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Evidence Based Practice Research Paper Diabetes Mellitus

Introduction

Problem Description

            Diabetes Mellitus (DM) is a common chronic metabolic condition that manifests majorly as hyperglycemia and results from insulin sensitivity or impaired production of insulin by the pancreatic beta cells. The risk factors for DM can be classified into both modifiable and non-modifiable. American Diabetes Association [ADA] (2019) lists the modifiable risk factors like tobacco, alcohol, physical inactivity, obesity/overweight, impaired fasting glucose/impaired glucose tolerance, and dyslipidemia. Contrarily, the non-modifiable risk factors include a family history of DM, ethnicity, hypertension, age >40 years, and previous gestational diabetes (ADA, 2019). Management of DM encompasses both lifestyle interventions and pharmacological therapy. In some cases, despite the recommended therapy, the blood sugar levels remain elevated, a condition referred to as uncontrolled diabetes. Various randomized controlled trial studies have, in an attempt to define uncontrolled diabetes, used hemoglobin A1C (HbA1C) levels as the rationale. Orozco-Beltran et al. (2017) define uncontrolled diabetes as HbA1C ?8%. However, in this paper, we will use a cutoff HbA1C of >9% to define uncontrolled diabetes.

Uncontrolled diabetes is a significant cause of worry to the public health due to the high risk of developing complications and increased health needs among the patients. According to the CDC (2020) reports on DM morbidity, 34.2 million Americans have diabetes, approximately 1 in 10. This is not different from the global prevalence where it is estimated that 1 in 11 adults have DM (CDC, 2020). Annually, over 1-million deaths are attributed to DM and have been ranked the 9th leading cause of mortality worldwide (CDC, 2020). Further, significant expenditures are incurred towards the management of DM and its related complications. In the United States, it is estimated that $327 billion is incurred annually to manage DM (CDC, 2020). Studies have not explored the epidemiology of uncontrolled DM; however, it is expected that uncontrolled DM burden surpasses that of well-controlled DM. Following the significant morbidity, mortality, and economic strain, DM is an important public health concern that must be addressed. Further, due to the admissions and increased demands for emergency care of patients with uncontrolled DM, and being conscious of the role of advanced practice nurses in care delivery, the condition increases the burden of advanced practice care.

Population, Intervention, Comparison, Outcome (s) and Time (PICOT)

            The PICOT question is as follows: In primary care patients with uncontrolled diabetes (HbA1c>9%) how does virtual telemedicine outreach compared to a telephonic outreach with a case manager influence diabetes control over the next 6 months? The population (P) consists of primary care patients with uncontrolled diabetes (A1C>9. Such patients have increased risks for complications and comorbidities; therefore, appropriate interventions must be established to reduce morbidity and mortality. The intervention (I) proposed in this paper is the use of telemedicine. Wootton (2012) defines telemedicine as the use of information and communication technologies to provide care to patients in remote areas. It can be synchronous-the use of live videoconferencing or asynchronous where information, for example, vital signs are entered, stored into e-health portals, and transmitted from home to the hospital information system (Wootton, 2012). The primary objectives of telemedicine in supporting the care of chronic conditions include intervention teaching, health education, transfer of health data, and facilitating follow-up of patients (Wootton, 2012).

The comparative © intervention is telephonic outreach. This involves making telephone calls to reach distant patients who are unable to have in-person visits (Orozco-Beltran et al., 2017). HbA1C levels are the primary outcomes (O) in this case. HbA1C is used to determine glycemic control in the past 3 months and the risk for diabetes-related complications. Current assays consider HbA1C less than 5.7% as normal while above 6.4% used as a diagnostic criterion for DM (ADA, 2019). For most patients with Type 2 DM, evidence-based guidelines recommend clinicians maintain the HbA1C levels between 7% and 8% (ADA, 2019). Values above 8% despite the therapeutic interventions herald the diagnosis of uncontrolled diabetes (Orozco-Beltran et al., 2017). Watt et al. (2021) however define uncontrolled diabetes as HbA1C >9% (75mmol/l), the values adopted in this paper. Besides the HbA1C levels, quality of life, rates of admission, number of emergency unit visits, and mortality rates can be used to compare the productiveness of the two interventions. A period of 6 months (T) is set to determine the influence of telemedicine on HbA1C as compared to the telephonic approach. In this paper, data has been extracted and synthesized from 16 articles regarding the use of telemedicine in the management of uncontrolled diabetes.

