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The PICOT guidelines are questions that help clinicians discover the answers to their research (Walden Student Center for Success, 2012). With these guidelines in mind I formulated the question “Is the daily use of CHG for all pediatric inpatients who have no allergy to CHG associated with a lower incidence of bacterial infection in these same patients?”
The P in the acronym stands for population or patients, in the case the characteristics of the population would be all patients who are staying in the hospital, especially for an extended period or those who have risk factors such as central lines.
The I stands for the intervention, which would be the daily chlorahexadine baths. This intervention would help reduce the risk of hospital acquired infections such as MRSA or c diff. Comparison is the next step and is what the C stands for.
In this case the comparison of the effectiveness of daily CHG baths would be compared to not doing CHG baths. The O stands for outcomes that we would hope to see, which would be a decrease in hospital acquired infections.
The T is the last and final letter and stands for time. In my hospital, the study was conducted over a three-month period to see if we saw a decrease in our hospital acquired infections. Using evidence based research I will find the conclusion to this question.
When conducting research, it is very important to have filtered information and unfiltered information. “Filtered information is information that has been appraised for quality and clinical relevance (Hierarchy of Evidence Pyramid).”
Filtered information includes systematic review, critically appraised topics and critically appraised individual articles (Hierarchy of Evidence Pyramid). “Unfiltered information is evidence that has not necessarily been appraised for quality.
This information tends to come from primary sources (Hierarchy of Evidence Pyramid).” Unfiltered information includes randomized controlled trials, cohort studies, case-controlled studies and expert opinion (Hierarchy of Evidence Pyramid).
When searching the Walden Database for articles on my PICOT question, I used the search terms “CHG Bath,” “CHG Bath in Pediatric Patients,” and “Reducing infection using CHG Bath.” The first article I found multiple studies done on multiple patients with bone marrow transplants.
The purpose of the study was to see if bathing them daily with CHG would decrease the acquired infections, which it did. This article would be considered a systemic review because it had multiple resources and multiple studies.
When searching for critically appraised topics it was very difficult to find one that had a cohort study that had to do with CHG baths, there were some articles about other ways to reduce infection, but none that involved CHG.
The next article I found falls under the topic of expert opinion, in the case the expert opinion came from the nurses. In this study done in 2017, they interviewed nurses, nurse’s aides and nurse managers. They found that all interviewed did find a decrease in infection when CHG baths were used, however many times the nurses did not have time to administer the baths.
I think that when conducting a search for evidence base practice it is important to stay open minded and patient. Staying open minded will help you think of different search terms that may yield different search results. It is also important to be patient while searching so that you can stay focused and weed out the unwanted results.
Laureate Education (Producer). 2012g). Hierarchy of evidence pyramid. Baltimore, MD:Author
Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC Infectious Diseases, 17(1)
Polit, D.F., & Beck C.T. (2017). Nursing research: Generating and assessing evidence for
nursing practice (10Th ed.). Philadelphia, PA: Wolters Kluwer
Robeson, P., Dobbins, M., DeCorby,K., &Tirillis, D. (2010). Facilitating access to pre-processed research evidence in public health. BMC Public Health,10,95.
Rosselet, R., Termuhlen, A., Skeens, M., Garee, A., Laudick, M., & Ryan-Wenger, N. (2009). CH
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Some healthcare conditions, such as cancer, diabetes, and heart disease, have high morbidity, mortality, and healthcare costs. They also increase the workload for healthcare providers, and attending to them is integral. Healthcare providers periodically evaluate population problems and develop evidence-based interventions to prevent risks, reduce compilations, and improve the health outcomes of populations. Some populations are vulnerable to specific health conditions.
For example, youths between 15-24 years are prone to sexually transmitted illnesses, while females between 40-55 years are prone to post-menopausal syndrome. Healthcare providers assess their population’s needs to determine their risks and intervene for better health outcomes. This paper presents a population problem, expounds on the population affected and the risks, and explores interventions that could help reduce the problem’s effects and promote better health outcomes.
Metabolic syndrome features at least three medical conditions occurring together, increasing a population’s risk for diabetes, stroke, and heart disease (Nilsson et al., 2019). These conditions include high blood pressure, blood sugar abnormalities, excess belly fat, and abnormal cholesterol and triglyceride levels. Having one f these conditions does not mean one has the disease but has an increased risk for diabetes, stroke, and heart disease. The condition presents less apparent symptoms such as body fat around the waist and some symptoms of diabetes such as thirst and fatigue. Metabolic syndrome is caused by increased insulin resistance, overweight and obesity, and inactivity.
The risk factors for the condition include diabetes, age (risk increases with age), ethnicity (Hispanic women are at the most significant risk), and other diseases such as non-alcoholic fatty liver disease and sleep apnea (Nilsson et al., 2019). Medications such as second-generation psychotropics that lead to weight gain, increased insulin resistance, and alteration in body fats and glucose metabolism significantly increase the risk for metabolic syndrome. Aggressive lifestyle and therapy changes can help reduce the risk of developing metabolic syndromes or metabolic syndrome complications. The condition’s prevalence is gradually rising, affecting about a third of the US population leading to poor quality of life through reduced abilities and increased susceptibility to life-threatening illnesses (Hirode & Wong, 20). The condition is preventable, and there is a need to implement change interventions that can help alleviate the problem
Patients with mental health conditions such as bipolar disorder and schizophrenia are some of the most neglected populations. Caring for mentally ill patients requires long-term treatment interventions. Healthcare providers prescribe medications and other interventions such as cognitive behavior therapy depending on patient needs and response to medications. These medications affect other areas, such as hypertension in CNS-acting drugs. Second-generation antipsychotics are associated with increased risk for metabolic syndrome due to their effects on weight gain and insulin resistance. Thus, populations with mental health issues such as bipolar disorder and schizophrenia are thus at risk for metabolic syndrome. The risk for mental health illnesses increases with age; thus, the population of interest is adults aged 20 and above.
