Respond to at least two of your    colleagues who were assigned to a different case than you. Explain how    you might apply knowledge gained from your colleagues’ case studies  to   you own practice in clinical settings. 

 

NOTE: Positive comment

                                             Main Post

 Case  Study: Volume 2, Case #21 focuses on the treatment of an adult  client  diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).   

 

Questions 

Question 1: Are you having problems with your loved one’s due being “argumentative and temperamental”?  

Rationale:  The client may have additional stress due to broken  relationships and  this could be due to his disorder.  “Emotional  dysregulation is  increasingly recognized as a core feature of ADHD”  (Stralen, 2016).  Signs of ADHD include low frustration tolerance and  explosive behavior  (Stralen, 2016).  

Question 2: 

What causes you the most anxiety?

It  is important to determine the triggers of the anxiety to help the   patient prepare for times when he is likely to be in high stress   situations. Planning a response when feeling overwhelmed can help the   patient remain in control of his emotions and allow the patient to   monitor his behavior. 

Question 3: 

You  stated that your father was abusive, was this physical or verbal  abuse  or both? Do you contribute some of your anxiety from previous  issues  with your father? 

It  is important for the provider to understand the client’s point of  view  in regards to his upbringing. He realizes it has affected in him  in some  way, as he has obtained psychotherapy in the past. I would want  to know  if he has ever spoken to his father about this and if his  father has  ever apologized for his actions. 

Questions for family

I  would want to talk with his mother to ask her how he did as a  child in  school and at home in regards to schoolwork, chores and would  want to  know if he had friends. Although  social problems are not part  of the diagnostic criteria for ADHD, the  peer relationship difficulties  faced by youth with this disorder are  profound (Hoza, 2007)

Diagnostics & Exams

A  full psychiatric evaluation which would include the Adult  Self-Report  Scale (ASRS). ASRS was been developed by the World Health  Organization  to determine if an individual (adult) may have ADHD. The  scale is made  up of 6 questions, and if a client has at least 4 of 6  symptoms, there  may need to be a diagnosis of ADHD made by a  professional (ADDA, 2018). Seay  et al. (2009) suggests the PMHNP should  utilize intelligence test,  broad-spectrum scales, tests of specific  abilities, and brain scans to  confirm the diagnosis and to rule out  other disabilities, autism,  auditory processing disorders or mood  disorders. In addition, a full medical work-up by a PCP in order to rule  out other medical conditions that could present similarly to ADHD. 

Differential DX

General Anxiety Disorder: The  patient exhibits symptoms of  generalized anxiety disorder, DSM-5 300.02  (F14.1). He has had the  symptoms for greater than six months with the  symptoms being severe  enough to interfere with the patient’s daily  functioning. The patient  complains of feels of worry that is difficult  to control, irritability,  restlessness, difficulty concentrating and  feeling on edge. The  patient symptoms have not been linked to a physical  condition or to  substance use (Reynolds & Kamphaus,2013).

ADHD:  client consistently complains of feeling tense, irritable, and  anxious  (Stahl Online, 2019).  Questions arise once the general  anxiety symptoms  are resolved and the client is left feeling  hyperactive, inattentive,  and the inability to focus (Stahl Online).

Post-Traumatic  Stress Disorder: The client’s diagnosis of anxiety  may have been  related to underlying issues related to a traumatic event  that he  experienced as a child. The client’s father was verbally  abusive to him  and was an alcoholic. It is a possibility that the  client’s issues could  have some relations to previous exposure as a  child. Post-Traumatic  Stress Disorder is a serious condition that can  occur in clients who  have experienced various incidents including abuse  (PTSD, 2018).

Medications

The  case states by year six the client has failed to achieve  remission on  an SSRI, a 5-HT1A receptor partial agonist, an  antihistamine anxiolytic  and an SGRI (Stahl Online, 2019).

Based on the pharmacological agents, I would select either  Cymbalta  60mg or Effexor XR 150mg.  Cymbalta did illicit a response,  but side  effects prevented the escalation of the dosage.  Augmenting  with  guanfacine an alpha-adrenergic agonist proved to be the therapy  that  elicited remission for this client.

Lessons Learned

I  learned to always consider additional differential diagnosis and   evaluate and re-evaluate every situation separately to be sure of the   correct diagnosis.  Patient’s  often have comorbid diagnosis and  treating both is vital to a  successful outcome for the patient.  Symptoms of mental illness change  overtime making continued care  necessary for the patient. The provider  must always be approachable and  helpful for the client to feel  comfortable in his/her presence. 

