Discuss the correlation between nursing education and positive patient outcomes. Include current research that links patient safety outcomes to advanced degrees in nursing. Based on some real-life experiences, explain whether you agree or disagree with this research. 

Please see attached instructions 

Monica Cooper (6052) Week 8 /Module 5 – Initial Posting by Monica M. Cooper: Patient Preferences and Decision Making

I previously managed a weight loss prevention program at a long-term care facility for three years.  Considering that weight loss is one of the most significant risk factors for mortality amongst older adults, patient interventions were implemented, received, and revised to ensure optimum patient outcomes.  The Registered Dietitian would recommend patients who were experiencing weight loss to have all meals served in the formal dining rooms vs. their private rooms.  Incorporating this invention had positive benefits such as close supervision and meal consumption monitoring, but it completely removed all autonomy from the patients.  As stated by Lindberg et al. 2018, it is a moral duty for staff to be more attentive to their personal traits, conditions, and wishes, generating opportunities for patients to be more participatory and with greater potential to influence their care.

The patient preference I suggested to the interdisciplinary team to counter negative consequences was to start an “all hands on deck” approach at mealtimes.  No matter their role or position, every employee was assigned designated units for which rounds were made at each meal.  This approach allowed for increased visibility of patients’ in their living quarters and monitoring meal consumption for all patients and not just for those experiencing weight loss.  The patients were happy, and so were their families.  Some family members even partook in their loved one’s treatment plan by making intentional visits at mealtimes.  For example, there was one patient whose daughter would visit at breakfast.  Her grandson would visit at lunch and another at dinner.  Meal consumption increased, making including the family a bonus!

According to Latenstein et al. 2020, decision aids present comparative information about the advantages and disadvantages of available options and evaluate the patient’s values and preferences.  They are proven to effectively improve knowledge, reduce decisional conflict, and change patients’ preferred treatment (Latenstein et al., 2020).  While decision aids do not assure compliance to treatment, they present a realistic overview of personalized guidelines for condition management. 

I chose the Malnutrition: Options to Limit Weight Loss in Older Adults decision aid (OHRI, 2019).  The aid’s value is relatively practical as it offers general information and specific recommendations based on preference.  I could not apply it to the exact experience I described; however, I completed it for myself as my eating habits are not satisfactory.  My appetite fluctuates depending on high busy I am.  I usually skip breakfast, and other days I only eat one meal.  After exploring my options, I made an informed choice to incorporate oral nutritional supplements into my diet.  They can be taken as a liquid supplement or as fortified food once or twice a day, between meals.

I might use this decision aid inventory further in my personal life by sharing it with friends who also struggle with meal imbalances.  I do understand that it is unhealthy to skip meals as it increases fatigue and other health concerns.  The decision aid helped me have a starting point to rectify my poor eating habits, and I think it would be beneficial to others.

Latenstein, C. S. S., Thunnissen, F. M., Thomeer, B. J. M., Wely, B. J., Meinders, M. J., Elwyn, G., & Reuver, P. R. (2020). The association between patients’ preferred treatment after the use of a patient decision aid and their choice of eventual treatment. Health Expectations, 23(3), 651–658. https://doi-org.ezp.waldenulibrary.org/10.1111/hex.13045

Lindberg, C., Fagerström, C., & Willman, A. (2018). Patient autonomy in a high‐tech care context—A theoretical framework. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 27(21–22), 4128–4140. https://doi-org.ezp.waldenulibrary.org/10.1111/jocn.14562

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/

Tiffany Dennis

main post

Being a mental health nurse, I have often found myself being the patient advocate because some healthcare workers believe that patients with mental illnesses do not have the same right as patients being treated in the hospital for any other medical reason. Evidence-based medicine (EBM) and shared decision making (SDM) should co-exist; however, this concept is not appreciated. SDM is the clinician and patient process jointly participating in a health decision after discussing the options, the benefits, and harms, and considering the patient’s values, preferences, and circumstances (Hoffmann et al., 2014). Sadly, this is the first time I have heard of decision aids, and I have been a nurse for 13 years. Position aids are used to increase a patient’s knowledge of options, improve awareness concerning medication and non-medicinal options; it provides a sense of comfort and control for patients (Melnyk & Fineout-Overholt, 2018). Often in an acute psychiatric setting, we receive patients in acute psychosis or mania. When the patient is in a state of mind, it is challenging to discern between reality and delusions.