The area of interest is a healthcare facility in the Bronx, New York, ZXIPI CODE 10451-5253, serving minority black and Hispanics. The target population is the minority blacks and Hispanics, ethnic groups that carry the most significant risk for metabolic syndrome. Hispanics, especially Hispanic women, have the most significant risk for metabolic syndrome (Phenninx & Lange, 2022). The population is also prone to poor access to mental health care and other social determinants of health such as low income, unemployment, cultural practices (eating practices), and genetic predisposition. Hispanic whites are also exposed to mental health issues due to similar determinants of health, such as low-income families and unemployment. Mental health issues and the genetic predisposition to the condition increase the risk and severity of metabolic syndrome in this population.
Measures to prevent metabolic syndrome are varied depending on the cause. The most common interventions in mental health include lifestyle changes such as increasing exercise and activity, diet changes, quitting smoking, treatment for obesity and overweight, and changes in treatment therapies associated with the development of metabolic syndrome. Nilsson et al. (2019) note that diet plays a significant role in determining the high-density and low-density lipoprotein levels and their effects on weight gain, obesity, and overweight. Nilsson et al. (2019) also note that patients who adhere to changes in diet and physical activity have better health outcomes than controls. However, interventions should be crafted to meet long-term sustainability without resulting in unhealthy behaviors.
Medication therapy changes are often the medication of choice due to the adherence issues for mentally ill patients. Changing afflicting medications while maintaining the targeted medication therapeutic outcomes has been used to help manage the condition. Changing medication does not eliminate all risks but significantly reduces the risk for metabolic disorders. Piras et al. (2022) note that switching the medications, often from second-generation to first-generation antipsychotics, reduce the risks significantly and leads to attained health, such as the arrest of weight gain and control of blood sugars. Hence, changing psychiatric medications is the intervention of choice, while maintaining the desired therapeutic outcomes is the intervention of choice.
The desired outcomes of the specific approaches depend on the confounders. The desired outcome is the prevention of metabolic syndrome in mentally ill patients. The desire is to ensure patients do not develop the condition during therapy. As mentioned earlier, metabolic syndrome results from either of the five conditions. These conditions are affected by various factors, especially in adults with mental health illnesses. Thus, the desired outcomes are attaining a healthy weight with decreased waist circumference, normal triglyceride levels, increased high-density lipoproteins, normal blood pressure, and blood sugars (Nilsson et al., 2019). The effectiveness of the interventions in preventing metabolic syndrome should be evaluated against these values because changes in any three could lead to metabolic syndrome.
Healthcare interventions vary in their effectiveness. Psychotropic medications take a short time to produce side effects such as weight gain. A more extended period, six months, is the idea to help monitor patients and ensure these effects do not appear later. The effects of the proposed intervention can be evaluated after six months of the intervention. According to Nilsson et al. (2019), management interventions for more than six months produce more permanent changes and reduce symptoms of relapse. Six months is the optimum period for developing, implementing, and evaluating the effectiveness of an intervention. Thus, the PICOT question is: Among mentally ill patients, do first-generation antipsychotics reduce the risk for metabolic syndrome, compared to second-generation antipsychotics, in six months?
The prevalence of metabolic syndrome in the US is rising gradually due to lifestyle changes and increased associated conditions such as diabetes, overweight, and obesity. Hirode and Wong (2020) conducted a study using the National Health and Nutrition Examination Survey 2011-2016 data to study the metabolic syndrome trends for adults above age 20. According to the study, the weighted prevalence of metabolic syndrome was 34.7%, with individuals between ages 20-39 presenting the lowest percentage (19%) and individuals above 60 years having the highest prevalence (48%) (Hirode & Wong, 2020). Thus, the risk for the disease increases with age.
Gurka et al. (2019) note that the geographical prevalence of metabolic syndrome was high in areas such as the high number of Hispanic women. Metabolic syndrome is associated with factors such as poor dieting, such as food with large volumes of fat leading to substantial or uncontrolled weight gain. The location of interest is a health facility dealing with minority blacks and Hispanics and dealing with many patients with diabetes, obesity, and mental health problems. It is thus a suitable setting to manage metabolic syndrome among mentally ill patients.
Phennix and Lange (2022) note that patients with mental health illnesses are at risk for premature mortality related to cardiovascular disorders. The most common cause of these cardiovascular disorders is metabolic syndrome, often caused by psychotropic medications. The most common disorders with increased risk for metabolic syndrome are bipolar disorder, major depression, and schizophrenia. Phennix and Lange (2022) show that bipolar disorder patients under psychotropic medications had a 1.72 times risk for developing metabolic syndrome than bipolar disorder patients without psychotropic medications. The study also revealed that 72% of the patients receiving second-generation antipsychotics reported weight gain and metabolic alterations (Phennix & Lange, 2022). The results are synonymous with other studies, such as Scaini et al. (2021).
