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RUFINA EWANE 

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Psychiatric emergencies are severe behavioral changes that may result from worsening mental illness. Psychiatric emergency is any disturbance in thoughts, feelings, or actions that require immediate therapeutic intervention (Stahl, S. M., 2014). The providers approach, attitudes and work environment may escalate the situation and interfere with the quality of care. Certain therapeutic measures can reduce the intensity of the situation and provide a more dignified way for patients to recover from the crisis. It is thus important that the PMHNP understand how to assess patient’s emergency status and address their unique needs while maintaining safety.

 Case selected.

Patient is a 25-year-old AA male who presents to the emergency department with psychotic behavior in believing he should kill his mother which led to his attempt to stab his mother. Patient is admitted for inpatient psychiatric stabilization. Patient has a history of schizoaffective disorder and major depression that was managed with use of clozapine 150mg twice a day and Zoloft 100mg daily. Family reported that patient has a history of medication non-compliant and had been on different psychiatric medications in the past but were not working for him. Additional reports by his parents shows that patient had missed several doses of his medication, decompensated and they had notices some changes  recently including increase agitation, delusional believes that he is the savior in the family and God had directed him to cast the demon in his mother. Reports also that he had drawn a picture of himself with knives cutting a woman he portrayed as a demon with blood flowing with a man standing to the side, laughing. Patient currently stated that he participates in a meeting with angels from which he gets directives on how to attack his mother which led to his attempt to stab his mother. Because of this, patient was considered dangerous to his mother per admitting physician. Patients symptoms include psychosis, extreme agitation, paranoia, verbal outburst, combative and very difficult to redirect. Patient has no known drug allergies per parents.  Verbal restraint was used including letting patient know what will happen if he does not comply, respecting his autonomy, empathetic listening, decrease environmental stimulation, reassure patient that they will be safe, and maintain a safe environment. The patient was given emergency medications including haloperidol lactate 5mg, lorazepam 2mg, and diphenhydramine 50mg all IM for severe agitation and danger to others. To prevent re-hospitalization within 12-24 hours of discharge, the physician ordered outpatient therapy and continued use of clozapine and Zoloft along with necessary lab work.

How I would treat the client differently if he or she were a child or adolescent

Children and adolescent are usually brought for treatment when their behavior or thoughts come to the attention of parents, teachers, social workers, or school.  For pediatric patients in a mental health crisis, the typical chaotic nature of the situation may easily further exacerbate an already traumatized state of the patient. Just like in adults, as a PMHNP I would perform an evaluation to determine the type of emergency and contributing factors in child and adolescent emergency by assessing not just the child but also the entire family. Additionally, safety and protection are essential mandate in psychiatric emergency evaluation especially when the patient pose imminent threat to self or others. What I will do different when interviewing children especially younger children is to assess the underlying cause of the violent behavior and delusional symptoms within a developmental context. Specifically, I would clarify that “bizarre thinking ” or accounts of seeing or hearing things that others do not see or hear are different from developmentally appropriate fantasy or difficulty while distinguishing inner voices from distressing hallucinations. On like in adults where they can provide information during the interview, when it comes to younger children, I would need to obtain information from parents or guardian. For adolescents, I would obtain information from the patient first then talk to their parent or guardian if the adolescent is able to tell most of their own story. This may also help to give a sense of autonomy and control to the adolescent which promote cooperation with the interview process.  However, information from family is very crucial particularly for a child who is psychotic, frightened, unable, or unwilling to corporate with the provider to help understand how the situation occurred and the severity of the behavior.

Same interviewing strategies used in adult may be used including speaking in a soft voice respecting patients’ autonomy, assuring safety, validating feelings, offering distractions (like video games) especially with very young children, and clear limit-setting can be helpful. However, children should be evaluated in a carefully planned setting with doors closed for limiting access, and be sure appropriate backup is available (Margret, C. P., & Hilt, R., 2018). 