Literature Search Methods

            Research methodology refers to the process of collecting data and analyzing the data. This process shows how data was collected, the methods used for collecting data, and how data is interpreted to give it meaning. For this particular research, data was obtained from secondary sources. To achieve this, I established the key words in the PICOT question and the supportive research questions, and run them through different databases, among the CINAHL, EBSCO, PubMed, Medline, and Google Scholar. I then filtered the results based on relevance, recency and accuracy. Across all platforms, the cumulative search results gave more than 200 resources, out of which 29 were eventually screened for relevance to this study. The research aims to find out if a virtual telemedicine outreach in comparison to a telephonic outreach with a case manager does influence diabetes control over 6 months period. Thus, the PICOT question is: In primary care patients with uncontrolled diabetes (A1c>9%) how does virtual telemedicine outreach compare to a telephonic outreach with case manager influence diabetes control over the next 6 months?

Findings

            For the past 20-years, copious amounts of research have been done surrounding the use of telemedicine in the management of chronic conditions. The process has however been slow due to a group of scholars who think that close interaction with the patient (face-to-face) is superior to remote monitoring. Nevertheless, the evidence available shows that telemedicine contributes massively to the management of chronic conditions such as diabetes, COPD, and heart failure.

Orozco-Beltran et al. (2017) researched to determine the role of telemedicine in the management of primary care patients with chronic conditions (diabetes, COPD, heart failure, and hypertension). The impetus for this was the changing population demographics (increasing aging population), the rise in chronic conditions prevalence, and the increased need for care models that are compatible with home care. Commonly used interventions compatible with home care are telemedicine and telephonic support; however, their effectiveness is not equal. Before the intervention, essential telemedicine equipment was distributed to the participants for self-monitoring. Among them include glucometers, blood pressure monitors, pulse oximeters, and weight scales. In addition to videos that instructed them on the use of the instruments, the patients were fully equipped. The spectrum of telemedicine as regards the research included entering vital signs into the e-health portals, and an alarm system that detects any alteration in the data entered. The alarm would therefore prompt the care team’s reaction and in return, intervention and health education would ensue. For a seamless transfer of data and interpretation, each patient had a unique e-health record and an identifier. Following the receipt of the information by the care team, a nurse would decide whether to make a call, go to the patient’s house, scheduled for a face-to-face visit or consult their seniors.

During the 1-year intervention, 521 participants completed the study. The majority of them were elderly, averagely 70.4 years; this proves that chronic conditions have a predilection for the aged population. The post-program analysis found that the intervention had a significant impact on weight loss, blood pressures, heart rate, and HbA1C levels. At the end of the study, while leveraging telemedicine technologies, the number of people who had ?8% HbA1C levels had reduced by 44% (Orozco-Beltran et al., 2017). A similar study by Watt et al. (2021) underpins the reduction in patients’ HbA1C levels after a virtual diabetic program. The study by Watt et al. (2021) explores the significance of a sustainability transformation program (STP) in promoting foot care and reducing risks of amputation among diabetic patients. The STP consists of primary care, face-to-face multidisciplinary foot (MDFT) care, a virtual MDFT, and community podiatry. At the beginning of the study which took 6-months, the weight and HbA1C ranges were as follows: 99.4 ± 25 Kg and 59.3 ± 16 mmol/l respectively.  At the end of the study, the weight and HbA1C ranges measured as follows: 95.5 ±24.2 Kg and 54.8 ±12.9 Mmol/l respectively. A different study by Meneghini et al. (1998) has almost the same findings; HbA1C decreased by 0.8% and 0.9% after a 6-month and a 12-month intervention respectively. From the study by Watt et al. (2021), it is evident that both weight and HbA1C levels decreased moderately after the 6-month duration of an STP program to diabetic patients. Cahn et al. (2018) underpin that virtual diabetic programs only cause a modest reduction in HbA1C but with increased patient satisfaction. Besides the virtual MDFT care, the community had a website and a Facebook page that facilitated interaction between the care team and the diabetic patients. Well-controlled diabetes, marked by a reduction in HbA1C levels decreases complications such as diabetic foot and therefore reduces the risks for amputation (Thomson et al., 2021; Watt et al., 2021). Even though specific statistics regarding the readmission rate and the mortality rates post the telemedicine projects are unavailable, Orozco-Beltran et al. (2017) estimate that Tele-monitoring has reduced readmission by 28% and mortality by 24 % among patients with chronic conditions. Contrarily, telephonic outreach has not caused a significant impact on the management of chronic conditions; however, studies report that it reduces mortality due to relapses in patients with heart failure and diabetes (Kelley et al., 2020; Orozco-Beltran et al., 2017).