Scaini et al. (2021) show that second-generation antipsychotics lead to mitochondrial activity alterations and subsequent metabolic syndrome results, especially in patients with schizophrenia and schizophrenia spectrum disorders. Phennix and Lange (2022) note that alterations in pathways involving neuroreceptors for dopamine and other neurotransmitters, such as serotonin, leading to metabolic syndrome development. Piras et al. (2022) agree with the study and show that psychotropic drugs induce weight gain and increase the risk for metabolic syndrome in these populations. Mental health issues increase with age, and so do metabolic syndrome, making mentally ill adults above age 20 a population of interest.
In another study, Abo Alrob et al. (2019) studied the effects of long-term use of second-generation antipsychotics on a Jordanian population. After six months of treatment with second-generation antipsychotics, 44% of the patients reported increased systolic pressure, 54.9% reported elevated triglyceride, and 31.9% developed glucose regulation problems (Abo ASlrob et al., 2019). In addition, the number of participants with metabolic syndrome increased from 14% at baseline to 31% at the end of the study. These results are supported by other studies, such as Fang et al. (2019), which report a direct correlation between second-generation antipsychotics and metabolic syndrome.
Fang et al. (2019) show that the prevalence of metabolic syndrome among schizophrenic patients on second-generation antipsychotics was 33%, presenting results similar to most other studies. In addition, Buhagiar and Jabbar (2019) note that individuals under first-generation antipsychotics report lower lipid level abnormalities rates than individuals on first-generation antipsychotics. However, first-generation antipsychotics are avoided due to their severe side effects, such as tardive dyskinesia. From these studies, it is clear that second-generation antipsychotics are associated with high rates and the development of metabolic syndrome compared to controls which include placebo and first-generation antipsychotics.
Gurusamy et al. (2021) note that diet and exercise can help alleviate complications of metabolic syndrome in individuals with schizophrenia. Diet and exercise help reduce lipid levels and promote maintenance of healthy body weight, thus alleviating metabolic syndrome. However, Gurusamy et al. (2021) note that patients with schizophrenia also present with exercise and diet adherence problems. Studies have shown that only a tiny percentage of patients adhere to diet and exercise regimens due to personal factors and other social determinants of health, such as income and education level. Despite the effectiveness of diet and exercise in preventing and alleviating metabolic syndrome, they remain underutilized. Swarup et al. (2021) also note that exercises are the most effective interventions in regulating risk factors for the condition. However, their compatibility with individuals with mental illnesses is the most significant barrier to their effectiveness.
Mazza et al. (2018) note that antipsychotic medications relay different effects on populations. Cariprazine is associated with less weight gain than other drugs such as olanzapine, quetiapine, and risperidone and can be used to replace them when patients report marked weight gain (Mazza et al., 2018). These medications, if unmonitored, can increase insulin resistance, lead to weight gain, and increase the risk for metabolic syndrome. The efficacy of the changed therapies remains in question hence the need for periodic evaluation and therapy changes as the need arises in these patients. Rimvall et al. (2021) note that patients manifest differently and respond differently to some interventions. A patient-centered transdiagnostic approach is vital to managing mental health illnesses and preventing complications.
The National Institute of Mental Health is the state agency with the mandate to control and prevent mental health illnesses in the population. The institute requires all studies to focus on using human subjects for research t ensure the studies are IRB-approved (NIMH, n.d.). Studies involving mentally ill patients should be conducted with their consent if they are deemed fit to give consent or with their care providers. Other ethical considerations applying to the general population should also be addressed. For example, the care provider/researcher should not withhold a proven intervention or lead to delays in any care delivery to these patients. In addition, other organizations such as HIPSS regulate information sharing, and researchers should ensure data privacy and the protection of the participants from population access to their personal information.
Sneller et al. (2021) note that patients are often provided with polypharmacy when care providers want to eliminate some drug side effects when achieving the targeted therapeutic outcomes. For example, care providers can prescribe lipids lowering drugs to patients reporting weight gain with lithium without stopping or lowering the lithium dose. Healthcare providers should practice safe prescriptions concerning policies regulating polypharmacy due to its consequences, such as superimposed side effects and widespread poor drug adherence (Ijaz et al., 2018). Ijaz et al. (2018) showed that polypharmacy has no significant effect on metabolic syndrome prevalence but could lead to other potentially harmful consequences.
Policies and regulations help support efforts in managing healthcare conditions. Swarup et al. (2021) note that the joint commission recommends blood pressure regulation to ensure it is less than 140/90 in the general population, below 130/80 for diabetic patients, and below 150/90 in individuals above 60 years. The regulations should be observed in mentally ill patients, and their regular evaluation will help healthcare providers intervene and prevent metabolic syndrome in the long run.
Notably, metabolic syndrome does not occur in mentally ill patients and the general population. Factors in the general population include physical inactivity, insulin resistance, poor nutrition, and dieting. Thus, interventions such as changing medications may be ineffective hence the need to address the specific causes of the diseases in individual patients. The literature review helps appreciate the role played by second-generation antipsychotics in metabolic syndrome development. However, patients taking first-generation antipsychotics or other mental health illnesses can develop the disorder when factors such as poor diet and nutrition, inactivity, and smoking are in play (Hirode & Wong, 2022). Thus, individualized care is essential despite implementing community-wide interventions.
