Please avoid plagiarism, professor is very exigent with this issue. Authomatic Zero is graded plus the integrity academic implications. Use additional not listed scholastic references not older than 5 years.Thank you.
PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.
In this Assignment, you investigate your stateâ€s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.
Scenario for Week 7 Case:
You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat†consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriendâ€s parents felt that their daughter was too young to be “dating.†The client stated in the suicide note that he could not “live without her†and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year oldâ€s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The clientâ€s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody†of the child. The clientâ€s mother demands that the client be discharged to home with her stating that her sonâ€s actions were nothing more than a “stunt†and “an attempt at manipulating the situation that he didnâ€t like.†The clientâ€s mother then becomes “nasty†and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now†she will make you “sorry.†How would you proceed?
To Prepare for this Practicum:
Review the Learning Resources concerning voluntary and involuntary commitment.
Read the Week 7 Scenario in your Learning Resources.
Research your stateâ€s laws concerning voluntary and involuntary commitment.
The Assignment (2–3 pages):
Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?
Based on the laws in your state(Florida), would the client be eligible for involuntary commitment? Explain why or why not.(Florida state).
Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.
If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.
If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.
References/required reading
Required Readings
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
Standard 9 “Evidence-Based Practice and Research†(pages 71-72)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadockâ€s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 4, “Theories of Personality and Psychopathology†(pp. 151–191)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Neurodevelopmental Disordersâ€
“Specific Learning Disorderâ€
“Motor Disordersâ€
Murphy, T. K., Lewin, A. B., Storch, E. A., Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with tic disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 52(12), 1341–1359. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00695-3/pdf
McGavey, E. L., Leon-Verdin, M., Wancheck, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120-126.
Kaltiala-Heino, R. (2010). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry Epidemiology, 45, 785-793. doi: 10.1007/s00127-009-0116-3.
Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. General Hospital Psychiatry, 32, 300-309. doi:10.1016/j.genhosppsych.2010.01.007
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However, state representatives receive resources from the national and local governments to promote regional development. Their increased access to resources makes most of them corrupt. They steal government resources creating a scarcity of resources. For example, they exaggerate the cost of a project to ensure that they embezzle more funds. Besides, they abuse office power by employing their relatives in government projects. Again, presidents abuse government resources as they manipulate the senate. For example, if they want to pass a particular bill, that suit their interests, they bribe members of the senate to ensure that they support their bill. Eventually, they end up misusing government resources. In line with that, heads of states receive resources from external sources in the form of loans. Instead of using these resources for the betterment of the citizens, they promote their selfish interests.
Explain how you would inform this nurse (and others) of the importance of standardized nursing terminologies.
Standardized nursing terminologies are the act of having a common language used in different healthcare settings where nursing services are offered. In this scenario, the nurse on target a nurse that stated: “We document our care using the standardized nursing language but we do not fully understand why we do (Rutherford, 2008)”. This was a strong statement that proved a majority of nurses do not understand the importance of standardized nursing terminologies and the good thing is that standardized nursing terminologies are meant to be understood and applied by other nurses to promote coordination. Information is said to be power and the manner in which the nurse who made the statement together with others that they work with would get informed would go a long way in determining how they will perceive standardized nursing terminologies and make use of them.
According to Thede, & Schwirian, (2014); there are a number of ways that can be used to inform the nurse and others. One of these ways is by written and published an article that captures vital information about standardized nursing terminologies and their importance. Through reading an article, the nurses would get to understand the message. The article, for instance, the one written by Rutherford has covered ample information about the issue and hand and can be made available to all the nurses to bring them to understand why they have to use the standardized language in their electronic systems.
The second method of informing is through a presentation where a comprehensive presentation about the issue at hand would be prepared and the nurses invited to attend the presentation. A presentation would come as an effective method because it is practical and the nurses would have the chance to ask questions and receive instant responses (Thede, & Schwirian, 2014). This means that nurses can be able to see the different standardized terminologies and why they should be used. The more reason is that using a presentation, it is possible to create a practical and clear image of the situation in the case standardizes language is not applied so that the nurses can relate to their working situation. According to Ajayi, et al., (2015); healthcare facilities that have a standardized nursing terminology presentation do not even require assembling a meeting. The presentation is made available on the facility’s website and nurses are requested to login and learn hence making the system of informing easy, convenient, and effective. The more reason is that nurses within a facility have different working schedules and the strategy allows all of them to get informed and keep on reviewing the presentation at their convenient time without interfering with the work schedule.
