The Assignment:

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients. In APA Format and proper citation, provide at least two references in each response post.

Colleagues’ Response Post #1

Patient with Post -Trauma Stress Disorder

Post-traumatic stress disorder (PTSD) is common among U.S military war veterans and about 20 of them are affected with estimates ranging from 8.1% to 15.2. Post-Traumatic Stress Disorder (PTSD) is a chronic psychological disorder that can develop from exposure to traumatic events in an individual’s life. It can also be caused by witnessing or perceived traumatic events (as serious injury, violence, or death), but war time veterans are more at risk.  Symptoms may include flashbacks, nightmares, severe anxiety hypervigilance, as well as recurrent thoughts about the event (American Psychiatric Association [APA], 2013 (Lancaster et al., 2016).  

The Diagnostic and Statistical Manual of Mental disorders (DSM-5) criteria of the traumatic event must include an actual exposure or threatened death, serious injury, a violence in at least one criterion (American Psychiatric Association, 2013). In this case, William meet the criterion for PTSD. He is an Iraq war veteran captain which implies he would have directly experienced the traumatic event, witnessing the event occur to others, exposure to adverse details of the traumatic events, and self-destructive behavior (American Psychiatric Association, 2013).

The focus in the case study is William Thompson as a military captain and an Iraq war veteran, Lawyer, husband who is about to lose his job, has lost his home as a result of his inability to pay his mortgage due to alcohol use and PTSD. As a result, he lives with his elder brother and his family

Therapeutic Approaches

In the case of Williams, I will be utilized both the psychotherapy and psychopharmacological treatment to manage his PTSD.

The first psychotherapy treatment I will use for this patient with trauma is the Eye Movement Desensitization and Reprocessing (EMDR). This therapy was developed to resolved symptoms from disturbing and unresolved life experiences like trauma. EMDR is a unique kind of psychotherapy used to eliminate negative emotions linked with traumatic events’ memories by focusing less on the traumatic event but more on the disturbing feelings that derive from the event (Wheeler, 2014). This therapy used approach to address past and present aspect of memories. Francine Shiparo was to first to develop this approach. The Veterans Affairs/Department of Defense clinical practice guideline for PTSD recommends treating PTSD with individual trauma-focused psychotherapy over medications.

Studies have shown that trauma focused therapies can lead to greater outcomes and last longer compared to using just medications (Norman, Hemblen, Schnurr, & Eftekhari, 2018).

           Secondly, Cognitive Behavioral Therapy (CBT) will be utilized both PTSD and alcohol abuse. In his case, he has already lost his home and may soon lose his job due to alcohol, CBT will benefit him. CBT focuses on learning to diminish problematic behaviors linked to substance abuse, in this case, alcohol (Wheeler, 2014)

Another therapy for PTSD or trauma survivors is Prolonged Exposure therapy.  In this therapy sessions, the client is required to relates the traumatic event or experience for an hour in the treatment session, and then listens to the audiotape of the session for an hour every day. Exposure therapy also requires in vivo exposure homework in which the client engages in an avoided activity related to the trauma. When this therapy is delivered in an intensive format, it has been shown to be highly effective in the treatment of PTSD (Hendriks, Kleine, Broekman, Hendriks, & Minnen, 2018).

           Psychopharmacologic therapy can be used if psychotherapy is not effective or in combination. In this case both will be utilized since his PTSD is causing him life. Problems. The Veterans Affairs/Department of Defense clinical practice guideline recommends the use of medication therapy if the client is nonresponsive to psychotherapy or if the client refuses to engage in therapy (Norman, Hemblen, Schnurr, & Eftekhari, 2018). The recommended medications for the treatment of PTSD are sertraline, paroxetine, fluoxetine, or venlafaxine but only sertraline and paroxetine are approved by the FDA for the treatment of PTSD (Norman, Hemblen, Schnurr, & Eftekhari, 2018).

Treatment Outcomes

With the expected results from EMDR, the client will process negative feelings to the scope of traumatic memories and can recalled without producing negative emotions (Khan et al., 2018). William Thompson will recognize his health concern and the need for therapy.

In regard to CBT, the expected outcomes are that of learning communication skills to addresses avoidance related to PTSD, relationship problems and challenging trauma-related beliefs. The benefit of CBT will cause the client to be aware of his health-related concerns and the need to receive the intervention (Flanagan, Jones, Jarnecke & Back, 2018). Also, with CBT, another expected outcome is the ability to resist alcohol use as several studies have demonstrated that CBT significantly reduces alcohol use disorder.

           In summary, the important thing to remember regardless of the treatment choice, is that therapy should be adjusted to the clients need. Using an individualized therapy, the therapy will be use with clients who get the greatest response. Also, the willingness to engage in therapy will depends on the patient. As PMHNP we have lots of different options to explore to help someone with a trauma in their life.  Everybody responds differently so one therapy might not work for one person but will work for the others.