Healthcare providers play vital roles in assessing population health and promoting better outcomes. The interest population is mentally ill adults aged 20 and above receiving care in the Bronx. The problem of interest is metabolic syndrome, a diagnosis of three conditions: elevated low-density lipoproteins, low high-density lipoprotein, increased waist circumference, poor glucose regulation, and elevated blood pressure. The risk factors include diabetes, age, overweight and obesity, and medications affecting metabolic activities.
The mentally ill are at risk for the disease precisely due to the second-generation antipsychotic medications’ ability to alter metabolic functions in the mitochondria and the CNS. Interventions such as diet, exercise, and changes in therapy target one or more conditions in metabolic syndrome. These interventions have been implemented with varying degrees of success in varied populations. Assessing population needs will help develop interventions that produce the desired outcomes-prevention of metabolic syndrome in mentally ill patients.
Abo Alrob, O., Alazzam, S., Alzoubi, K., Nusair, M. B., Amawi, H., Karasneh, R., Rababa’h, A., & Nammas, M. (2019). The effect of long-term second-generation antipsychotics use on the metabolic syndrome parameters in Jordanian population. Medicina, 55(7), 320. https://doi.org/10.3390/medicina55070320
Buhagiar, K., & Jabbar, F. (2019). Association of first-vs. second-generation antipsychotics with lipid abnormalities in individuals with severe mental illness: a systematic review and meta-analysis. Clinical Drug Investigation, 39(3), 253-273. https://doi.org/10.1007/s40261-019-00751-2
Fang, X., Wang, Y., Chen, Y., Ren, J., & Zhang, C. (2019). Association between IL-6 and metabolic syndrome in schizophrenia patients treated with second-generation antipsychotics. Neuropsychiatric Disease and Treatment, 15, 2161. https://doi.org/10.2147/NDT.S202159
Gurka, M. J., Filipp, S. L., & DeBoer, M. D. (2018). Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutrition & Diabetes, 8(1), 1-8. https://doi.org/10.1038/s41387-018-0024-2
Gurusamy, J., Gandhi, S., Damodharan, D., Ganesan, V., & Palaniappan, M. (2018). Exercise, diet and educational interventions for metabolic syndrome in persons with schizophrenia: A systematic review. Asian Journal of Psychiatry, 36, 73-85. https://doi.org/10.1016/j.ajp.2018.06.018
Hirode, G., & Wong, R. J. (2020). Trends in the prevalence of metabolic syndrome in the United States, 2011-2016. JAMA, 323(24), 2526-2528. https://doi.org/10.1001/jama.2020.4501
Ijaz, S., Bolea, B., Davies, S., Savovi?, J., Richards, A., Sullivan, S., & Moran, P. (2018). Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews. BMC Psychiatry, 18(1), 1-13. https://doi.org/10.1186/s12888-018-1848-y
Mazza, M., Marano, G., Traversi, G., Carocci, V., Romano, B., & Janiri, L. (2018). Cariprazine in bipolar depression and mania: state of the art. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 17(10), 723-727. https://doi.org/10.2174/1871527317666180828120256
National Institute of Mental Health (NIMH), (n.d.). Human Subject Research Issues. Mental Health Information. https://www.nimh.nih.gov/funding/managing-your-grant/human-subjects-research-issues
Nilsson, P. M., Tuomilehto, J., & Rydén, L. (2019). The metabolic syndrome–What is it, and how should it be managed? European Journal Of Preventive Cardiology, 26(2_suppl), 33-46. https://doi.org/10.1177/2047487319886404
Penninx, B. W., & Lange, S. M. (2022). Metabolic syndrome in psychiatric patients: overview, mechanisms, and implications. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2018.20.1/bpenninx
Piras, M., Ranjbar, S., Laaboub, N., Grosu, C., Gamma, F., Plessen, K. J., Gunten, A., Conus, P., & Eap, C. B. (2022). Evolutions of Metabolic Parameters Following Switches of Psychotropic Drugs: A Longitudinal Cohort Study. Schizophrenia Bulletin. https://doi.org/10.1093/schbul/sbac133
Rimvall, M. K., van Os, J., & Jeppesen, P. (2021). Promoting a patient-centered, transdiagnostic approach to prevention of severe mental illness. European Child & Adolescent Psychiatry, 30(5), 823-824. https://doi.org/10.1007/s00787-020-01563-y
Scaini, G., Quevedo, J., Velligan, D., Roberts, D. L., Raventos, H., & Walss-Bass, C. (2018). Second generation antipsychotic-induced mitochondrial alterations: Implications for increased risk of metabolic syndrome in patients with schizophrenia. European Neuropsychopharmacology, 28(3), 369-380. https://doi.org/10.1016/j.euroneuro.2018.01.004
Sneller, M. H., De Boer, N., Everaars, S., Schuurmans, M., Guloksuz, S., Cahn, W., & Luykx, J. J. (2021). Clinical, biochemical and genetic variables associated with metabolic syndrome in patients with schizophrenia spectrum disorders using second-generation antipsychotics: a systematic review. Frontiers in Psychiatry, 12, 625935. https://doi.org/10.3389/fpsyt.2021.625935
Swarup, S., Goyal, A., Grigorova, Y., & Zeltser, R. (2021). Metabolic syndrome. In StatPearls [internet]. StatPearls Publishing.