According to Ajayi, et al., (2015); training and conferences about standardized nursing terminologies can also be used as a good way to inform the nurses. A majority of hospitals have been able to inform their nurses about standardized nursing language that the facility uses especially during orientation/induction training. The trainer or the conference speaker can focus on elaborating about standardized nursing terminologies and their importance in a manner that all nurses can understand. This means by the time nurses are being hired, they can be informed and for those that were already in employment by the time the standardized language was being implemented to be introduced to the idea and informed about its benefits. Training and conference are an effective means of informing because they would grant nurses ample time to be trained and also share among themselves on how they can make use of standardized language to improve on effectiveness and efficiency levels.
Describe the benefits and challenges of implementing standardized nursing terminologies in nursing practice.
According to Tastan, et al., (2014); implementing standardized nursing terminologies comes with its fair share of benefits mixed with challenges. It is a process and project that benefits the healthcare facility massively and at the same time can bring a lot of chaos. One of the benefits as stated by Rutherford, (2008); is that standardized language helps in improving communication among nurses. Improved communication is realized because nurses have a common language that they use something that makes it easy for them to understand each other better. For instance, all the nurses using the same electronic system understand what the other nurse means whenever a common terminology is used. It is important to note that nurses work in shifts and when common terminologies are used, the other nurse on the next shift would only require reading through and getting the entire message in an accurate and reliable manner.
The second benefit is that standardized nursing terminologies help in increasing the visibility of nursing terminologies. In the nursing profession, nurses are required to state exactly what they do or have done to every patient. Sometimes the services are long, complex, and demanding to the point that explaining them can lead to confusion. Common terminologies help in putting a long statement into a few words that explain the entire services that nurses. Hence, the tasks of a nurse become more visible with limited efforts being put in place. Thirdly, it helps in improving patient care because of the ease of handing over and common language ensuring that nurses understand each other. This is important because every nurse that takes over from the previous nurse does not have to get confused but rather proceed from where the other nurse stopped. This translates to mean that standardized nursing terminologies help in reducing nursing errors hence upgrading patient safety.
According to Conrad, et al., (2012); there are three major barriers that come with the implementation of a standardized nursing terminologies system. These barriers are; system barriers, NP user barriers, and the EHR operational barriers. On the system barriers, Conrad, et al., (2012); claims that implementing the system comes with challenges like high implementation and maintenance cost and also attracts other expenses like training to keep all nurses informed. It is also demanding in the sense that it requires ample time and skilled human resources to document. Also, in the case of system breakdown, it brings the nursing operation to a standstill a situation that would affect the health of the patients. On the NP user barrier, all nurses need to be computer literate for them to work effectively with the system and also understand the common language. Failure to have the skills and competence would lead to miscommunication and confusion that would increase nursing errors instead of reducing them. Lastly, HER operational barriers entail the complex mapping of terminologies references and the system also must have the reporting capability to facilitate smooth transactions from taking place.
References
Ajayi, A., Adeola, R., Daniel, O., Stephen, N., Gusen, N., Ajayi, A., … & Gusen, N. (2015). Knowledge and utilization of standardized nursing language among nurses in Jos university teaching hospital plateau state, Nigeria.
Conrad, D., Hanson, P. A., Hasenau, S. M., & Stocker‐Schneider, J. (2012). Identifying the barriers to use of standardized nursing language in the electronic health record by the ambulatory care nurse practitioner. Journal of the American Academy of Nurse Practitioners, 24(7), 443-451.
Tastan, S., Linch, G. C., Keenan, G. M., Stifter, J., McKinney, D., Fahey, L., … & Wilkie, D. J. (2014). Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: A systematic review. International journal of nursing studies, 51(8), 1160-1170.
Thede, L., & Schwirian, P. (2014). Informatics: The Standardized Nursing Terminologies: A National Survey of Nurses’ Experience and Attitudes—SURVEY II: Participants’ Perception of the Helpfulness of Standardized Nursing Terminologies in Clinical Care. OJIN: The Online Journal of Issues in Nursing, 20(1).
Rutherford, M. (2008) Standardized Nursing Language: What Does It Mean for Nursing Practice?
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How do public information and public education link to emergency planning?/In your essay discuss the key difference between Public Education and Public Information, include the main goals of public education, and identify three of the barriers emergency management agencies face in getting people to take action following public education. Dont forget to use case studies or examples to illustrate your points.
2. What do you see as some of the important issues in the managing of, and planning for spontaneous volunteers in emergency situations? (800 words.)
Essay of 2,400 words divided into three sections of 800 words each.
1. How do public information and public education link to emergency planning?(800 words.)
In your essay discuss the key difference between Public Education and Public Information, include the main goals of public education, and identify three of the barriers emergency management agencies face in getting people to take action following public education. Dont forget to use case studies or examples to illustrate your points.