Colleagues’ Response Post #2

Observation of Client

           William, the client in question, is a former military Captain and Iraqi war veteran. He is currently homeless and staying with his brother and his brother’s family due to an inability to pay his rent previously. William moved in with his brother because of these issues and is currently dealing with problems with his job being in jeopardy because of his current alcohol troubles. William presents with a flat affect and his family describes him as not “having it together”. According to the American Psychiatric Association (2013), DSM-5 criteria for a Post- Traumatic Stress Disorder diagnosis includes many things that William displays. Some diagnostic criteria includes “exposure to actual or threatened death or serious injury” (APA, 2013). William was exposed to these things and could have possibly experienced fellow platoon members die in war. Along with this, William exhibits signs that his disturbances cause significant distress or impairment “in social, occupational, or other important areas of functioning” by attempting to cope with his problems with alcohol use (APA, 2013). Mahoney et al. (2020) explain that PTSD “is associated with higher levels of alcohol use among returning veterans” as they turn to alcohol when they don’t know how to cope.

Therapeutic Approaches

           When considering the treatment approach for clients with PTSD and excessive alcohol use, it is important to think about the specific targeted outcomes as well as the trauma the client has gone through that has caused the issues at hand. Simons et al. (2017) explains that PTSD often debilitates Operation Iraqi Freedom veterans, and the prevalence of these veterans having PTSD has significantly increased since the year 2002, to a “current estimate of 23%”. Goodnight, Ragsdale, Rauch, and Rothbaum (2019) note that clients with PTSD should be approached with trauma-focused therapies as treatment as “trauma-focused treatments are safe and effective for PTSD even when higher-risk comorbidity presents”. If the client struggles with flashbacks and nightmares that interrupt sleep, one could consider prescribing Prazosin. If the client struggles with stopping his alcohol dependence, rehab could be considered, or even prescribing Naltrexone would be acceptable. Taylor, Petrakis, and Ralevski (2016) found that pharmacotherapy, specifically Zoloft, is helpful in reducing PTSD symptoms, and naltrexone combined with psychotherapy is “better for drinking outcomes”.

Expected Outcomes

           For this client specifically, it is important for his treatment goals to include becoming free of alcohol addiction and learning ways to effectively cope with his PTSD. Some medications may be needed in reaching these goals, but without a doubt, this client could benefit greatly from psychotherapy. Alcohol use and PTSD both have shown great improvements with effective psychotherapies. This client will likely need trauma-focused therapy and pharmacotherapy both to get himself to a desired level of functionality. Ultimately, with these issues addressed, we would want the client to have no issues with his job and financial situations, able to work without problems, and be able to move out of his brother’s house and support himself in a stable environment, both financially and emotionally.

Please note that the teacher marked me down for reference, she really wants an ENGLISH TITLED PEER REVIEWED NURSING JOURNAL. (Thanks :))

 

APA format: The letter h in Running head is not capitalized. The title after the words, Running head, is related to the title of the paper (review guidelines for formulating a running head). No first initials used for in text citation. The reference page is alphabetized. Remove hyperlinks from the reference page. 

Please, respond to the following discussion, the response requires reference from one peer-reviewed Nursing journal not older than 5 years from database and not internet. 

There are several ways nurses can make an impact on helping in improving health disparities within vulnerable populations.   Involvement in developing a program that target a population and a health issue within that population is an option.  There needs to be several individuals involved in the development of a program and keeping it running.  Going out there and becoming involved in an issue that means something as a health care provider could be the first step into addressing health disparities.  The textbook gives several examples in chapter 22 of programs that the textbook’s authors have been involved in (De Chesnay & Anderson, 2016). 

            While nurses are working, whether it’s in the inpatient or outpatient setting, they can educate themselves about the various groups of vulnerable populations the tend to at work.  Making an effort to learn a language from a minority group would help in taking care of the patient, and in providing education during the hospital stay or visit to an outpatient center.  Many factors effect vulnerable populations, nurses can as they are in the forefront of patient care, can advocate for their patients (Strunk, Townsend-Rocchiccioli & Sanford, 2013). 

 

Instructions

You are caring for five patients on a busy, 28-bed neurological medical-surgical unit, which recently transitioned to all electronic documentation and healthcare computerized provider order entry (CPOE). There is no longer any bedside paperwork.

All of your staff members have completed the required training and you have been assigned as expert lead for any questions that may arise during your shift. The expectation is that all nurses and clinical staff will document all care delivery in the bedside computers located in each patient’s room or via the workstation on wheels (WOW).

However, you have noticed a trend with experienced nurses spending extra time at the end of their shifts (30 or more minutes) documenting the nursing care provided during the shift. The expectation is that they should be documenting care delivery as soon as it is complete rather than at the end of their shifts.

Answer the following questions based on the information provided:

1. Explain how you would address the concern with the delay in nursing documentation with your team.
2. Do you see the transition to all electronic documentation as having a positive or negative effect on patient-centered care? Support your answer with evidence from the literature.
3. Explore the role of advancement in information technology and its effect in patient care. Does more technology use improve time with patients? Use at least two sources to support your response.

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
3. The PICOT question will provide a framework for your capstone project. 
4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.