Also Read: NRNP 6635 Week3 Assignment Mood Disorders
Discussion: Existential-humanistic therapy
For Part 1, select a client whom you observed or counseled this week (other than the client used for this week’s Discussion). Then, address the following in your Practicum Journal:
Michael Price, M. (2011). Searching for meaning. American Psychological Association. Vol. 42, No.10. P. 58
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Nagy, T. F. (2011). Ethics in psychotherapy. In Essential ethics for psychologists: A primer for understanding and mastering core issues (pp. 185–198). Washington, DC: American Psychological Association. doi:10.1037/12345-010
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.
Laureate Education (Producer). (2012b). Clinical supervision follow-up [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2015d). On a hamster wheel [Video file]. Baltimore, MD: Author.
Bugental, J. (n.d.). Existential-humanistic psychotherapy [Video file]. Mill Valley, CA: Psychotherapy.net.
May, R. (n.d.). Rollo May on existential psychotherapy [Video file]. Mill Valley, CA: Psychotherapy.net.
Steinert , T. (2016). Ethics of coercive treatment and misuse of psychiatry. Psychiatric Services. doi:10.1176/appi.ps.201600066.
Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Two widely used approaches in psychotherapy are Humanistic-Existential Psychotherapy and Cognitive-Behavioral Therapy (CBT). Humanistic-Existential Psychotherapy emphasizes the individual’s unique experiences, growth potential, and self-determination. In contrast, CBT focuses on the modification of negative thinking patterns and behavior to improve a patient’s mental health. In this paper, we will describe Humanistic-Existential Psychotherapy and Cognitive-Behavioral Therapy and discuss their differences, as well as their potential impact on the practice of a Psychiatric-Mental Health Nurse Practitioner (PMHNP).
Humanistic-Existential Psychotherapy: Humanistic-Existential Psychotherapy emphasizes the importance of the individual’s unique experiences, free will, and choice in the therapeutic process. It recognizes the individual’s potential for growth, self-awareness, and self-determination. The therapist’s role in this therapy is to create an environment conducive to personal exploration, self-reflection, and authenticity (Sood, 2021). The therapist provides a supportive, non-judgmental environment that allows the patient to explore their thoughts, emotions, and behaviors freely. In addition, the therapist helps the patient to identify and express their feelings and needs and to set personal goals for growth and development.
Cognitive-Behavioral Therapy (CBT): Cognitive-behavioral therapy (CBT) is a form of psychotherapy that emphasizes the modification of negative thinking patterns and behavior to improve mental health. It is based on the premise that negative thinking patterns and maladaptive behaviors contribute to emotional distress and psychological problems (Van der Zweerde et al., 2020). CBT focuses on identifying and changing negative thoughts, beliefs, and behaviors that contribute to emotional distress. It also involves teaching patients new coping skills and strategies to help them manage stress and other emotional challenges more effectively.
Humanistic-Existential Psychotherapy focuses on the individual’s unique experiences and growth potential, while CBT focuses on the modification of negative thinking patterns and behaviors. In Humanistic-Existential Psychotherapy, the therapist creates an environment that is supportive and non-judgmental, allowing the patient to explore their feelings, emotions, and behaviors freely. In contrast, CBT involves teaching patients new coping skills and strategies to manage their emotional challenges more effectively (Davison, 2022).
Humanistic-Existential Psychotherapy emphasizes the present, while CBT focuses on the past and present. In Humanistic-Existential Psychotherapy, the therapist helps the patient explore their current thoughts, feelings, and behaviors to identify areas for growth and development. In contrast, CBT involves exploring past experiences and beliefs contributing to negative thinking patterns and behaviors. Humanistic-Existential Psychotherapy emphasizes self-determination, allowing the patient to set personal goals for growth and development. In contrast, CBT focuses on cognitive restructuring, helping the patient to identify and change negative thinking patterns and behaviors (Davison, 2022).
The differences between Humanistic-Existential Psychotherapy and CBT can have significant implications for PMHNP practice. PMHNPs who use Humanistic-Existential Psychotherapy would focus on creating a supportive, non-judgmental environment that allows the patient to explore their feelings, emotions, and behaviors freely (Davison, 2022). They would help patients identify areas for growth and development and set personal goals for improvement. PMHNPs who use CBT would focus on identifying and modifying negative thinking patterns and behaviors. They would teach patients new coping skills and strategies to help them manage stress and other emotional challenges more effectively.
Humanistic psychology is used because it helps people reach their full potential by encouraging them to take a more in-depth, all-encompassing view of themselves and their surroundings. While treating mental illness, a client-centered approach takes a hands-off approach. The therapist plays a vital role in helping the patient recognize their inner conflict. The client can learn to make sense of their environment and come to terms with the things that are influencing them. James Bugental explains what it feels like to truly hear and comprehend a client’s story of satisfaction. In this way, the therapist can feel the client’s happiness and sadness with them (Psychotherapy Net, 2009). The technique is used to help the client make the mental and emotional connection necessary to master their emotions and develop self-awareness. As revealed by James Bugental, the therapist’s goal is to help the patient discover who they are by asking probing questions about their background and upbringing. Top of Form
Due to its emphasis on the patient’s observable patterns of behavior, cognitive behavioral therapy (CBT) has been shown to yield significant improvements for its patients (Chen et al., 2020). Using current events, CBT reveals how the client’s emotions impact their lives and provides a guidepost for therapists to point clients on the proper path for successful psychotherapy by re-framing the client’s actions and feelings (Yoshinaga et al., 2015). Clients should expect to learn more constructive thought patterns, how to modify maladaptive behaviors and effective coping strategies through CBT.
