NR 507 Week 6 Recorded Disease Process Presentation
NR 507 Week 6 Recorded Disease Process Presentation
NR 507 Week 6 Recorded Disease Process Presentation
Introduction
In research, it is always important for any nurse to identify their area of interest within the nursing field because it comes with immense benefits. For instance, an area of interest often motivates one to focus more on identifying some of the problems existing in the area of interest and working towards finding a solution to the problem. The aim is to ensure that other change strategies are implemented in the particular field of study to help address the existing issues that impact the population. In my case, mental health has been an area that I believe is faced with several problems, which require further research to find evidence-based solutions that can be utilized to solve the problems. Therefore, by utilizing an EBP model, this discussion aims to identify the issues of concerns in the mental health field and provide a recommendation that can be utilized to address the concerns. Besides, the discussion focuses on the external and internal factors that can impact the realization of the needed change.
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Evidence-based Practice (EBP)
Engaging in evidence-based projects exposes master’s-prepared nurses to numerous benefits to the nurse in ensuring that their nursing practice and professions are always informed. EBP is considered the most simplistic factor that all nursing practice is based upon. The practice primarily involves using scholarly research studies that nurses can critique and develop solutions to address health issues. This demonstrates that through EBP, nursing professionals can identify an informed course of action so that healthcare practices are improved. In this regard, the nurse needs to gather the best evidence from current literature, analyze the evidence, and apply it to clinical practice to ensure that quality and safe care is achieved because the nurses can always make well-founded decisions regarding care. According to Hickman et al. (2018), the study demonstrated that by acquiring evidence-based practice skills and knowledge, they become more competent in completing any nursing practice project that aims to solve the existing health issues.
Conceptual Model
The John Hopkins Nursing Evidence-Based Practice Model would be applied in developing the EBP project by ensuring all steps provided in the models are followed and adhered to, leading to a comprehensive project. The model remains a powerful tool in problem-solving, making it more appropriate for application in the project. It gives room for one to conduct an inquiry of the problem, which gives room for identifying the best practices that can be implemented to improve the current practices in the best way possible (John Hopkins Medicine. n.d.). Besides, the model provides room for reflection and learning that are always critical in translating evidence into nursing practice. Therefore, when developing the project, it is important to consider three basic processes that the model highlights, including developing practice questions relating to the particular field practice, developing questionnaires, and translating and interpreting the evidence to produce results.
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My desire to pursue Psych-Mental Health NP is motivated because it introduces one to various aspects of care that promote proper care for patients with psychiatric disorders. For instance, the profession entails various approaches, such as collaborative and holistic care and patient-centered care. By focusing on these areas of care, I will become more informed about my field of study.
Non-compliance to medication in all medical fields remains a major problem that impacts many patients across the divide. This is because it leads to treatment failure and poorer outcomes that complicate the entire care process for mentally ill patients. When a patient is no-compliant with the prescribed medications, it means that their condition will worsen, calling for further interventions that might be costly. According to Semahegn et al. (2018), it is evident that psychotropic medication non-adherence is becoming a challenge, contributing towards the increasingly poor health outcomes. For instance, many psychiatric patients who fail to adhere to the medication have often developed chronic conditions that impact the entire line of care. This means that families with patients who suffer from the disorders face many problems when dealing with them because failing to comply with the medications exposes them to other uncontrollable problems (Du Plessis et al., 2021). The same findings can also be linked to other scholarly research, demonstrating that non-adherence is indeed a problem that impacts the recovery process among psychiatric patients. The main contributing problem is the patients’ beliefs and attitudes regarding the medications and the associated side effects. However, there is not much evidence concerning the link between the two factors and non-adherence. Hence, there is a need to conduct subsequent research to help generate concrete evidence concerning these factors and how they contribute to non-compliance, especially among patients with severe mental disorders.
Area of Interest
As more research continues to take shape concerning the improvement measures that should be implemented to address non-compliance, it is important to note that as a PMNHP, I have a key role to play in ensuring an informed EBP strategy is communicated not only to the care providers but also the patients and their family members. Developing a solution to the problem requires understanding all the factors associated with non-compliance. By understanding these factors, a psychiatrist can identify the key areas to focus on in the EBP project. To achieve this goal, there is a need to inquire more about the issues, especially among the affected family members, so that the evidence can be translated into practice to address the problem.
Issues/Concerns for Recommendation
In terms of increasing awareness concerning the need to implement evidence-based intervention on medication adherence, I recommend that psychiatrists consider a set of integrated interventions for utilization, as demonstrated by Semahegn et al. (2018). However, when integrating various interventions, it is important to understand that medication adherence can only be achieved when more weight is given to the main factors that lead to non-adherence.