Despite the significance of technology in the management of chronic conditions, its use is affected by the patients’ geographical location, access to the internet, education level, and patient knowledge regarding information communication technology (ICT). According to Itamura et al. (2020) research on the uptake of virtual visits in the otolaryngology department during the COVID-19 pandemic, patients report difficulty in communication with the care providers while using the telecommunication devices; others mentioned the audio-video lag and the server speed. To minimize the digital divide attributed to lack of knowledge on ICT, the project team educated the participants regarding the use of software applications and Tele-monitoring devices (Emerson et al., 2015; Orozco-Beltran et al., 2017; Watt et al., 2021; Wootton, 2012). Further, the patients received contact details from the companies where the hardware and the software were procured. Even though telemedicine benefits outweigh that of telephonic outreach in terms of HbA1C control, readmission rates and mortality, the Luddites and the majority of the elderly would prefer telephone calls due to ease of use and lack of complex technologies required (Huygens et al., 2016; Orozco-Beltran et al., 2017; Watt et al., 2021; Wootton, 2012).

The current increased use of telemedicine devices is attributed to the COVID-19 pandemic. Despite the guidelines established by the World Health Organization and various governments such as the restriction of movement, social distancing, and the stay at home, care must continue. This is therefore a timely opportunity to leverage technology in the care of vulnerable populations. Telemedicine interventions ensure care continuity even with the stay-at-home and social distancing initiatives. Horrell et al. (2020) conducted a study to determine the magnitude of Telemedicine use among patients with chronic diseases during the COVID-19 pandemic. Further, Horrell et al. (2020) examined the causal relationship between socio-demographic characteristics and telemedicine use. Participants of the study were patients with chronic conditions such as hypertension, COPD, asthma, hyperlipidemia, Type 2 DM, heart failure, HIV, and Alzheimer’s disease. The measure of the Telemedicine engagement was determined by asking the patients ‘yes’ or ‘no’ questions. For instance, have you received any virtual care from your doctor for the last 4-months? Further, the participants were asked how they obtain information regarding COVID-19, their main concerns during the pandemic, and the sources/platforms they use to learn more about the COVID-19 pandemic. The findings revealed that 49% of the 2210 participants had participated in virtual visits with their health care provider; 45% rescheduled or canceled their regular clinic visits and 37% rescheduled or postponed their routine medical check-up. The high number of people (49%) participating in virtual visits can be attributed to the COVID-19 pandemic restrictions which limit movement and encourages people to stay at home. Communication with the care providers occurred via phone (73%) and e-portals (43%); the statistics depict significant embracement of telemedicine.

The socio-demographics affected the telemedicine use in the following ways: more women participated in telemedicine than men; those with higher incomes >$100000/year engaged more than those with <$30000/year; the higher the level of education, the greater the telemedicine use; telemedicine use was more among those <55 years of age and decreased dramatically among people <56 years of age. From the study, there was reported improved quality of life among the patients who continued care via virtual visits as opposed to those who canceled or postponed care to later dates. Among the diabetic patients, improved quality of life was defined by better glycemic control which is determined by the HbA1C levels, and reduced symptoms such as polyuria, polydipsia, and acute complications, for instance, non-ketotic hyperglycemic coma. A similar study by Iyer et al. (2021) underpin that telemedicine improved quality of life, satisfaction, and reduced exposure to COVID-19 among geriatric patients who engaged in virtual visits during the pandemic. Embracement of technology is more among younger patients as compared to the elderly population (Horrell et al., 2020; Iyer et al., 2021; Jain et al., 2020). There is ambivalence towards the use of telemedicine technologies which is attributed to patients’ knowledge of ICT and personal qualities (Dugdale et al., 2020; Jain et al., 2020; Norden et al., 2020; Orozco-Beltran et al., 2017). All the studies, however, in one way or the other, provide enough evidence that telemedicine use in the management of chronic conditions is superior to telephonic outreach. Further, the studies underpin the increased implementation of telemedicine in the management of diabetes especially during the COVID-19 pandemic as this would decrease HbA1VC levels as well as reduce exposure to COVID-19.