Humanistic-Existential Psychotherapy and Cognitive-Behavioral Therapy are two distinct approaches to psychotherapy with different theoretical foundations, techniques, and goals. While Humanistic-Existential Psychotherapy emphasizes personal growth, self-awareness, and self-determination, Cognitive-Behavioral Therapy focuses on modifying negative thinking patterns and behaviors to improve mental health. The differences between these two approaches have important implications for the practice of Psychiatric-Mental Health Nurse Practitioners (PMHNPs), as they need to tailor their treatment approaches to individual patient needs. Ultimately, the choice of approach should depend on the patient’s needs, preferences, and presenting problems. By selecting the most appropriate approach, PMHNPs can help their patients achieve better mental health outcomes and improve their overall well-being.
Chen, C. L., Lin, M. Y., Huda, M. H., & Tsai, P. S. (2020). Effects of cognitive behavioral therapy for adults with post-concussion syndrome: a systematic review and meta-analysis of randomized controlled trials. Journal of Psychosomatic Research, 136, 110190. https://doi.org/10.1016/j.jpsychores.2020.110190
Davison, G. C. (2022). Personal Perspectives on the Development of Behavior Therapy and Cognitive Behavior Therapy. In Behavior Therapy: First, Second, and Third Waves (pp. 17-52). Springer.
Psychotherapy Net. (2009, June 29). James Bugental live case consultation psychotherapy. [Video]. YouTube. https://www.youtube.com/watch?v=Zl8tVTjdocI
Sood, S. (2021). The humanistic-existential psychology of coronavirus. Academia Letters, 2. https://doi.org/10.20935/AL3256
Van der Zweerde, T., Lancee, J., Slottje, P., Bosmans, J. E., Van Someren, E. J., & Van Straten, A. (2020). Nurse-guided internet-delivered cognitive behavioral therapy for insomnia in general practice: results from a pragmatic randomized clinical trial. Psychotherapy and Psychosomatics, 89(3), 174-184. https://doi.org/10.1159/000505600
Also Read: Outcomes And Patient Care Efficiencies Essay 2
Focused Thyroid Exam Chantal, a 32-year-old female, comes into your office with complaints of “feeling tired” and “hair falling out”. She has gained 30 pounds in the last year but notes markedly decreased appetite. On ROS, she reports not sleeping well and feels cold all the time.
She is still able to enjoy her hobbies and does not believe that she is depressed.Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones.
For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.
In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor. Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance.
Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.With regard to the case study you were assigned: Review this week’s Learning Resources and consider the insights they provide.
Consider what history would be necessary to collect from the patient. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Identify at least fivepossible conditions that may be considered in a differential diagnosis for the patient.
The AssignmentUse the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources.
Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ORDER HERE FOR ORIGINAL, ORDER THROUGH BOUTESSAY ON Discussion: Leadership styles influence legal and ethical issues
Critique how nursing leadership styles influence legal and ethical issues. Read the case study and relate it to the ethical isssues
cases_2_and_1___ethical_and_legal_dilemma.docxWatch the following 3 videos and then read the Game Changer Case Study. Answer all the questions posed in the case study and make sure that you are considering your answers from the view of physiology and pathophysiology.
Sports Concussions and Youth Athletes – Full Video (05:48)
Sports Concussions and Youth Athletes Video Transcript
Trickle-Down Safety: Sports Concussions – Full Video (08:33)
Trickle-Down Safety: Sports Concussions Video Transcript
The Hidden Epidemic: Post-Concussion Syndrome – Full Video (39:45)
The Hidden Epidemic: Post-Concussion Syndrome Video Transcript
The Game Changer: Keeping Your Head in Contact Sports – By Patrick R. Field and Kelsey L. Logan
“The Game Changer is an interrupted case study that traces the football career of Anthony ‘Tony Tonka Truck’ Williams and the types of brain trauma that he suffers from playing football, from junior league level through high school, college, and his draft into the pros” (Field & Logan, 2018).
As sports-related concussions and head injuries have become more prevalent and more of a mainstream topic, as a provider you should expect to see these patients in your office. The Hidden Epidemic video looks at head injuries and how these relate to the mental health of young people in our country.
This assignment asks you to summarize each part of the case and to respond to all questions posed. Incorporate topics covered in Weeks 12 and 13 that focused on neurological health, pain, and psychological dysfunction. When responding to the questions in the case study, consider the information included about Anthony’s mental health and keep in mind any plausible/possible DSM-5 diagnosis.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Discuss disparities related to ethnic and cultural groups relative to low birth weight infants and preterm births. Describe the impact of extremely low birth weight babies on the family and on the community (short-term and long-term, including economic considerations, on-going care considerations, and co-morbidities associated with prematurity).
Identify at least one support service within your community for preterm infants and their family. Provide the link for your colleagues to view. Does the service adequately address needs of this population? Explain your answer.
(2)You are the registered nurse performing a health assessment on a newborn infant. From the functional health pattern portion of the assessment, you learn the mother is reluctant to breastfeed her baby. How do you respond? Explain the approach you will take to ensure adequate nutrition for the newborn, with or without breastfeeding. Provide rationale for your answer.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.
Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often, having a friend proofread your paper for obvious errors is advantageous. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. Letting your essay run over the recommended number of pages is better than compressing it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted and double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Mr. Charles Lamont is a 45-year-old patient visiting his primary care physician for his annual checkup. His wife is waiting for him in the lobby; she is hoping that Mr. Lamont will tell the physician about his recent bout of coughing and shortness of breath.
