Angela La Dow 

 

Manage Discussion Entry 

The name of the condition is Neonatal Abstinence Syndrome (NAS). The baby will be born with opioids on board and will require opioids or partial opioid receptor agonists to help the baby through withdrawl and detox. This process can be started while in utero with the mother in medication assisted treatment (MAT). The idea behind MAT is to use opioid agonists that do not fully cover the opioid receptors thereby reducing the euphoria of the full opioid (morphine, hydrocodone, fentanyl, oxycodone, & heroin). There are three treatment modalities for MAT; methadone, buprenorphine or the combo buprenorphine/naltrexone (Suboxone), and naltrexone itself (SAMHSA, 2018

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). Buprenorphine in combination with naltrexone completely blocks the full receptor so the effects can not be overcome by more opioids (to a certain extent) and reduces cravings. Once a patient is in MAT and dosed appropriately with a Suboxone dose that is the smallest dose to keep withdrawl away visits can be extended out if they are working therapy and group therapies such as NA and AA the psychosocial aspect of addiction. When a pregnant women starts MAT the amount of medication that crosses the placenta is the same as the mother’s and the fetus can start to slowly and safely reduce their exposure to full opioids (McQueen and Oikonen, 2016

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). A patient has to be off full opioids for at least 3 days before starting MAT with Suboxone. They are given Imodium, gabapentin, and clonidine to help reduce the withdrawl symptoms. If they are not they will go into full withdrawl with the initiating dose due to the naltrexone. 

Risks for the baby are low birth weight, STI infections, potential abuse and neglect, and preterm birth (McQueen & Oikonen, 2016). Opioid withdrawl for infants is more serious that opioid withdrawl for adults due to the seizures and other neurologic symptoms it can cause. Depending the type of opioid and the amount taken by the mother the severity of withdrawl will be different for each infant. There will be tremors, diarrhea, irritability, tachycardia and tachypnea, poor feeding, and possibly seizures (McQueen and Oikonen, 2016). Long-term effects of NAS are not well studied but it has been found that there can be some behavioral problems and mental health issues with these children as well as abuse and neglect by the parents (McQueen and Oikonen, 2016). 

There is a misconception that a women will automatically be placed in jail if the are using opioids while pregnant once they give birth so they do not seek prenatal care and sometimes will wait until they are in labor to be seen. There was on NAS infant in the hospital I work at who was born to the girlfriend of a MAT patient we were seeing. She left the hospital AMA because she did not tell anyone she was a heroin addict and started withdrawl. She could have been treated appropriately in the hospital and reduced her risk of hemorrhage and death and stayed with her baby. The goal for these women is to get them to bond with the baby, be able to manage their care in their home, and find supports for them over the long term (McQueen and Oikonen, 2016). 

My last preceptor became certified in addiction treatment with Suboxone so I got the opportunity to work with this population and see first hand the initiation of treatment, pride in getting clean, pride in staying clean, and the disappointment of relapse. There are not a lot of providers that are certified to do this treatment and they are only allowed a certain amount of patients per provider. The certifying body that maintains it just opened certification to NPs and PAs to manage patients. Generally recreational drug use and alcohol abuse escalates to heroin use. I saw at least four patients that started with legit prescriptions for opioids and progressed to heroin use. The others started with other recreational drug use and alcohol abuse. My last preceptor stated to me that if a pregnant women seeks MAT and is on it while in labor there are better outcomes for the baby and the mother and child protective services may be willing to work with her.

References

McQueen, K., & Oikonen, J. (2016). Neonatal Abstinence Syndrome. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1600879 

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SAMHSA. (2018). Medication assisted treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment

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Links to an external site.