In violent situations children may require a different approach in deescalating the situation than adults. Safety is the essential mandate in an aggression evaluation, with the interviewer specifically looking for imminent threats, plans, targeted people, and access to means of harm (Margret, C. P., & Hilt, R., 2018). Because adults are much stronger, they may require physical restrain specially to administer medication to calm the patient. Verbal restrain such as providing verbal directions in a nonthreatening manner, setting limits, and assuring the child that treatment may help them calm may be used for children first. However, if the child is dangerously out of control and aggressive, they may need medication to keep them calm and safe.

Legal or ethical issues I would consider when working with a child or adolescent emergency case

The ethical issue I will consider when working with children and adolescent is respect for their autonomy, privacy, and confidentiality. For very young children parents must consent to treatment and the health care provider treating the child should make every reasonable effort to obtain and document informed consent. (American Academy of Pediatrics, 2015). Just like adults, maintaining a patient’s confidentiality is an important ethical consideration when providing care to children and adolescents. However, when a PMHNP is concerned that the patient may be at imminent risk for harm to self or others, confidentiality requirements no longer apply (Chun, T. H., Katz, E. R., & Duffy, S. J., 2013). This means that the PMHNP in this situation may disclose information collected  from patient to caregivers or others as needed and may obtain information from others such as friends, family members, school personnel, employers and other without obtaining consent from the patient or guardians (Chun, T. H., Katz, E. R., & Duffy, S. J., 2013. Patient autonomy is a major principle in making decisions about an individual’s health, and as a PMHNP we are obligated to respect this right and allow patients to practice their autonomy in the course of their treatment (Parsapoor, A., Parsapoor, M. B., Rezaei, N., & Asghari, F., 2014). However, a psychiatric emergency and age may limit a child’s ability to make such decisions. Regardless, it is always important to involve the child in informed decision making even if the consent is signed by the parents or guardian.

References

Chun, T. H., Katz, E. R., & Duffy, S. J. (2013). Pediatric mental health emergencies and special

health care needs. Pediatric clinics of North America, 60(5), 1185–1201. Retrieved from,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792398/

Da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020). The

Impact of Mental Illness Stigma on Psychiatric Emergencies. Frontiers in psychiatry, 11,

573. https://doi.org/10.3389/fpsyt.2020.00573

Margret, C. P., & Hilt, R. (2018). Evaluation and Management of Psychiatric Emergencies in

Children. Pediatric Annals, 47(8), e328–e333. https://doi-

org.ezp.waldenulibrary.org/10.3928/19382359-20180709-01

Parsapoor, A., Parsapoor, M. B., Rezaei, N., & Asghari, F. (2014). Autonomy of children and

adolescents in consent to treatment: ethical, jurisprudential and legal considerations.

Iranian journal of pediatrics, 24(3), 241–248. Retrieved from,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276576/

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New

York, NY: Cambridge University Press.

 

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

• Reflect on the Resources related to digital information tools and technologies.
• Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
• Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

By Day 6 of Week 6

Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

 

The DNP scholar, who is seeking to learn more about the different types of inquiry, Research, Quality Improvement, and Evidence-based practice, will bridge the gap between knowledge, research, application, and translation of evidence to nursing practice. There will be interrelationships between nursing practice, education, theory, and research. A systematic review is an important tool for the DNP scholar who is seeking evidence (Polit & Beck, 2017). Dang & Dearholt inform us that systematic reviews utilize meta-synthesis and meta-analysis to analyze the results of several studies. Therefore, these two most reliable methods and the highest standards in evidence-based care could lead the DNP scholar; further determine the effects of nursing interventions, prevention, treatment, and rehabilitation. Case-controlled studies, case series, and case reports make the DNP do in depth research of individual units, which gives insight into the specific intervention. Cohort studies considered observational studies where the DNP scholar can be able to answer questions on the disease etiology, diagnosis, and prognosis except interventions. DNP scholar uses random control trials to measure the different interventions therefore make the best clinical decision on the outcome of each intervention. Critically appraised individual articles are less reliable however, it helps to assess the outcomes for evidence doing an individual study. Critically appraised topics help to understand the strength of evidence provided and creates an understanding on how to evaluate and synthesize multiple research studies. The least reliable evidence yet helpful for the DNP scholar is the ideas, opinions anecdotes, and editorials. It is crucial as a DNP scholar to understand the pyramid of evidence (all seven levels) and to identify the levels needed for their study. 