Mr. Lamont works for a construction company as a heavy machine operator. He smokes 1½ packs of cigarettes per day. His wife has been encouraging Mr. Lamont to stop, but he has not shown any interest in quitting. Laura, the registered nurse, takes
Mr. Lamont went to an examination room. Laura asks him about his overall health, and he tells her about a nagging cough and how he sometimes feels short of breath. He then denies any other health problems.
Laura takes Mr. Lamont’s vital signs and gets the following results: blood pressure 156/94 mm Hg, temperature 99.8° F orally, apical pulse 104 beats/min, respirations 25 breaths/min, and regular and pulse oximetry 95%.
Mr. Lamont asks Laura if everything is normal. Before she answers, she reviews the results and determines which are abnormal. What are Laura’s findings? What would be normal for any of these that are not normal?
The primary care physician examines Mr. Lamont and tells him he should quit smoking. He gives him an antihypertensive medication to help lower his blood pressure. Mr. Lamont asks Laura if she can teach his wife to take his blood pressure. Laura agrees and brings Mrs. Lamont in to explain the process.
Laura decides to use a demonstration to teach Mrs. Lamont the procedure, but she also wants to explain some important concepts. What should she include? Select all that apply.
A. Choose a cuff that is the right size.
B. Ensure that the patient is sitting or lying.
C. Support the extremity.
D. Ensure proper cuff application.
Mr. Lamont tells Laura that he doesn’t understand how smoking could influence his blood pressure. How should Laura respond?
Mr. Lamont tells his wife that the physician said his respiratory rate increased. Mrs. Lamont asks Laura what could cause him to breathe faster. What factors could cause his increased respirations? Select all that apply.
A. Smoking
B. Medications
C. Increased activity
D. Pain
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.
Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often, having a friend proofread your paper for obvious errors is advantageous. Handwritten corrections are preferable to uncorrected mistakes. Early Childhood Safety and Health Discussion
Use a standard 10 to 12 point (10 to 12 characters per inch) type ace. Smaller or compressed type and papers with small margins or single-spacing are hard to read. Letting your essay run over the recommended number of pages is better than compressing it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted and double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Please consider how you have developed the knowledge, skills, and attitudes that enable your achievement of the course goals listed in the syllabus. Then write a minimum of 400 words describing how this course has helped you achieve these goals
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.
Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often, having a friend proofread your paper for obvious errors is advantageous. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. Letting your essay run over the recommended number of pages is better than compressing it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted and double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Also Read:
Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two-sentence responses, simple statements of agreement or “good post,” and off-topic responses will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Your initial responses to the mandatory DQ are graded separately and do not count toward participation.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days for three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything due during the week.
Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the resources tab in LoudCloud, for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
I discourage the overutilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly.
As Master’s level students, you must be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding or critical analysis of the content.
It is best to paraphrase content and cite your source.
For assignments that need to be submitted to LopesWrite, please be sure you have received your report, and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper more of someone else’s thoughts than yours?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud, for tips on improving your paper and SI score.
The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
Per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask questions or send messages. This will be checked at least once every 24 hours.
Draft a 6-page report on outcome measures, issues, and opportunities for the executive leadership team or applicable stakeholder group.
Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
SHOW LESS
As a nurse leader, you may be called upon to submit a detailed report to your executive leadership team and key stakeholders that describes a quality or safety problem and its effects on outcomes, fully supported by relevant and credible data.
This assessment provides an opportunity to draft such a report in which you can call attention to quality and safety issues and opportunities, effectively support your position, and lay out a plan for change.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Analyze quality and safety outcomes from an administrative and systems perspective.
Competency 3: Determine how specific organizational functions, policies, processes, procedures, norms, and behaviors can be used to build reliability and high-performing organizations.
Competency 4: Synthesize the various aspects of the nurse leader’s role in developing, promoting, and sustaining a culture of quality and safety.
Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable organizational, professional, and scholarly standards.
CHECK YOUR PROGRESS
Use this online tool to track your performance and progress through your course.
Toggle Drawer
As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.
Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment. Organizational functions, processes, and behaviors can include leadership practices, communications, quality processes, financial management, safety and risk management, interprofessional collaboration, strategic planning, using the best available evidence, and questioning the status quo on all levels.
Toggle Drawer
The following resources are required to complete the assessment.
SHOW LESS
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid.
The MSN-FP6212 Health Care Quality and Safety Management Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
The following resources provide context and background information that will help you with this assessment.
Fessele, K, Yendro, S., & Mallory, G. (2014). Setting the bar: Developing quality measures and education programs to define evidence-based, patient-centered, high-quality care. Clinical Journal of Oncology Nursing, 18, 7–11.
Goll, C. & Cahill, S. (2014). Leading the way: Enculturating the value of process improvement. American Nurse Today, 9(8), 1–4.
Huffstutler, C.D. & Thomsen, D. (2015). A framework for performance excellence and success. Frontiers of Health Science Management, 32(1), 45–50.
Masica, A. L., Richter, K. M., Convery, P., & Haydar, Z. (2009). Linking Joint Commission inpatient core measures and National Patient Safety Goals with evidence. Baylor University Medical Center Proceedings, 22(2), 103–111.
The Joint Commission (n.d.). National Database of Nursing Quality Indicators (NDNQI). Retrieved from http://nursingandndnqi.weebly.com/index.html
Vila Health: Quality and Safety Gap Analysis | Transcript.
