Archive for month: August, 2019

The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering. It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches.

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

“Captain of the Ship” – Depressive Disorder

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.

Learning Objectives

Students will:

· Recommend psychopharmacologic treatments based on therapeutic endpoints

for clients with depression disorders

· Recommend psychotherapy based on therapeutic endpoints for clients with

depression disorders

· Identify medical management needs for clients with depression disorders

· Identify community support resources for clients with depression disorders

· Recommend follow-up plans for clients with depression disorders

Assignment (Project)

To prepare for this Assignment:

Select an adult or older adult client with a depressive disorder you have seen in your practicum.

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

Describe the HPI and clinical impression for the client. Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints 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 including PCP or medical provider

Tip for the Assignment

This week assignment, you will ‘captain the ship’ you are the provider and writing the diagnostic work-up and treatment plan for a patient with DEPRESSIVE DISORDER. You will develop plans for a patient that you have worked with in your practicum.

A few comments about the ‘Captain of the Ship’ assignment. The spirit of the assignment is that you are directing the client’s care, not simply writing a paper about depressive disorder. When you are the team leader, it’s important to provide authoritative direction for other providers. In your treatment plan, it’s good to outline your collaboration with client’s other providers. Later in the quarter, you will have another opportunity to complete ‘Captain of the Ship’ project.

I have attached an excellent example of a different Captain of the Ship project with this assignment and. Note that this assignment is on depressive disorder, not on Obsessive Compulsive.

riginal work, proper reference and in-text citation with the use of subheadings. Also proper grammar and English

Directions:

Compose a 1,000-1,250 word reflective analysis incorporating your personal philosophy of nursing including the following core elements:

1. What is your central belief about the individual person?

2. How does your personal worldview influence your approach to patients?

3. What constitutes the environment?

4. How do the individual and the environment interact?

5. What is your view of health?

6. How does illness relate to health?

7. What is the central reason for the existence of nursing

In addition to Journal Entries, SOAP Note submissions are a way to reflect on your Practicum experiences and connect these experiences to your classroom experience. SOAP Notes, such as the ones required in this course, are often used in clinical settings to document patient care. Please refer to this week’s Learning Resources for guidance on writing SOAP Notes.

Select a patient who you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note:

Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies.

Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.

Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.

Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

Julie has been a nurse at Memorial Hospital for three years. During that time, she has developed productive relationships with her colleagues and has earned a reputation for providing exceptional care to patients. One day she approaches you, her manager, and asks to speak in private. Once you are alone, Julie explains that over the past couple of months she has heard a physician and two nurses repeatedly make disparaging remarks about people who are homosexual. She appears visibly upset as she tells you this. Julie says that the situation has become so uncomfortable that she no longer feels safe in this environment.Does this scenario reflect a possible case of sexual harassment? How would you respond to Julie, and what steps might you take next?

Sexual harassment is an important topic in today’s organizations–one that is often addressed through HR presentations and trainings. However, even for experienced nurse managers and HR professionals, it can be challenging to recognize some of the behaviors and actions that may indicate sexual harassment. Nurses in leadership and management positions have a critical responsibility to become attuned to the various interactions that can be problematic, including inappropriate remarks and jokes, improper fraternization, quid pro quo situations, and potentially offensive images.

To prepare

Review the articles, “Sexual Harassment – A Touchy Subject for Nurses,” “Why Are Nurses Leaving? Findings from an Initial Qualitative Study on Nursing,” and “Bullying, Harassment, and Horizontal Violence in the Nursing Workforce.” Consider sexual harassment situations most commonly experienced by nurses.Think about a work environment with which you are familiar. Have you witnessed or experienced any behaviors that–perhaps with the benefit of hindsight and increasing awareness–may be construed as sexual harassment, even if you did not think of them that way at the time? Do you recall any instances in which you might have intentionally or unintentionally contributed to or participated in an environment that tolerated harassment against one or more individuals? If so, what were your thoughts and feelings at the time? How, perhaps, has your perspective since shifted?Select one of the following options:

Option 1: Conduct research via the Walden Library, or other scholarly sites, to select an article that presents an authentic example of workplace sexual harassment.

Option 2: Identify an authentic example of suspected or proven sexual harassment from your professional experience.Conduct research related to your selected example to assess the ramifications that may result from instances of sexual harassment.

Consider how you could partner with HR to mitigate situations of sexual harassment in your workplace. In addition, think about specific steps you could take to diminish inappropriate behaviors in the workplace.

Submit a 3- to 5-page paper in which you do the following:

Describe an authentic example of suspected or proven sexual harassment.

Explain how this specific instance of sexual harassment impacted the workplace.Identify at least two legal ramifications that could have (or did) result from this situation and how they could (or did) negatively impact the workplace.

Briefly explain other ramifications (e.g., organizational culture, staff relationships, individual and team performances, patient safety, quality of care) that could have (or did) result because of this specific instance.Describe the actions that were taken to resolve the situation, if applicable.Formulate an action plan that can be used to mitigate and/or ameliorate behaviors that constitute sexual harassment.

Based on your example, explain how you would educate staff on the identification and prevention of inappropriate behaviors. Describe at least two specific steps you would take to diminish similar sexual harassment situations.Describe at least two ways you could partner with HR to effectively accomplish your action plan.

NOTE:

For the purposes of this assignment, please do not reveal the name of your workplace or the individuals involved.Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Required ReadingsLussier, R. N., & Hendon, J. R. (2016). Human resource management: Functions, applications, & skill development (2nd ed.). Thousand Oaks, CA: Sage Publications. Chapter 3, “The Legal Environment and Diversity Management” (pp. 78–117) Chapter 3 provides an in-depth overview of the laws that mandate equal employment opportunities in the workplace. The authors define discrimination and sexual harassment and explain how knowledgeable managers can detect and mitigate these behaviors in their workplaces.Cogin, J., & Fish, A. (2009). Sexual harassment – A touchy subject for nurses. Journal of Health Organization and Management, 23(4), 442–462. Retrieved from the Walden Library databases. This article describes a mixed-methods research study that was conducted to analyze the prevalence of sexual harassment in clinical settings. Findings indicated that patients and physicians are the primary instigators of sexual harassment. The article highlights ethical decision making and intervention techniques.MacKusick, C. I., & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. Medsurg Nursing, 19(6), 335–340. Retrieved from the Walden Library databases. For this study, the researchers interviewed nurses who decided to leave the profession after only a few years of service. Study participants commonly cited one or more of the following reasons for leaving: unfriendly workplace (i.e., bullying and/or sexual harassment), emotional distress, and fatigue and exhaustion. Participants shared authentic examples and feelings about each factor.Vessey, J. A., DeMarco, R., & DiFazio, R. (2010). Bullying, harassment, and horizontal violence in the nursing workforce: The state of the science. Annual Review of Nursing Research, 28, 133–157. Retrieved from the Walden Library databases. Over the years, bullying, harassment, and horizontal violence (BHHV) among nurses has increased in health care settings. The authors of this article illustrate BHHV situations and solutions through the use of models and authentic example