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Note: You cannot post to this discussion until week 3.

The registered nurse is making a home care visit to a patient recovering from a deep partial thickness burn of the left hand, forearm, and left side of the chest. The RN assesses the wound and asks the patient and family member who assists the patient to describe how wound care is performed. The RN learns that honey has been used instead of the topical antibiotic, silver sulfadiazine (Silvadene), because it is hard for them to clean the wound after the Silvadene is used and the process is very painful. When the nurse asks the patient to rate the pain on a 0-10 verbal pain scale the patient responds It is an 8. I had so much pain when I was in the hospital I keep having nightmares.

Discuss appropriate nursing interventions based on this scenario. Would the RN support the continued use of honey or would the RN emphasize the need to only use the Silvadene, which was ordered by the health care provider, for wound care? What else would the nurse consider? What evidence would support the RN’s decision?

The following articles may provide information to help you create an evidence-based response to this issue.

·        

Belcher, J. (2012).
 
A review of medical-grade honey in wound care
.
 British Journal of Nursing
, 21(15), S4-S9.

·        

Connor-Ballard, P.A. (2009).
 
Understanding and managing burn pain: Part 1
.
 American Journal of Nursing
, 109(4), 48-56.

·        

Connor-Ballard, P.A. (2009).
 
Understanding and managing burn pain: Part 2
.
 American Journal of Nursing
, 109(5), 48-56.

In your responses to your peers’ posts provide constructive and insightful comments that go beyond that of agree or disagree.

Compose your work using a word processor and save it, as a Plain Text or an .rtf, to your computer. When you’re ready to make your initial posting, please click on the Create Thread button and copy/paste the text from your document into the message field. Be sure to check your work and correct any spelling or grammatical errors before you post it.

You are required to post your initial response to the discussion question by Wednesday at 11:59 PM (EST) of the week it is due. Your initial post cannot be a response to another student’s post. Students who do not submit their response to the discussion questions as noted above will have 10 points deducted from their discussion question grade for that week.

When you’re ready to make your initial posting, please click on the Create Thread button and copy/paste the text from your document into the message field.

This activity will be assessed according to the
 
AD Nursing: Discussion Question Rubric

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1) THE ASSIGNMENT IS ATTACHED AS ——Captain of the Ship Project –

Obsessive- Compulsive Disorders. (Assign 1-WK 7(A)

&

(2) SEE THE ATTACHED EXAMPLE FOR “Captain of the Ship Project” FOR

GUIDANCE)
Assignment: “Captain of the Ship”Project – Obsessive-Compulsive Disorders

Although actual statistics vary, obsessive-compulsive disorder impacts approximately 1.2% of the population in the United States (APA, 2013, p. 239). It is characterized by the presence of obsessive thoughts, which are manifested as persistent thoughts, images, or even “urges.” The only way that the individual can disperse the anxiety of these persistent thoughts/images or urges is to perform a behavior (the compulsion). The compulsion could be checking things, counting, reciting a silent prayer, or repeating a number of phrases. The disorder becomes so pervasive that the person can spend a significant amount of time each day attending to the compulsion in order to relieve the anxiety caused by the obsession.

Assignment

In this assignment, you will become “captain of the ship” as you take full responsibility for a client with an obsessive-compulsive disorder by recommending psychopharmacologic treatment and psychotherapy, identifying medical management needs and community support, and recommending follow-up plans.

Remember that there is an excellent example for ‘Captain of the Ship’ project attached with this ASSIGNMENT.

Instructions:

To prepare for this Assignment

Select an adult or older adult client with a bipolar disorder that you have seen in your practicum/clinical rotation site.

In 3-4 pages, write a treatment plan for your client. In which you do the following:

· Describe the history of the present illness (HPI) and clinical impression for the client.

· Recommend psychopharmacologic treatments based on evidence-based practice and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).

· Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

· Identify medical management needs, including primary care needs, specific to this client.

· Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.

Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

N: B. (1)The Captain of the Ship project needs to show that you are evaluating the patient, making a diagnosis, providing treatment plans and outcomes as well as collaborating with other providers. The project MUST meet all these requirements. (2) The choice of medications should be clear, and the medical management should be clear. (3) Consider using the bipolar disorder algorithm from http://www.psychiatrictimes.com/bipolar-disorder/new-psychopharmacology-algorithms

Learning Resources

Required Readings

-Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 10, “Obsessive-Compulsive and Related Disorders” (pp. 418–436)

-Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

Chapter 21, “Obsessive-Compulsive Disorder”

-American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Obsessive-Compulsive and Related Disorders”

-Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Obsessive-compulsive disorder Medication

citalopram

clomipramine

escitalopram

fluoxetine

fluvoxamine

paroxetine

sertraline

venlafaxine

vilazodone

-Thompson-Hollands, J., Edson, A., Tompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis. Journal of Family Psychology, 28(3), 287–298. doi:10.1037/a0036709

Required Media

-Bruce, T. & Jongsma, A. (Producers). (n.d.) Evidence-based treatment planning for obsessive compulsive disorder [Video file]. Mill Valley, CA: Psychotherapy.net.

Optional Resources

-Himle, J. A., Chatters, L. M., Taylor, R. J., & Nguyen, A. (2013). The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment. Spirituality in Clinical Practice, 1(S), 53–70. doi:10.1037/2326-4500.1.S.53

-Wheaton, M. G., Rosenfield, D., Foa, E. B., & Simpson, H. B. (2015). Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder: What moderates improvement? Journal of Consulting and Clinical Psychology, 83(5), 926–937. doi:10.1037/ccp0000025
Week 5 Assignment 1 Captain of the Ship

Obsessive Compulsive

SSS University

Nurs 5555: PMHNP Role II

Dr. Jack Taa

January 10, 2017

Obsessive Compulsive Disorder (OCD) is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions (Sadock, Sadock, & Ruiz, 2014). These recurring obsessions or compulsions cause severe distress to the person. An obsession is a recurrent and intrusive thought while a compulsion is a conscious, standardized, recurrent behavior. The purpose of this paper is to explore management strategies of OCD in adult clients. As the PMHNP, I will discuss a case and recommend treatment modalities, medical management, follow-up plan and collaboration in the care of a client with OCD.

History of present illness (HPI) and Clinical Impression

HPI: K. K. a 22 yo CF referred for a psychiatric evaluation by her PCP. Karen reports a complaint of “I need help, I can’t keep a job because of these rituals I have.” She reports that she cannot maintain a job because of her rituals of checking locks. Karen has recurrent thoughts that she had left the door of her apartment and car unlocked. She reports leaving work several times daily to check the locks on both her car and apartment. Additionally, because she often had the thought that she had not locked the door to the car, it was difficult for her to leave the car or apartment until she had repeatedly checked that it was secured causing her to be late for work. She has been fired several times for tardiness and poor attendance however checking the locks decreases her anxiety about security. Karen denies any medical issues and is not currently taking any medications. She also denies the use of any alcohol, tobacco or illicit drugs. Reports a family history of depression in both maternal and paternal grandmothers. Karen recognizes that she is needs help and is eager to begin treatment.

Assessment: A healthy, well-groomed 22yo CF in no acute distress. A, A&Ox4, pleasant and appropriately dressed. Makes good eye contact however mood is depressed with a flat affect; recent and remoter memory are intact. Karen’s thoughts are circumstantial and preoccupied with obsessions and compulsions. Her insight and judgment are fair. Denies SI/HI/AVH.

Clinical Impression: Based on the diagnostic criteria in APA (2013), a diagnosis of OCD is made.

Psychopharmacology

If the patient’s symptoms cause a significant impairment in function or distress, treatment is recommended (Fenske and Petersen, 2015). Based on Karen’s report of losing several jobs because of tardiness and attendance, there is a significant impairment in social and home functionality. Karen also reports that her rituals cause her significant distress. The standard approach is to start treatment with an SSRI or clomipramine and then move to other pharmacological strategies if the SSRI is not effective (Sadock, Sadock, & Ruiz, 2014). I will initiate Prozac 40mg oral daily as it is Food and Drug Administration (FDA) approved for treatment of OCD (Stahl, 2014). I will have the patient return to clinic in week to assess for tolerability and increase to the suggested 80mg oral daily. Higher dosages have often been necessary for a beneficial effect (Stahl, 2014). I prefer to initiate with an SSRI (Prozac) as opposed to tricyclic (Clomipramine) for the less troubling adverse effects associated with Clomipramine. Karen will be informed that she might experience sleep disturbances, nausea, diarrhea, headache and anxiety which are all adverse effects of SSRIs. The desired outcome of pharmacotherapy is to reduce the patient’s intrusive thoughts that cause the compulsions that interfere with her home and work life. Well controlled studies have found that pharmacotherapy, behavior therapy, or combination of both is effective in significantly reducing the symptoms of patients with OCD (Fenske and Petersen, 2015).