Strengths and Limitations

            Following an intensive literature search, the review provides adequate information regarding the influence of telemedicine on the management of diabetes. It differs from the majority of the reviews which explore the effect of telemedicine on chronic diseases in general without distinctiveness. Part of the limitation of the study is that each of the articles was regarded as having equal values. Further, it was difficult to synthesize data from several studies.

Summary

            The use of technology in the management of chronic diseases has been intensively explored by varied researchers. According to Orozco-Beltran et al. (2017), after a 1-year telemedicine program, the number of people with HbA1C levels above 8% reduced significantly by 44%. A similar study conducted by Watt et al. (2021) underpins that a 6-month implementation of a virtual diabetic program moderately reduced HbA1C levels from a range of 59.3±16 to54.8±12.9. Telemedicine acceptance has even increased during the COVID-19 pandemic due to the guidelines on movement restrictions and stay-at-home initiatives (Horrell et al., 2020; Itamura et al., 2020; Iyer et al., 2021). Besides HbA1C levels reduction, other outcomes reported while using telemedicine devices include improved quality of life, patient satisfaction; readmission rates, and reduced mortality (Cahn et al., 2018; Dugdale et al., 2020; Emerson et al., 2015; Horrell et al., 2020). According to Iyer et al. (2021), telemedicine use is limited by a lack of basic ICT knowledge and the elderly population which recommends easier methods to communicate with the care providers. To increase the acceptability of telemedicine, patients and care providers are taught how to operate the telecommunication devices before the commencement of the project (Itamura et al., 2020; Jain et al., 2020; Kelley et al., 2020; Norden et al., 2020; Smart et al., 2021).

Based on the body of evidence extracted from the articles, it is recommended that hospitals should embrace telemedicine in care for patients with chronic conditions such as diabetes. Further, it is recommended that telemedicine use should continue even after the COVID-19 pandemic to minimize health disparities caused by geographical locations (proximity to care centers). Since fewer elderly people embraced telemedicine more than the younger population, a recommendation to the project implementation team includes intensive training on the use of the ICT devices and possible use of simpler technologies.

Conclusion

            20 years ago, even though the technology was available, its maximal effects in healthcare had not been realized. For the past two decades, the healthcare sector has seen immense advancement in technology and increased implementation of healthcare informatics projects. The projects involving the use of telemedicine in the management of chronic diseases have been increasingly reported. Multiple studies have since then explored the influence telemedicine has in the management of chronic diseases such as diabetes hypertension, heart failure, and COPD. With regards to uncontrolled DM (HbA1C>9%), the studies have found a moderate reduction in the levels. Therefore, diabetic patients who engage in telemedicine interventions show improved glycemic control, reduced readmission rates, decreased mortality, and improved quality of life. The COVID-19 pandemic has been an impetus for patients to change their face-to-face appointments to virtual visits and a few express their willingness to continue with the telemedicine interventions even after the COVID-19 predicament cease.