                                                References

Attention Deficit Disorder Association. (2018). Adult ADHD Test. Retrieved from https://add.org/adhd-test/

Generalized Anxiety Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Posttraumatic Stress Disorder. (2018). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

Seay, B., McCarthy, L. F., and Williams, P. (2009). Your complete ADHD/ADD diagnosis guide.

            Retrieved from https://www.additudemag.com/adhd-testing-diagnosis-guide/

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical

            Applications (4th ed.). New York, NY: Cambridge University Press.

Stralen, J. W. (2016). Emotional dysregulation in children with attention-deficit/hyperactive disorder.

            Attention Deficit Hyperactivity Disorder. 8(4). p. 175-187. Retrieved from

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110580/

Hoza  B, Mrug S, Gerdes AC, Bukowski WM, Kraemer HC, Wigal T, et al.  What  aspects of peer relationships are impaired in children with   attention-deficit/hyperactivity disorder? Journal of Consulting and  Clinical Psychology. 2005b;73:411–423. 

Reynolds, C. & Kampaus, R. (2013). Generalized Anxiety Disorder. Pearson. Retrieved from:

www.images.pearsonclinical.com/images/assets/basc-3/basc3resources/DMS-5_

Comment 1

Qualitive research is known as information focused on generating meaning and understanding to data that are related to opinions, concepts, values and behaviors of people in a social context. Qualitive data is collected from interviews, observation field notes, audio/video recording and personal experiences (McLeod, 2017). Sometimes researchers become overwhelmed with the vast amount of data collected. However, with proper organization and using a proper system for tracking will facilitate the analysis. A useful method to organize qualitative research is to use a coding scheme that helps group data with key terms, themes, patterns. Researchers would need to review each data collected and label them to help identify them in a group and help find information a lot easier when starting the analysis process. However, before conducting the analysis researcher needs to make sure there is no missing data and all data is accurate. Making copies of the information and safely storing it is also very important. How the researchers decide to organize their qualitative data needs to be a method that works for them and simplifies finding the information needed.  

Comment 2

Phenomenological qualitative research is different from grounded theory in several ways.  Phenomenological research tries to explain and describe experiences by targeting people who have the experience.  The data is collected through interviews and refer to it as the “lived experience.”  This experience allows researchers to then report their findings as characteristics of the experience.  It is based on philosophy and interprets and enhance others real experiences.  Grounded Theory is based in sociology which tries to create a “grounded theory” to describe what is being studied.  Unlike phenomenological, grounded researchers use all data gathered through interviews, observations, dairies and literature.  This is called constant comparison.  They compare all elements and try to use contradictory elements to strengthen their case. They use language, relationships, religion, etc. to find a deeper meaning.
 

Phenomenological qualitative research and grounded theory are similar in that they both examine real life experiences and situations.  Both require in-depth interaction between the researchers and whom or what they are researching and keep their experiences free from the researchers influence or preconceived ideas. 

  

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.

Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.

Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from

Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

By Day 7 of Week 7

Learning Resources

Note: To access this module’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

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)

Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c

Note: You will access this article from the Walden Library databases.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9

Note: You will access this article from the Walden Library databases.

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5

Note: You will access this article from the Walden Library databases.

Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733

Note: You will access this article from the Walden Library databases.

Document: Critical Appraisal Tool Worksheet Template (Word document)

Required Media

Laureate Education (Producer). (2018). Appraising the Research [Video file]. Baltimore, MD: Author.

Accessible player 

Laureate Education (Producer). (2018). Interpreting Statistics [Video file]. Baltimore, MD: Author.

Accessible player 

Laureate Education (Producer). (2018). Review of research: Hierarchy of evidence pyramid [Mutlimedia file]. Baltimore, MD: Author.

Schulich Library McGill. (2017, June 6). Types of reviews [Video file]. Retrieved from https://youtu.be/5Rv9z7Mp4kg

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6052_Module04_Week07_Assignment_Rubric

Grid View

List View

Excellent Good Fair Poor

Part 3A: Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tool Worksheet Template. Be sure to include: · An Evaluation Table 

45 (45%) – 50 (50%)

The critical appraisal accurately and clearly provides a detailed evaluation table. The responses provide a detailed, specific, and accurate evaluation of each of the peer-reviewed articles selected.