Secondly, there is a need to start a very active conversation concerning the impacts of non-adherence to the prescribed medication or any other intervention to address their mental health conditions. Active conversations mean having verbal communication with the patients and their family members about how they would wish the medication to be administered to enhance compliance throughout the care process.
Lastly, educating the patients and families I also critical procedures that help instill knowledge to the patient, families, and the general public on the need to adhere to treatment plans designed for psychiatric patients. Educating the people means giving them the responsibility to understand why they should prioritize their health.
Factors Influencing Change
Initiating a particular change to address the existing problem can either succeed or fail depending on various factors that occur both at the internal and external levels. One of these factors is an individual’s belief system, which tends to deny them the opportunity to comply with the designed treatment plan. Religion remains an essential aspect in determining how people live their lives. Therefore, if the patients’ belief systems do not allow them to believe in any other alternative form of healing, different from that which the gods provide, they cannot adhere to proposed changes (Yoo et al., 2019). Secondly, various cultural aspects highly limited the full realization of change. For instance, certain cultures do not allow new scientific evidence to address some of the problems people face. This means that before the EBP can be introduced to the patients, a cultural-based search must be conducted to identify the level of acceptance with the evidence. A hostile environment also means that the proposed might not succeed in carrying out the tasks it is meant to. Change can only take place in a supportive environment to meet the change objectives.
Externally, it is important to consider family support and health service support programs that primarily function to focus the change needed. Without family support, it means that the psychiatrist might not get feedback regarding patients’ progress following the EBP program to enhance their compliance. The same applies to the health service support programs that support the patients in ensuring that all steps of medication compliance are achieved and enhanced throughout the caring period.
NONPF Competencies
Practice inquiry competencies primarily involve the NP’s ability to apply translational research into practice. This is a critical competency skill that would ensure that the John Hopkins Nursing Evidence-Based Practice Model is properly used in the EBP report achieves the intended actions. Completing the project should begin with inquiring so that one can gather enough evidence on why non-compliance is becoming a common problem in psychiatry. Hence, it is the only sure way to know the facts behind the phenomena. After that, the evidence must be translated to practice to help find a more defined solution. The second NONPF competency is the NP-patient relationship, which plays a critical role in determining the honesty with which patients would share their concerns about the identified problem (Chan et al. 2020). Besides, a positive relationship means that the nurses would even suggest what they think would be appropriate for them to address their concerns.
Conclusion
In conclusion, the presented has highlighted the importance of applying evidence-based nursing practice. It is a factor that determines the particular project’s efficiency in addressing the prevailing nursing problem. This shows that it is important to understand what one pursues as a nurse practitioner, making it possible to understand the particular EBP model that would be appropriate for implementation to inform the project in question. Identifying the area of interest means that the NP can successfully develop a plan, which in essence is critical in achieving the set goals at the end of project implementation.
References
•Chan, T. E., Lockhart, J. S., Thomas, A., Kronk, R., & Schreiber, J. B. (2020). An integrative review of nurse practitioner practice and its relationship to the core competencies. Journal of Professional Nursing, 36(4), 189-199. https://doi.org/10.1016/j.profnurs.2019.11.003
•Du Plessis, J. M., Poggenpoel, M., Myburgh, C., & Temane, A. (2021). Family members’ lived experiences of non-compliance to psychiatric medication given to female adults living with depression. CURATIONIS Journal of the Democratic Nursing Organization of South Africa, 44(1), 2105. https://journals.co.za/doi/full/10.4102/curationis.v44i1.2105
•Hickman, L. D., DiGiacomo, M., Phillips, J., Rao, A., Newton, P. J., Jackson, D., & Ferguson, C. (2018). Improving evidence based practice in postgraduate nursing programs: A systematic review: Bridging the evidence practice gap (BRIDGE project). Nurse education today, 63, 69-75. https://doi.org/10.1016/j.nedt.2018.01.015
•John Hopkins Medicine. (n.d.). John Hopkins Nursing Evidence-Based Practice Model. Retrieved from http://www.hopkinsmedicine.org/evidence-based-practice/jhn_ebp.html
•Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2018). Psychotropic medication non-adherence and associated factors among adult patients with major psychiatric disorders: a protocol for a systematic review. Systematic reviews, 7(1), 1-5. Doi: 10.1186/s13643-018-0676-y
•Yoo, J. Y., Kim, J. H., Kim, J. S., Kim, H. L., & Ki, J. S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PloS one, 14(12), e0226742.
I really enjoyed your presentation and felt like I learned more about Addison’s disease. I was interested in this subject matter due to someone I know having this disease and wanting to understand more about her condition.