You can use the following additional resources to improve your writing skills and as source materials for seeking answers to specific questions.
This assessment is based on the executive summary you prepared in the previous assessment.
Your executive summary captured the attention and interest of the executive leadership team, who have asked you to provide them with a detailed report addressing outcome measures and performance issues or opportunities, including a strategy for ensuring that all aspects of patient care are measured.
Note: Remember that you can submit all or a portion of your draft report to Smarthinking for feedback before you submit the final version for this assessment. However, be mindful of the turnaround time of 24–48 hours for receiving feedback, if you plan on using this free service. Discussion: Outcome Measures Issues & Opportunities in Healthcare Organizations
Note: The requirements outlined below correspond to the grading criteria in the Outcome Measures, Issues, and Opportunities Scoring Guide. Be sure that your written analysis addresses each point, at a minimum. You may also want to read the Outcome Measures, Issues, and Opportunities
Scoring Guide and Guiding Questions: Outcome Measures, Issues, and Opportunities (linked in the Resources) to better understand how each criterion will be assessed.
Format your document using APA style.
Portfolio Prompt: You may choose to save your report to your ePortfolio.
Newman pointed out that “nurse client relationships often begin during periods of disruption, uncertainty, and unpredictability in patient’s lives” (Smith & Parker, 2015, p. 288). Discussion: Nurse Client Relationships
Explore what she means by this statement. Then, reflect on a patient that you cared for that you could apply her theory to. Provide details of the interaction and outcomes.
Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly Discussion: Nurse Client Relationships.
Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages Discussion: Nurse Client Relationships.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Margaret A. Newman developed the theory of Health as expanding consciousness after working with Martha Rogers and affirming Rogers’ theory with her experience in caring for her mother earlier in life. Rogers’s work, The Science of Unitary Human Beings, is a well-known nursing model due to its assumption that man is a unified whole, possessing integrity and manifesting characteristics that are more than and different from the sum of his parts (Edwards-Maddox et al., 2021).
Rodgers viewed health as a unitary and transformative process. From this understanding, Newman embraced the unitary and transformative paradigm of nursing. In this discussion, I will explore what Newman meant when she pointed out that nurse-client relationships often begin during periods of disruption, uncertainty, and unpredictability in a patient’s life. I will share a reflection on a patient care situation where I could apply her theory and the details of the interaction and outcomes.
Newman’s health as expanding consciousness theory is based on the assumptions that health is an evolving unitary pattern of a whole, consciousness is the informational capacity of the whole, revealed in the evolving pattern, and the pattern identified in the person-environment process, which is characterized by meaning.
According to Mitsugi (2019), Newman believed health and illness evolve in a pattern, and pattern changes enfold and unfold based on the patient’s interaction with the environment. Therefore, at some point, the patient’s life may be orderly (health), then through interaction with the environment, their life becomes difficult and chaotic (illness presence). The orderly and disorderly phases in the patient’s life are parts of expanding consciousness.
By pointing out that nurse-client relationships begin during a period of uncertainty, disruption, and unpredictability in a patient’s life, Newman meant the point at which the pattern has evolved into disorder. At this point, the patient has interacted with the environment, and their pattern has evolved, leading to a disorderly phase; the illness has struck.
The patient is usually in chaos, confused, disrupted, and needs assistance to get their life back in order. Mitsugi, Endo & Ikeda (2020) note that the nurse-client relationship begins as a nursing intervention that Newman defined as a caring partnership in the nurse-client relationship. Both parties mutually recognize the pattern, determining a course of action, and therefore evolve together in consciousness, leading to achieving health and order in the patient’s life.
As an oncology nurse, I cared for a patient with breast cancer, and I applied Newman’s theory in our interaction. When she came to the clinic, she had just been diagnosed with breast cancer, at stage two, and decided to seek specialized care services. At this point, her life was in disorder, unpredictable, and with a lot of uncertainty. At the nurse-client relationship’s initiation phase, the patient lost hope.
It took effort to comfort her and convince her to participate actively in our interaction. We worked together to mutually recognize the pattern and actions we would take to contribute to health. The actions taken were biologic, chemo, and radiation therapies. We evolved in the pattern together in consciousness, as an improvement would be seen at every follow-up. The patient had positive health outcomes since she had fully recovered by the end of the 18th month.
Newman’s health as expanding consciousness theory is a widely applied nursing theory that guides the nurse-client relationship, emphasizing working in partnership to recognize the pattern and evolve together in consciousness. Nurse-client relationships are initiated when the patient’s life is in chaos, and through the interaction, they work together to restore health, hope, and order.
Edwards-Maddox, S., Cartwright, A., Quintana, D., & Contreras, J. A. (2021). Applying Newman’s theory of health expansion to bridge the gap between nursing faculty and Generation Z. Journal of Professional Nursing, 37(3), 541-543. https://doi.org/10.1016/j.profnurs.2021.02.002
Mitsugi, M. (2019). A transforming process based on Newman’s caring partnership at the end of life. International Journal for Human Caring, 23(1), 40-50. https://doi.org/10.20467/1091-5710.23.1.40
Mitsugi, M., Endo, E., & Ikeda, M. (2020). Recognizing One’s Own Care Pattern in Cancer Nursing and Transforming toward A Unitary Nursing Practice Based on Margaret Newman’s Theory. Asia-Pacific Journal Of Oncology Nursing, 7(2), 225–228. https://doi.org/10.4103/apjon.apjon_1_20