2. What do you see as some of the important issues in the managing of, and planning for spontaneous volunteers in emergency situations? (800 words.)
3. Read the provided readings, as well as locating some additional readings yourself, around the benefits and barriers of psychological debriefing and analyze the conflicting and consistent viewpoints. (800 words.)
Note: you have to use in-text citation for EACHNEWIDEA or SUBTOPIC.
use these references with additional highly academic journals
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Advanced practice nurses often treat patients with vein and artery disorders such as chronic venous insufficiency (CVI) and deep venous thrombosis (DVT). While the symptoms of both disorders are noticeable, these symptoms are sometimes mistaken for signs of other conditions, making the disorders difficult to diagnose. Nurses must examine all symptoms and rule out other potential disorders before diagnosing and prescribing treatment for patients. In this Assignment, you explore the epidemiology, pathophysiology, and clinical presentation of CVI and DVT.
To prepare:
•Review the section “Diseases of the Veins” (pp. 585–587) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.
•Explore patient factor ethnicity, Think about how the factor might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
•Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.
To complete:
Write a 2- to 3-page paper that addresses the following:
•Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.
•Explain how the patient factor you selected might impact the psychopathology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
THIS IS VERY IMPORTANT TOO:
•CONSTRUCT TWO MIND MAPS—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.
This paper needs to explore more of the pathophysiology at the point of where the bacteria enters the body or when it begins.
Also, MUST USE RESOURCES THAT ARE NO OLDER THAN 5 YEARS. HAS TO BE CURRENT ARTICLES.
Required Resources
Readings
•Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby. ?Chapter 22, “Structure and Function of the Cardiovascular and Lymphatic Systems”
This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.
? Chapter 23, “Alterations of Cardiovascular Function”
This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.
? Chapter 24, “Alterations of Cardiovascular Function in Children”
This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart disease from acquired cardiovascular disorders.
•McPhee, S. J., & Hammer, G. D. (2012). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical. ?Chapter 11, “Cardiovascular Disorders: Vascular Disease”
This chapter begins with an overview of the vascular component of the cardiovascular system and how the cardiovascular system is normally regulated. It then describes three common vascular disorders: atherosclerosis, hypertension, and shock.
Media
•Laureate Education, Inc. (Executive Producer). (2012a). Alterations of cardiovascular functions PPT lecture. Baltimore, MD: Author.
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Nanotechnology (also called nanotech) is a branch of materials science that deals with manipulating matter on the atomic scale. It is so called because this field deals with engineering on the scale of a billionth of a meter, also known as a nanometer. Nanotechnology seeks to solve a wide range of problems from the construction of atomic scale machines to changing material properties at the atomic level.
Use the Internet to research the field of nanotechnology.
Write a paper discussing some of the basic scientific and technical concepts of nanotechnology. Do the following in your paper:
Discuss current or future applications of nanotechnology in fields such as medicine, engineering, space exploration, fuel cell development, air and water purification, and agriculture.
Provide at least three examples of real-world applications in use or in development with reliable references.
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About 200,000 healthcare-associated infections (HAIs) are acquired by patients whilst receiving some form of health care in Australia in a one year period (AIHW, 2011). National hand hygiene compliance rates are low, 68.3%, which is concerning given that hand hygiene is the single most important task health care workers can to do prevent HAIs (Girou, Loyeau, Legrand, Oppein, & Brun-Buisson, 2002, p.362). The purpose of this report is to investigate the best methods of hand hygiene to decrease the rate of cross-infection in a hospital setting. To focus the search, this report defines ‘best methods of hand hygiene as the best products to wash ones hands with. Therefore, methods of hand-drying and hand washing protocols are excluded, as well as literature discussing compliance rates and educational interventions.
2. METHODOLOGY.
Practice Question: what are the best methods of hand hygiene to decrease the rate of cross-infection in a hospital setting?
PICOT:
Population: hospital-based personnel, i.e. health-care workers, students.
Intervention: products to wash your hands with, including liquid soap, 70% alcohol based hand rub, chlorhexidine gluconate 4%, and 10% povidone-iodine. (N.B. Interventions of compliance, education and hand-drying were NOT measured).
Control: other products to wash your hands with.
Outcome: infection rates and microbial counts on hands.
Type of study: randomised-controlled trial or experimental studies.
The Search Process: used keywords (or MESH/subject headings) combined with Boolean phrases “and”, then limited the final result to randomised-controlled trial.
1. Hand hygiene
2. Cross infection
3. Hospital units or hospitals
4. Hospital* or unit*
5. 3 or 4
6. 1 and 2 and 5
7. Limit 6 to randomised-controlled trials (RCTs), human subjects and English.
•Inclusion criteria: RCTs or experimental studies, English and human subjects.
