (2008, February 5). Qualitative vs Quantitative Research | Simply Psychology. Retrieved from https://www.simplypsychology.org/qualitative-quantitative.html

Instructions :

Use the practice problem and a quantitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

References

Creswell, J., (2008). Educational research: Planning, conducting, and evaluating quantitative and qualitative research (3rd edition), Upper Saddle River, NJ: Prentice Hall. 2008, p. 300. ISBN 0-13-613550-1

APA format 3 peer review references 1 and half pages long MSN degree 

due Saturday 9/8/18 at 4pm EST

JC is an at-risk 86-year-old Asian male with numerous factors that impact his ability to seek adequate care. One major source of concern is his physical and financial dependence on his daughter that is unable to devote ample time and money to him. JC has numerous comorbidities that require consistent medication therapy. JC suffers from hypertension and takes lisinopril daily for management. Failure to treat the hypertension would result in him being at greater risk of suffering from a myocardial infarction or ischemic cerebrovascular accident related to atherosclerosis of various arteries due to continued hypertension. JC also appears to be at risk for developing depression. His feelings of being a burden to his daughter signal that he may already be suffering from the effects of depression related to his overall condition. It is imperative that the clinician further assesses his feelings and his fears to determine his emotional state. Demirtürk and Hacıhasanoğlu Aşılar (2018) stated that patients suffering from depression are at much greater risk for non-adherence to antihypertensive medication therapy, placing them at risk for the complications listed above.

JC also suffers from gastroesophageal reflux disease and takes prilosec daily for management. Failure to treat this condition could cause gastrointestinal ulcers and severe gastrointestinal pain. JC also suffers from vitamin B12 deficiency and gets vitamin B12 injections monthly to correct his deficiency. Failure to seek treatment monthly would result in increased fatigue and place JC at risk for muscle atrophy and activity intolerance related to a sedentary lifestyle. Finally, JC suffers from chronic prostatitis and takes cipro daily. Failure to take the prescribed medication therapy could result in prolonged suffering from the side effects of the disease, including frequency, urgency, and difficulty initiating urination. Each of these side effects places JC at greater risk for falls, as he would likely have to attempt to make it to the restroom frequently if he is able to do so. A lack of physical ability places JC at risk for not being able to routinely get his prescriptions filled, which places him at risk for the adverse complications of non-adherence to medication therapy listed above for each comorbidity. A lack of funding places JC at risk for not being able to pay for his prescriptions that yields the same risks.

JC’s statement concerning not wanting to be a burden to his daughter serves as proof that the clinician needs to further explore that situation and determine if his daughter is able to be of assistance with JC’s care. If JC is unable to provide self-care and lacks resources that allow him to seek care outside of his daughter that is unable to assist, then the clinician needs to seek resources for JC so that he does not avoid healthcare out of ignorance or embarrassment. Lee, Rhee, Kim, and Ahluwalia (2015) conducted a study of Asian American immigrants to determine their health literacy compared to participants of other descents, and determined that the Asian American participants had significantly lower health literacies than the other ethnicities in the study. The study concluded that for this reason, Asian American patients are much less likely to seek indicated healthcare for necessary reasons.

When interacting with JC, it would be important to be sensitive regarding the self-care activities that he is unable to do for himself. It is apparent the JC is embarrassed concerning his inability to care for himself, as he is stating concern about being a burden to his daughter. For this reason, it is extremely important that the clinician be sensitive regarding his inability to provide self-care so that JC does not shut down emotionally. Also, the clinician would need to be very careful not to break JC’s spirit by focusing on the unfavorable circumstances regarding his inability to provide self-care and the lack of support resources that JC possesses. JC is making an active effort to seek healthcare despite his shortcomings. It is important that the clinician avoid overwhelming JC with the facts of the situation to avoid breaking JC’s spirit and causing him to lose the aspiration to seek necessary medical care. Applauding JC’s effort and perseverance throughout the circumstances could be effective in inspiring JC to continue putting forth his best effort.

To further assess the patient’s health history, I would ask the following questions:

Is there anyone else besides your daughter that can assist you with your healthcare needs?

Can you further explain the aspects of your care that you need assistance with so that I can be in a better position to get you the care that you need?

Do you consistently take your prescribed medications? If not, what keeps you from consistently taking them?

What are your feelings regarding assisted living?

Would you be interested in speaking with a social worker to further explore your specific situation so that we can provide you with the assistance that you need?

            The above listed questions would aid the clinician in establishing a rapport with JC while also providing needed information concerning JC’s needs. Ball, Dains, Flynn, Solomon, and Stewart (2015) stated that it is important to build rapport prior to progressing the patient’s health history for better comfort and results. The questions above introduce the idea of additional support resources without coming across as aggressive or forceful. In JC’s case, it is important that the clinician present these things in a helpful manner to ensure that JC doesn’t begin to feel as if he is a burden to the clinician or any of the support resources.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Demirtürk, E., & Hacıhasanoğlu Aşılar, R. (2018). The effect of depression on adherence to antihypertensive medications in elderly individuals with hypertension. Journal of Vascular Nursing, 36(3), 129-139. doi:10.1016/j.jvn.2018.06.001

Lee, H. Y., Rhee, T. G., Kim, N. K., & Ahluwalia, J. S. (2015). Health literacy as a social determinant of health in Asian American immigrants: Findings from a population-based survey in California. Journal of General Internal Medicine, 30(8), 1118-1124. doi:10.1007/s11606-015-3217-6