40 (40%) – 44 (44%)

The critical appraisal accurately provides an evaluation table. The responses provide an accurate evaluation of each of the peer-reviewed articles selected with some specificity.

35 (35%) – 39 (39%)

The critical appraisal provides an evaluation table that is inaccurate or vague. The responses provide an inaccurate or vague evaluation of each of the peer-reviewed articles selected.

0 (0%) – 34 (34%)

The critical appraisal provides an evaluation table that is inaccurate and vague or is missing.

Part 3B: Evidence-Based Best Practices Based on your appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research. 

32 (32%) – 35 (35%)

The responses accurately and clearly suggest a detailed best practice that is fully aligned to the research reviewed.

The responses accurately and clearly explain in detail the best practice, with sufficient justification of why this represents a best practice in the field. The responses provide a complete, detailed, and specific synthesis of two outside resources reviewed on the best practice explained. The response fully integrates at least two outside resources and two or three course-specific resources that fully support the responses provided.

Accurate, complete, and full APA citations are provided for the research reviewed.

28 (28%) – 31 (31%)

The responses accurately suggest a best practice that is adequately aligned to the research reviewed.

The responses accurately explain the best practice, with adequately justification of why this represents a best practice in the field. The responses provide an accurate synthesis of at least one outside resource reviewed on the best practice explained. The response integrates at least one outside resource and two or three course-specific resources that may support the responses provided.

Accurate and complete APA citations are provided for the research reviewed.

25 (25%) – 27 (27%)

The responses inaccurately or vaguely suggest a best practice that may be aligned to the research reviewed.

The responses inaccurately or vaguely explain the best practice, with inaccurate or vague justification for why this represents a best practice in the field. The responses provide a vague or inaccurate synthesis of outside resources reviewed on the best practice explained. The response minimally integrates resources that may support the responses provided.

Inaccurate and incomplete APA citations are provided for the research reviewed.

0 (0%) – 24 (24%)

The responses inaccurately and vaguely suggest a best practice that may be aligned to the research reviewed or are missing.

The responses inaccurately and vaguely explain the best practice, with inaccurate and vague justification for why this represents a best practice in the field, or are missing. A vague and inaccurate synthesis of no outside resources reviewed on the best practice explained is provided or is missing. The response fails to integrate any resources to support the responses provided.

Inaccurate and incomplete APA citations are provided for the research reviewed or is missing.

Written Expression and Formatting—Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. 

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time.

APA format, 350 words, scholar authors and see references below

Our “world” starts with our own community, county, and state, then moves out in concentric rings from that point to include our country and eventually the world. Disease is transmitted from person to person through direct contact, or from a source such as a vector or contaminated water through a variety of means, such as flood waters or even terrorist actions. Individuals with limited

 or no knowledge of safe sex methods may have unprotected sexual relations and knowingly or unknowingly transmit disease to their partners, then to their partners’ partners, and on and on. Often it is the role of the public health nurse to investigate a disease outbreak, contain it, and then educate others so that the same situation doesn’t happen again.

Create a brief description of your setting, providing some context; for example, how many patients are seen, size or capacity of the facility as applicable, and/or the location of the office or organization.

A pediatrician’s office 

• What is your policy on accepting patients who refuse vaccinations?
• What are the most common reasons parents decline vaccinations for their children in this particular office?
• What is the policy at this office for giving antibiotics to treat viral syndromes?

The eyes of the public health nurse (PHN). Imagine you are the PHN and have been asked to investigate an outbreak at this facility.

• What questions would you ask?
• What suggestions could you make to avoid a disease outbreak at the facility?
• What would your role as a change agent be for any deficiencies you find in your on-site inspection?

 A 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

References

Holtz, C. (2017). Global health care: Issues and policies (3rd ed.). Burlington, MA: Jones & Bartlett.
Chapter 9, “Infectious Diseases from a Global Perspective” (pp. 229-254)
Chapter 13, “Global Perspectives on Violence, Injury, and Occupational Health” (pp. 347-378)
Chapter 7, “Global Perspectives on Mental Health” (pp. 173-196)
 

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.
Chapter 13, “Infectious Disease Prevention and Control” (pp. 286–318)

Public Health Nursing: Population-Centered Health Care in the Community, 9th Ed. by Stanhope, M., & Lancaster, J. Copyright 2015 by Elsevier Health Science Books. Reprinted by permission of Elsevier Health Science Books via the Copyright Clearance Center.
 

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.
Chapter 12, “Epidemiology” (pp. 256–285)