References

• American Diabetes Association. (2019). 1. Improving care and promoting health in populations: Standards of Medical Care in diabetes-2019. Diabetes Care, 42(Suppl 1), S7–S12. https://doi.org/10.2337/dc19-S001
• Cahn, A., Akirov, A., & Raz, I. (2018). Digital health technology and diabetes management: Journal of Diabetes, 10(1), 10–17. https://doi.org/10.1111/1753-0407.12606
• Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. Cdc.Gov. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
• Dugdale, D., Khor, S., Lee, E. S., Marcotte, L., & Flum, D. (2020). Transforming population?based hypertension management—an efficient and effective approach. Health Services Research, 55(S1), 81–81. https://doi.org/10.1111/1475-6773.13442
• Emerson, J. F., Welch, M., Rossman, W. E., Carek, S., Ludden, T., Templin, M., Moore, C. G., Tapp, H., Dulin, M., & McWilliams, A. (2015). A multidisciplinary intervention utilizing virtual communication tools to reduce health disparities: A pilot randomized controlled trial. International Journal of Environmental Research and Public Health, 13(1), ijerph13010031. https://doi.org/10.3390/ijerph13010031
• Horrell, L. N., Hayes, S., Herbert, L. B., MacTurk, K., Lawhon, L., Valle, C. G., & Bhowmick, A. (2020). Telemedicine use and health-related concerns of patients with chronic conditions during COVID-19: Survey of members of online health communities (preprint). In JMIR Preprints. https://doi.org/10.2196/preprints.23795
• Huygens, M. W. J., Vermeulen, J., Swinkels, I. C. S., Friele, R. D., van Schayck, O. C. P., & de Witte, L. P. (2016). Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes. BMC Health Services Research, 16(1). https://doi.org/10.1186/s12913-016-1484-5
• Itamura, K., Rimell, F. L., Illing, E. A., Higgins, T. S., Ting, J. Y., Lee, M. K., & Wu, A. W. (2020). Assessment of patient experiences in otolaryngology virtual visits during the COVID-19 pandemic. OTO Open, 4(2), 2473974X20933573. https://doi.org/10.1177/2473974X20933573
• Iyer, S., Mehta, P., Weith, J., Hoang-Gia, D., Moore, J., Carlson, C., Choe, P., Sakai, E., & Gould, C. (2021). Converting a geriatrics clinic to virtual visits during COVID-19: A case study. Journal of Primary Care & Community Health, 12, 21501327211000236. https://doi.org/10.1177/21501327211000235
• Jain, S. R., Sui, Y., Ng, C. H., Chen, Z. X., Goh, L. H., & Shorey, S. (2020). Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review. PloS One, 15(8), e0237647. https://doi.org/10.1371/journal.pone.0237647
• Kelley, L. T., Phung, M., Stamenova, V., Fujioka, J., Agarwal, P., Onabajo, N., Wong, I., Nguyen, M., Bhatia, R. S., & Bhattacharyya, O. (2020). Exploring how virtual primary care visits affect patient burden of treatment. International Journal of Medical Informatics, 141(104228), 104228. https://doi.org/10.1016/j.ijmedinf.2020.104228
• Meneghini, L. F., Albisser, A. M., Goldberg, R. B., & Mintz, D. H. (1998). An electronic case manager for diabetes control. Diabetes Care, 21(4), 591–596. https://doi.org/10.2337/diacare.21.4.591
• Norden, J. G., Wang, J. X., Desai, S. A., & Cheung, L. (2020). Utilizing a novel unified healthcare model to compare practice patterns between telemedicine and in-person visits. Digital Health, 6, 2055207620958528. https://doi.org/10.1177/2055207620958528
• Orozco-Beltran, D., Sánchez-Molla, M., Sanchez, J. J., Mira, J. J., & ValCrònic Research Group. (2017). Telemedicine in primary care for patients with chronic conditions: The ValCrònic quasi-experimental study. Journal of Medical Internet Research, 19(12), e400. https://doi.org/10.2196/jmir.7677
• Smart, M. H., Mandava, M. R., Lee, T. A., & Pickard, A. S. (2021). Feasibility and acceptability of virtual academic detailing on opioid prescribing. International Journal of Medical Informatics, 147(104365), 104365. https://doi.org/10.1016/j.ijmedinf.2020.104365
• Thomson, A. J., Chapman, C. B., Lang, H., Sosin, A. N., & Curtis, K. M. (2021). Outpatient virtual visits and the “right” amount of telehealth going forward. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association. https://doi.org/10.1089/tmj.2020.0468
• Watt, A., Beacham, A., Palmer-Mann, L., Williams, A., White, J., Brown, R., Williams, E., Richards, G., White, L., Budge, P., Darvall, K., Bond, E., & Paisey, R. (2021). Service user and community clinician design of a partially virtual diabetic service improves access to care and education and reduces amputation incidence. BMJ Open Diabetes Research & Care, 9(1), e001657. https://doi.org/10.1136/bmjdrc-2020-001657
• Wootton, R. (2012). Twenty years of telemedicine in chronic disease management–an evidence synthesis. Journal of Telemedicine and Telecare, 18(4), 211–220. https://doi.org/10.1258/jtt.2012.120219

Key

THT- Telehealth Technology

HIPAA-The Health Insurance Portability and Accountability Act

Synthesis Statement

The studies focused largely on determining the efficacy of telehealth use in patient monitoring, particularly from the patient perspective. The results show that with effective and appropriate implementation, leveraging telehealth in patient monitoring not only improves patient interaction, communication, and experience with the caregiver, but also results in better patient health outcomes.