•Exclusion criteria: non-English studies, non-human subjects, studies below level II (controlled trial without randomisation, case-control or cohort study, systematic review of qualitative or descriptive studies, qualitative or descriptive study, expert opinion or consensus).
Hand-drying, hand-washing protocols, compliance and educational interventions were not made exclusion criteria by applying limits to the database or negative keywords in the initial search. Instead the abstracts of each article from the final search result were read and assessed for appropriateness (screening), as the number generated was a manageable size to appraise (n=77, see flow diagram on next page). 71 of these 77 articles were excluded, essentially because they focused on compliance, educational interventions, hand drying methods, and hand-washing protocols. It was established at the beginning of the report that ‘best methods of hand hygiene was defined as the best products to wash ones hands, which guided the inclusion and exclusion criteria. Six full-text articles were printed; with one of these articles being excluded as the setting was a university campus instead of a hospital setting (incorrect population). The five studies that were kept investigated the best methods of hand hygiene (i.e. different products to wash ones hands) to decrease the rate of cross-infection in a hospital setting.
•Study types included: level II studies – RCTs or experimental studies.
•Places/databases searched: Pubmed, CINAHL, and Medline.
Critical Appraisal Process: Is the study design valid?
N.B. The criteria used to evaluate the remaining five study designs validity was that used by Fineout-Overholt, Melnyk, Stillwell & Williamson (2010), prescribed reading 2 of the week 7 reading list NURS1007.
Rapid Critical Appraisal Questions (Fineout-Overholt et al., 2010, pp. 44-45):
1. Are the results of the study valid?
A. Were the subjects randomly assigned to the intervention and control groups?
B. Was random assignment concealed from the individuals enrolling the subjects?
C. Were the subjects and providers blind to the study group?
D. Were reasons given to explain why subjects didnt complete the study?
E. Were the follow-up assessments long enough to fully study the effects of the intervention?
F. Were the subjects analysed in the group to which they were randomly assigned?
This method of analysis is termed “intention-to-treat analysis”, whereby researchers keep participants in their assigned groups when conducting the analysis and intends to reduce possible bias (Fineout-Overholt et al., 2010, p. 46).
G. Was the control group appropriate?
H. Were the instruments used to measure the outcomes valid and reliable?
I. Were the demographics and baseline clinical variables of the subjects in each of the groups similar?
2. What are the results?
A. How large is the intervention or treatment effect?
Indicated by the odds ratio (OR), which measures the association between an intervention and an outcome (Fineout-Overholt et al., 2010, p. 46).
B. How precise is the intervention or treatment?
The intervention or treatment is significant if the P-value is less than 0.05 (P < 0.05) and the confidence interval (CI) for OR does not include 1.0, meaning the findings are reliable. Findings that are not statistically significant could have been obtained by chance, so cannot be confidently put into practice (Fineout-Overholt et al., 2010, p. 48).
3. Will the results help me in caring for my patients?
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Is the treatment feasible in my clinical setting? (i.e. has enough time been allowed to measure outcomes & the process of implementing the intervention).
Yes – RCT is the gold standard study. 82 episodes of handwashing were included in the study.
What are my patients and their families values and expectations for the outcomes and the treatment itself?
Patients expect a high standard of care, which includes an aseptic surgical scrub by the surgeon prior to surgery, to prevent them from acquiring a HAI from bacterial contamination of the surgeons hands in case the sterile glove perforates.
Table above: Summary of Critical Appraisal Results (Fineout-Overholt et al., 2010 Criteria):
READING 3 Continued: Hajipour, Longstaff, Cleeve, Brewster, Bint & Henman, 2006.
Summary of Critical Appraisal Results (Fineout-Overholt et al., 2010 Criteria):
READING 4: Larson, Cimiotti, Haas, Parides, Nesin, Della-Latta, & Saiman, 2005.
Are the results valid? Ask:
Were the subjects randomly assigned to the intervention and control groups?
No (Clinical trial using crossover design)
Was random assignment concealed from the individuals enrolling the subjects?
No – potential for bias.
Were the subjects and providers blind to the study group?
No – potential for researcher bias.
Were reasons given to explain why subjects didnt complete the study?
Yes – 12 nurses withdrew: 9 left the neonatal ICU and 3 no longer wanted to participate.
Were the follow-up assessments long enough to fully study the effects of the intervention?
Yes – Data collection periods were March 1, 2001 to January 31, 2002, (year 1), and March 1, 2002, to January 31, 2003, (year 2), with a one month hiatus (February 2002) for product crossover.
Were the subjects analysed in the group to which they were randomly assigned?
N/A
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