Discuss the risk factors and the connection to the etiology of the initial injury to the cell/tissue/organ
One of the things I found most interesting about Addison’s that I did not remember from nursing school was the most common cause of Addison’s being tuberculosis worldwide. Upon further research, I found that this is not common in further developed countries such as the United States, but in those underdeveloped countries (Burton, Cottrell, & Edwards, 2015, p. 488). Most often in established countries the cause is an autoimmune disease as you mentioned. Example of the autoimmune diseases would be type 1 diabetes, or Graves’ disease. Other risk factors include other chronic infections, removal of part of the adrenal gland, or polyendocrine deficiency syndrome. These autoimmune disorders cause breakdown of the adrenal cortex most often causing Addison’s disease.
Provide a brief diagnosis of how the disease is diagnosed
In your presentation you mentioned that diagnosis is made based on laboratory values to determine either primary or secondary adrenal insufficiency with high ACTH being primary and low ACTH being secondary. It is important to understand that the cortisol levels must be drawn in the morning to give a more accurate result. In my research, I found that patients are often misdiagnosed until they progress into Addisonian crisis due to providers focusing on other differential diagnoses based on the patient’s sign and symptoms (Burton, et. al, 2015, p.489). Once patients have become this ill, they usually present to the emergency department and the diagnosis is made based on presentation, laboratory values of hyperkalemia and hyponatremia, and then can be confirmed by morning cortisol levels. The delay in diagnosis was the most interesting.
Burton, C., Cottrell, E., & Edwards, J. (2015). Addison’s disease: identification and management in primary care. The British Jounral of General Practice, 65(638), 488-490. http://doi.org/10.3399/bjgp15X686713Links to an external site.
Analyze pathophysiologic mechanism associated with Addison’s Disease:
Mediated destruction
Sanne van Haren, Hannah, Alex & Gijs (2018) indicated as did you that Addison’s Disease Caused by Tuberculosis. Just like Aspergillus Pneumonia, Addison’s disease is difficult to diagnose and treat. Fichna, Żurawek, Bratland, Husebye, Kasperlik-Załuska, Czarnocka & … Nowak. (2015) stated that Interleukin-2 subunit alpha (soluble receptor) reveals and confirms a direct connect between 21OH=directed reactivity and AAD, and 11.2 SNP. Fichna, Żurawek, Bratland, Husebye, Kasperlik-Załuska, Czarnocka & … Nowak. (2015) continued that Addison’s disease (AAD) has a direct connect to T-cell destruction of the adrenal cortex.
So there is lyphocytic infiltration of the adrenal gland, autoantibodies, 21 hydroxylase (21OH). It is also indicated that he etiology remains obscure but genetic and environmental factors can be significant. Your PowerPoint presentation was excellent. I read about genes influencing T-cell fate. Is this true about transcription factors STAT4, GATA3, interleukin-23 (IL23A: activates STAT4) and interferon-Gamma production aides in the production of interferon-Gamma by the memory CD4+ cells.
- Relate research findings to the management of patients with complex pathophysiologic dysfunction of the adrenal cortex and how the hormones are all related. I can see the difficulty with the treatment in that rifampicin and steroids is part of the treatment, but low dose of steroids can be a problem with any long disorder, especially those who are immunocompromised. In addition, Aspergillus Pneumonia which is a rare opportunistic fungal infection would have a field day and be invasive to this type of individual. Any type of compromised disease would contribute to a host of problems later down the line. As with the disease that I had chosen, systemic considerations should be taken when it comes to signs and symptoms. For example, similarities exist with both diseases in that weight loss and gastrointestinal symptoms are common signs and symptoms for both. Clara, Joana, Marina, Fábio, Sara, Alexandre & … Teresa (2018) also agree that it is difficult to diagnose Addison’s disease in that this disease is rare and even gave a case about a teenager having multiple visits to the emergency room to which the teenager was treated with hydro cortisone and fludrocortisone and added that Addison’s disease has unspecific symptomatology.
References:
Clara, P., Joana, C., Marina, P., Fábio, B., Sara, L., Alexandre, F., & … Teresa, B. (2018).
Addison’s disease – the difficulty of diagnosis. Nascer E Crasser , Vol 27, Iss 1, Pp
39-42 (2018), (1), 39.
Fichna, M., Żurawek, M., Bratland, E., Husebye, E. S., Kasperlik-Załuska, A., Czarnocka,
B., & … Nowak, J. (2015). Interleukin-2 and subunit alpha of its soluble receptor in
autoimmune Addison’s disease–an association study and expression analysis.
Autoimmunity, 48, 2, 100-107. doi:10.3109/08916934.2014.976628
Sanne van Haren, N., Hannah, V., Alex, M., & Gijs, L. (2018). Addison’s Disease
Caused by Tuberculosis: Diagnostic and Therapeutic Difficulties. European
Journal of Case Reports In Internal Medicine (2018), doi:10.12890/2018_000911
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