Psychotherapy

Some studies indicate that behavior therapy is as effective as pharmacotherapies in OCD and some indicate that the beneficial effects are longer lasting with behavior therapy (Sadock, Sadock, & Ruiz, 2014). Many clinicians consider behavior therapy the treatment of choice for OCD and also because it can be conducted in both outpatient and inpatient settings. With the prinicpal behavioral approaches being exposure and response prevention, patients must be committed to improvement as Karen is. Behavior therapy will be initiated the same week as pharmacotherapy. The goal of therapy is to change the client’s behavior to reduce dysfunction and to improve her quality of life. A psychotherapist will be consulted to intiate and manage therapy sessions.

Medical Management

I will consult with Karen’s PCP for updates and additional concerns. Since she has been with her PCP for more than 5 years, he has good insight into her life. We will discuss baseline labs such as CBC, CMP, TSH, hepatic panel. Since with SSRIs, nausea, headache dry mouth and diarrhea are common side effects, monitoring the patient’s electrolytes is important. I would also recommend an EKG for baseline and follow up after medication initiation as SSRIs can lengthen the OT interval in otherwise health people (Sadock, Sadock, & Ruiz, 2014). Community resources such as the local chapter of the OCD Foundation will be provided to Karen for support services.

Follow -up Plan and Collaboration

Karen was instructed to follow up in 1 week to monitor tolerability and compliance of medicaiton and dose adjustment. Subsequently, she will return every 4 weeks for medication management. She is also instructed to begin behavior therapy the same week as medication are initiated and to follow up weekly for therapy sessions. I will consult with the therapist weekly for updates and any concerns or questions. I will reiterate and reinforce to both the PCP and therapist the importance of monitoring for suicidal ideations as the patient is taking an antidepressant and abuptly stopping will increase risk of suicide. About one-third of patients with OCD have major depressive disorder, and suicide is a risk for all patients with OCD (Sadock, Sadock, & Ruiz, 2014).

Conclusion

A poor prognosis is indicated by Karen yielding to rather than resisting compulsion or the need for hospitalization. A good prognosis for Karen is indicated by good home, social and occupational adjustment. The importance of an interdisciplinary team including PCP, therapist and other ancillaries will benefit the client for a better quality of life.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Fenske, N. & Petersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management. American Family Physician, 92(10): 896-903. Retrieved from http://www.aafp.org.afp

/2015/1115/p896.html

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer

Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Course Project: Introduction to Course Project

Evidence-based practice involves a great deal more than simply reading nursing periodicals on a regular basis. Nurses can take a more proactive approach to evidence-based practice by identifying authentic problems and concerns, and then using that to guide their inquiries into current research. In this way, nurses can connect the results of relevant research studies to their nursing practice.

For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the Course Project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice.

Before you begin, review the Course Project Overview document located in this week’s Learning Resources.

Course Project: Part 1—Identifying a Researchable Problem

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One of the most challenging aspects of EBP is to actually identify the answerable question.

Evidence-based practice nursing essay examples

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.

Evidence-based practice nursing essay examples To prepare:

Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.

Review the section beginning on page 71 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.

Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.

Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.

Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?

Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:

Write a 3- to 4-page Evidence-based practice nursing essay examples paper that includes the following:

A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

The 5 questions you have generated and a description of how you analyzed them for feasibility

Your preliminary PICOT question and a description of each PICOT variable relevant to your question

At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

By Day 7

WEEK 5

Course Project: Part 2—Literature Review

This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.

Evidence-based practice nursing essay examples To prepare:

Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.

Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.

Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.

Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Write a 3- to 4-page literature review that includes the following:

A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

Your literature review summary table with all references formatted in correct APA style

wEEK 7

Assignment: Critiquing Quantitative, Qualitative, or Mixed Methods Studies

Critiquing the validity and robustness of research featured in journal articles provides a critical foundation for engaging in evidence-based practice. In Weeks 5 and 6, you explored quantitative research designs. In Week 7, you will examine qualitative and mixed methods research designs. For this Assignment, which is due by Day 7 of Week 7, you critique a quantitative and either a qualitative or a mixed methods research study and compare the types of information obtained in each.

Evidence-based practice nursing essay examples To prepare:

Select a health topic of interest to you that is relevant to your current area of practice. The topic may be your Course Portfolio Project or a different topic of your choice.

Using the Walden Library, locate two articles in scholarly journals that deal with your portfolio topic: 1) Select one article that utilizes a quantitative research design and 2) select a second article that utilizes either a qualitative OR a mixed methods design. These need to be single studies not systematic or integrative reviews (including meta-analysis and metasynthesis). You may use research articles from your reference list. If you cannot find these two types of research on your portfolio topic, you may choose another topic.

Locate the following documents in this week’s Learning Resources to access the appropriate templates, which will guide your critique of each article:

Critique Template for a Qualitative Study

Critique Template for a Quantitative Study

Critique Template for a Mixed-Methods Study

Consider the fields in the templates as you review the information in each article. Begin to draft a paper in which you analyze the two research approaches as indicated below. Reflect on the overall value of both quantitative and qualitative research. If someone were to say to you, “Qualitative research is not real science,” how would you respond?

To complete this Assignment:

Complete the two critiques using the appropriate templates.

Write a 2- to 3-page paper that addresses the following:

Contrast the types of information that you gained from examining the two different research approaches in the articles that you selected.

Describe the general advantages and disadvantages of the two research approaches featured in the articles. Use examples from the articles for support.

Formulate a response to the claim that qualitative research is not real science. Highlight the general insights that both quantitative and qualitative studies can provide to researchers. Support your response with references to the Learning Resources and other credible sources.

As you complete this Assignment, remember to:

Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

Combine all three parts of this assignment into one Word document including both critique templates and the narrative with your references. Submit this combined document.

week 10

Evidence-based practice nursing essay examples Course Project

By Day 7

Submit your Course Project. Reminder: You will combine Parts 1, 2, and 3 of your Course Project (assigned in Weeks 2, 4, and 8 respectively) into one cohesive and cogent paper.

Note: In addition, include a 1-page summary of your project.

For this final iteration you will need to:

Submit your Evidence-based practice nursing essay examples paper to Grammarly and SafeAssign through the Walden Writing Center. Based on then Grammarly and SafeAssign reports, revise your paper as necessary.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

Note: The Course Project will be your Portfolio Assignment for this course.

Evidence-based practice nursing essay examples Submission and Grading Information

To submit your completed Evidence-based practice nursing essay examples Project for review and grading, do the following:

Please save your Project using the naming convention “WK10Proj+last name+first initial.(extension)” as the name.

Click the Week 10 Project Rubric to review the Grading Criteria for the Project.

Click the Week 10 Project link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Proj+last name+first initial.(extension)” and click Open.

If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.

Click on the Submit button to complete your Evidence-based practice nursing essay examples submission.

I was christened as a Christian four years ago I was a Christian My grandma and aunt are Christians I started out as a church member with them and later I learned the Bible I feel full of love for everything I want Learning to decide to become a Christian I am grateful to my grandma Yes He made me realize that the Christian faith has really changed me Many of the things that make me from timid to become cheerful and confident. I used to be afraid of myself or my family flying, but since I became a Christian, I began to pray, there is no fear. I think every good thing I do God knows I thank my family

source..

Explain how the practice of medicine is becoming increasingly complex. What does it mean for the amount of information people working in clinical settings are expected to know? How can technology be used to educate and update employees on the changing requirements for healthcare professionals?

Just a paragraph or two will do. Thank you

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Written assignment of 2500 words
Students are asked to outline a case example, involving a person they have worked with, or are currently working with; with a focus on social factors in the lives of the person identified. Students need also to reflect on how they facilitated and enabled the individual towards the optimum of their self-care/self-management, with a focus on social need. The work must include the following:
An introduction;
A description of what occurred;
Discussion of social factors according to the experiences of the
service user;
A conclusion;
The use of relevant literature

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Why Choose US

6+ years experience on custom writing
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