One time I remember a very physically fit and robust patient arriving at the unit out of control. The drug of choice in this situation was to administer a Thorazine injection stat. The patient kept yelling; I cannot take that; I cannot take that. I am allergic to that medicine. Of course, the nurse assumed the patient was lying and did not want to be sedated; therefore, the medication was given regardless after a glance to make sure that the medicine was not an allergy listed on the transfer paperwork. Within minutes after the injection, the patient had an adverse reaction. Once the nurse had the opportunity to look over the patient’s history, Thorazine was listed as an allergy with a severe reaction. In this particular situation, if the nurse would have just taken a little longer to research or allow the patient to speak and validate the patient concerns and contact the physician for another medication, perhaps the patient would not have required a higher level of care and lapse in the treatment of the acute mental illness. It is vital to include patient preferences and values while providing nursing care.

Especially in mental health because most of the time, patients are admitted on an involuntary basis. Allowing the patient to be a part of the treatment and hearing a doctor’s reasoning behind medication changes could improve medication compliance. I did not find a decision aid for Schizophrenia, but I did see one on Bipolar II. The Bipolar II decision aid is broken down into three main sections, medications, psychological options, and making decisions. It is designed to help patients and their families decide about treatment and prevent relapse (Bipolar II DECISION AID, 2019).  A rule of thumb that has stuck with me since nursing school is that if a patient questions a procedure, medication, or statement, “this is not what I usually take,” is always to pause, re-look, and double-check. I can utilize these positions aids to help educate patients and also as resources during nursing education groups.

References

Bipolar II DECISION AID. (2019). The Ottawa Hospital Research Institute. Retrieved October 20, 2020, from https://www.bipolardecisionaid.com.au/guideline/introduction.html

Hoffmann, T., Montori, V., & Del Mar, C. (2014). The Connection Between Evidence-Based Medicine and Shared Decision Making. Journal of the American Medical Association, 312(13), 1295–1296. https://doi.org/10.1001/jama.2014.10186

Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

3 SOURCES ON EACH DISCUSSION

Instructions for DQ Replies to 3 DQS

DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.

1- Each reply should be at least 200 words.

2- Minimum One scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA 6th edition style needs to be followed.

4- Each response should have reference at the end of each reply

5- Reference should be within last 4 years

Discussion: Clinical Supervision

In Week 3, you collaborated with colleagues as you participated in your first clinical supervision. This week, you have the opportunity to continue your collaboration as you reflect on and discuss your experiences with counseling children and adolescents in group settings. Psychotherapy with these clients is often more complex than psychotherapy with the general adult population. Personal reflection and discussion with colleagues are essential to your development and success as a psychiatric mental health nurse practitioner. For this clinical supervision, consider a child or adolescent client you are counseling who you do not think is adequately progressing according to expected clinical outcomes.

Learning Objectives

Students will:

• Assess clients presenting for child and adolescent group psychotherapy
• Evaluate the effectiveness of therapeutic approaches for clients receiving child and adolescent group psychotherapy

To prepare:

• Review this week’s media and consider the insights provided on group therapy with children and adolescents.
• Reflect on a child and adolescent group that you are currently counseling at your practicum site.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

Note about Uploading Media: Refer to the Kaltura Media Uploader instructions document located in the menu bar. It provides guidance on how to upload media for the Clinical Supervision Discussions.

By Day 3

Post a 3- to 5-minute Kaltura video that addresses the following:

• Describe a child and adolescent group you are counseling.
• Describe a client from the group who you do not think is adequately progressing according to expected clinical outcomes. Note: Do not use the client’s actual name.
• Explain your therapeutic approach with the group, including your perceived effectiveness of your approach with the client you identified.
• Identify any additional information about this group and/or client that may potentially impact expected outcomes.

Note: Nurse practitioners must have strong oral communication skills. This Discussion is designed to help you hone these skills. When filming your Kaltura video, be sure to dress and speak in a professional manner.