 I need a comment for this post at least 2 paragraphs and 2 sources no later than 5 years. 

 

1) Minimum 7 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

 

Parts 5, 6, and 7 must be different. Different writing and perspective, but always answering questions objectively

              Part 1: Minimum 1 page

              Part 2: minimum 1 page

              Part 3: minimum 1 page

              Part 4: minimum 1 page 

              Part 5: Minimum 1 page

              Part 6: minimum 1 page

              Part 7: minimum 1 page

           

Submit 1 document per part

2)¨******APA norms, please use headers

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:

Think for a while about cultural practices and how they affect health or illness in your own family. They may be difficult to identify as such at first, but they do exist.

1. What ideas about illness prevention does your family adhere to? 

2. What do you do when someone gets sick? 

3. What rituals does your family practice when someone dies?

Part 2:

1. Mention one of the therapeutic options use as intervention for child sexual abuse (Cognitive-behavioral treatment).

2.  How does it work? (explain it)

Part 3:

Case Study, Chapter 10, Mandatory Minimum Staffing Ratios 

A nurse manager is attending a national convention and is attending a concurrent session on staffing ratios. Minimum staffing ratios are being discussed in the nurse manager’s own state. The nurse manager has a number of questions about staffing ratios that the session is covering. The nurse manager knows that evidence exists that increasing the number of RNs in the staffing mix leads to safer workplaces for nurses and higher quality of care for patients.

1. What are the three general approaches recommended by the American Nurses Association (2017) to maintain sufficient staffing?

2. Summarize the findings that are often cited as the seminal work in support of establishing minimum staffing ratio legislation at the federal or state level.

3. Analyze what proponents and critics say about whether mandatory minimum staffing ratios are needed.

Part 4:

 

1.List and discuss at least two of the special nutritional needs of aging women.

2. Describe factors that may disturb sleep in older adults.

Part 5:

 

1. Name the first Registered Nurse elected to Congress 

      a. List at least one contribution (Policy) enacted since holding the RN selected.

2. Name at least one nurse legislator 

     b. name the state affiliated.

Part 6:

 

1. Name the first Registered Nurse elected to Congress 

      a. List at least one contribution (Policy) enacted since holding the RN selected.

2. Name at least one nurse legislator 

     b. name the state affiliated.

Part 7:

 

1. Name the first Registered Nurse elected to Congress 

      a. List at least one contribution (Policy) enacted since holding the RN selected.

2. Name at least one nurse legislator 

     b. name the state affiliated.

 

Personal Leadership Philosophies

Many of us can think of leaders we have come to admire, be they historical figures, pillars of the industry we work in, or leaders we know personally. The leadership of individuals such as Abraham Lincoln and Margaret Thatcher has been studied and discussed repeatedly. However, you may have interacted with leaders you feel demonstrated equally competent leadership without ever having a book written about their approaches.

What makes great leaders great? Every leader is different, of course, but one area of commonality is the leadership philosophy that great leaders develop and practice. A leadership philosophy is basically an attitude held by leaders that acts as a guiding principle for their behavior. While formal theories on leadership continue to evolve over time, great leaders seem to adhere to an overarching philosophy that steers their actions.

What is your leadership philosophy? In this Assignment, you will explore what guides your own leadership.

To Prepare:

• Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
• Reflect on the leadership behaviors presented in the three resources that you selected for review.
• Reflect on your results of the CliftonStrengths Assessment, and consider how the results relate to your leadership traits.

The Assignment (2-3 pages):

Personal Leadership Philosophies

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

• A description of your core values
• A personal mission/vision statement
• An analysis of your CliftonStrengths Assessment summarizing the results of your profile
• A description of two key behaviors that you wish to strengthen
• A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.
• Be sure to incorporate your colleagues’ feedback on your CliftonStrengths Assessment from this Module’s Discussion 2.