In developing the evidenced based project to improve/increase formal workplace violence reporting utilizing the current “RL Solutions” software, there are several aspects of implementation that will affect the impact of the delivery and success of the plan. The first aspect to consider is the financial impact that the project will have on the organization. The plan entails a unit-based educational piece detailing: What constitutes workplace violence? and how to navigate RL solutions to document violent events, Education will also include the importance and impact of formal documentation, as well as what support processes to anticipate as follow-up to incident reporting. Educational material will be nominal, including a three-fold poster board and small fliers in strategic high nursing traffic areas. It will involve several in-services 10-15 minutes in length, provided by project leader to reach all staff. The larger impact to violence in the workplace is astounding. A 2017 report prepared for the American Hospital Association estimated that workplace violence costs U.S. hospital and health systems $2.7 billion in 2016, including $280 million related to preparedness and prevention, $852 million in unreimbursed medical care for victims, $1.1 billion in security and training costs and an additional $429 million in medical care, staffing, indemnity and other costs related to violence against hospital employees. (ashclinicalnews.org)Other costly aspects associated with WPV are lost wages, legal expenses, workman’s comp claims, diminished public image and employee turn-over expenses. The U.S.Department of Labor, estimates the cost to replace an employee due to workplace violence is approximately two-thirds to twice the annual salary of the employee being replaced.( www.osha.gov)Clinically, the impact of workplace violence leads healthcare workers to commit a greater number of medical errors which correlates with poorer patient outcomes. Also. Healthcare workers who must must take time off work to manage physical or psychological impact of violence put a strain on staffing availability. “Healthcare workers who were victims of violence experienced an average of 112.8 hours her year of sick, disability” (ashclinicalnew.org) which is a little more than twice that of those who did not experience workplace violence. Poor Staffing ratios due to lost staffing availability also stand to impact patient outcomes. The aspect of quality of care is also affected by episodes of workplace violence. A study published in 2001 by Judith Arnetz and Bengt Arnetz, “suggest that the violence experienced by healthcare staff is associated with lower patient ratings of the quality of care.”Additionally, workplace violent incidents contribute to decreased job interest, productivity and confidence, which directly impact the delivery of quality service to the patient. The RL solutions system is already in place, therefor there is no added cost required to design a program from the ground up. The project simply intends to increase the utilization of the current reporting system. Increased reporting will allow the organization to collect and analyze data that can assist the employer with developing prevention and intervention strategies to ultimately reduce workplace violence against workers and the physical and psychological impact victims suffer. It will also help to reduce the deleterious financial consequences associated workplace violence.  Arnetz, J.,& Arnetz, B., (Feb. 2001). Violence Toward Healthcare Staff and Possible effects on the Quality of Patient Care. Social Science and Medicare. Vol.52 Issue 3Beck, D., (Dec. 2018). Hazardous to Your Health: Violence in the Health-Care Workplace. ASH Clinical News. Retreived on Nov. 18, 2019, from https://www.ashclinicalnews.org/features/hazardous-health-violence-health-care-workplace/Hartley, D., Ridenour, M., Craine, J., & Morrill, A. (2015). Workplace violence prevention for nurses on-line course: Program development. Work (Reading, Mass.), 51(1), 79–89. doi:10.3233/WOR-141891Nowrouzi-Kia, B., (2017). The Impact of Workplace Violence on Health Care Workers’ Quality of Life. Developmental Medicine & amp; child Neurology. Vol. 59. Issue 7

Two professional registered nurses are interested in evidence-based practice and have developed research questions to study.  The nurses discuss what evidence-based practice is all about and are trying to determine if the organizational culture supports nurses who seek out and use research to change long-standing practices that are rooted in tradition rather than science.

1. What is the best explanation of the difference between evidence-based practice and best practices?

2. The two registered nurses review a variety of research studies to answer their proposed research questions. What is the difference in the efficacy of randomized controlled trials, integrative reviews, or meta-analysis with practice-based evidence for continuous process improvement?

3. The registered professional nurses must consider alternative support mechanisms when searching for the best evidence to support their clinical practice. What are possible mechanisms of support for evidence-based practice?

4.  Describe the challenges that exist today for nurses in implementing evidence-based practice?

 

 

This is a Collaborative Learning Community (CLC) assignment. 

The purpose of this assignment is to assess leadership styles, traits, and practices as a nursing professional, establish the importance of effective interprofessional communication as a leader in nursing, and to explore the role of servant leadership in nursing practice.

Read the study materials on leadership and complete the topic quiz activities to better understand your leadership qualities.

Upon completion, summarize and share with your group what you learned about your specific leadership qualities, so you can become familiar with how you are similar and different from your peers when it comes to being a leader.

As a group, review the study materials related to servant leadership. Using what you have learned about the tenets of servant leadership and traits and practices of successful leaders, create a 10-12 slide PowerPoint presentation with speaker notes. Add an additional slide for references at the end of your presentation.  

Include the following in your presentation:

1. Each group member: Create a slide that summarizes your leadership style, traits, and practices.
2. Compare the personal leadership styles of your group members, including commonalities between group members’ strengths and weaknesses.
3. Explain why it is important for nursing professionals to be aware of their personal leadership style, traits, and practices.
4. Discuss what leadership traits and styles are necessary to be an effective communicator. Explain the importance of leaders adapting communication approaches when working interprofessionally (across ancillary departments, vendors, community members).
5. Discuss how nursing professionals can benefit from integrating the tenets of servant leadership to empower and influence others as they lead.
6. Discuss how leaders who practice servant leadership and have a strong understanding of their personal leadership traits can successfully lead others and navigate the unique challenges that are part of nursing and health care. Provide two examples that illustrate your main ideas.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. 

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style. 

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. 

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

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