I need a response for the following peer

Breast Lump Case Study

The case involves a 37-year-old woman, gravida 2 para 2, who presents to the clinic with a chief complaint of a lump in her left breast. Her family is positive for breast cancer. Both children, aged 9 and 7, are alive and delivered without complications. She has a healthy weight (BMI 22), and does not smoke, but drink a glass of wine most evening with supper. She has regular physicals and is up to date with smears. A physical examination revealed a firm lump near the surface with no masses. The lump was aspirated, removing an opaque liquid. The aspiration vanished the lump. 

The most probable diagnosis is a breast cyst. Cysts are formed by the accumulation of fluid inside the breast glands. A majority of cystic lesions are benign while the majority of solid lesions are malignant. Most breast cysts are small (5 mm to 20 mm) and painless. They are strongly influenced by hormones and are common in women of childbearing age. While a breast cyst is palpable, it can be confused with a solid mass. Therefore, one of the fundamental approaches is a fine-needle aspiration biopsy. The aspirated fluid does not contain blood or other cystic components. However, if it contained blood, it would have been critical to send the fluid for cytology and consultation from a surgeon. 

Further evaluation of the breast lump or mass is guided by findings on history, physical examination, imaging, and biopsy. In this case, a triple test of clinical breast exam, ultrasonography, and needle biopsy may be necessary to find a definitive diagnosis. Based on the extent of clinical suspicion, the practitioner should order mammography before a pathologic diagnosis. Mammography is essential in the evaluation of palpable lesions. However, if the lump is suggestive of a fibroadenoma by ultrasound and mammography, short-term follow-up and re-imaging are essential. Fibrocystic changes present on a mammogram as round or oval, well-defined masses. A biopsy is also necessary to identify whether the cysts are malign. Complex cysts with both fluid and solid matter necessitate biopsy (Brown, Phillips, Slanetz, Fein-Zachary, Venkataraman, Dialani & Mehta, 2017). The fine needle aspiration provides sufficient cellular material to facilitate adequate cytologic evaluation. However, core biopsy is recommended because it uses a large cutting needle that allows the collection of tissues suitable for histologic analysis that is familiar to most pathologists. 

Breast cysts do not increase the risk of breast cancer. According to Lin, Peng, and He (2018), cysts, including complex cysts have a low risk of breast cancer. However, benign breast diseases (BBD) are not life-threatening, some may increase the risk of breast cancer. Cysts are classified as non-proliferative disorder and their absolute risk of causing cancer is estimated to be 2% (Stachs, Stubert, Reimer & Hartmann, 2019). Etiologically, cysts are associated with fibrocystic changes. More than 50% of women develop symptomatic fibrocystic changes in their lifetime. Fibrocystic changes are caused by hormonal changes and are common in women between 20 and 59 years. Breast cancer risk factors are numerous and diverse, including age (65 years and above), atypical hyperplasia, history of early-onset breast cancer, high postmenopausal endogenous estrogen, and high-dose radiation to the chest. 

However, it is important to consider her family history of breast cancer. A hereditary predisposition to breast cancer increases the risk of developing breast cancer at a younger age. Therefore, early identification of patients with a hereditary predisposition is vital to exploit the numerous opportunities provided by enhanced surveillance, chemoprevention, and risk-reducing surgery. Patient can be counseled on breast self-examination and a follow-up schedule established. Follow-up is critical in detecting missed cancer. During the follow-up, it is fundamental to evaluate recurrent masses or fluid.

Need Help. Please Follow Rubric 

 How does mentoring facilitate the networking process? Discuss this from the perspective of a mentor, and from the perspective of a mentee. PLEASE INCLUDE IN-TEXT CITATION AND REFERENCE

Have you ever been involved in a lease-or-buy decision at work? In your personal life?

Please describe this situation and be sure to include the following information:

• How did you approach making this decision? 
• What factors went into making the decision to lease or to buy?
• In hindsight, do you think that you made the right decision? 
• Do you think that you made the cost effective decision?

The benefits, concerns, and challenges of a systems approach offers the practice scholar several ways to view a health problem. Select a practice problem within your unique setting and consider the following.

• Describe the selected problem from two of the three systems levels (micro-, meso-, and macro).
• Explain how the outcomes of one system level effect the other level?
• How is a systems approach beneficial in improving healthcare quality and safety?