Evidence-Based Practice Telemedicine Sample Paper

Introduction                                                   

Technology in medicine has made it possible for healthcare providers to remotely diagnose and treat patients. Other factors such as reduced mobility due to diseases and chronic conditions have advanced the case for telemedicine. Evidence-Based Practice help nursing practitioners to make effective decisions concerning the healthcare services provided to patients. EBP is a critical part of nursing practice because it ensures the use of up-to-date information and technology to diagnose and treat patients within and outside the healthcare settings. There are numerous technologies used for diagnosing and dispensing medicine remotely such as remote patient monitoring video and technologies, and store and forward technologies. In America, up to 95% of Americans own cell phones while 77% have access to smartphones (Cristancho-Lacroix et al., 2017; Ng, Alexander & Frith, 2018). These devices are being leveraged to increase access to medical care and boost health outcomes. This paper is an evaluation of community-based clinic utilizing virtual telemedicine in helping diabetic patients with uncontrolled diabetes

Methods/PICOT

The purpose of this study was to develop an assessment, control, and monitoring criterion for evaluating telemedicine outreach compared to a telephonic outreach. The study also aimed at developing the appropriate pharmacologic treatment plan for the remote monitoring of patients through telehealth technologies. Being the most common chronic disease in the US, diabetes remains a dangerous chronic disease that affects millions of people across America and Canada (Sipes, 2017). This study contains a comprehensive description of what diabetes is, its causes, and the best pharmacology treatment for the disease.

Research methodology refers to the process of collecting data and analyzing the data. This process shows how data was collected, the methods used for collecting data, and how data is interpreted to give it meaning. For this particular research, data was obtained from two sources, i.e. primary sources and secondary sources. The research aims to find out if a virtual telemedicine outreach in comparison to a telephonic outreach with a case manager does influence diabetes control over 6 months period. Thus, the PICOT question is: In primary care patients with uncontrolled diabetes (A1c>9%) how does virtual telemedicine outreach compare to a telephonic outreach with case manager influence diabetes control over the next 6 months?

Primary Sources

The research aimed to get a first-hand account of how telemedicine changed the lives of patients particularly those who have reduced mobility. The best way to get this information was by conducting an extensive interview with the selected participants to find out their experiences (Ledford, 2018). From the research materials provided, some studies were conducted through online surveys, interviews, and others were done through quasi-experiments. The surveys and the experiments captured all the pertinent areas that the study sought to cover concerning telemedicine. Interviews were done in the participants’ natural environment which gave the researchers a good opportunity to observe how telemedicine works and its impacts on patients. The interview questions consisted of open-ended questions as well as some sections with multiple answers. A total of twenty women working in the oil and gas industry were interviewed in this research. This interaction with the participants was particularly helpful to the research because researchers were in a position to identify any biases on the part of the respondents as well as any weaknesses in the research. Apart from getting a first-hand account of the respondents, the researchers also got valuable opportunities to observe the participants in their natural living environment which helped in shaping the direction of this research work.

Secondary Sources

Apart from using primary sources of data, many of the research articles being studied also relied heavily on secondary sources of data. Secondary sources of data such as scholarly books, articles, journals, and periodicals were integral sources of information for providing background information on telemedicine (Fletcher, 2017, p. 181). Many of the works being studied relied on previous scholarly studies and experiments done in this area. The importance of relying on previous literary work on telemedicine is that these materials gave background information on telemedicine. By analyzing secondary sources, the researchers were able to identify the areas that have not been covered regarding the issue of telehealth/telemedicine use in patient treatment and management. By dwelling on areas that have not been covered in the available literature, the researchers were able to give a new and different perspective to the study of telemedicine that has not been explored before by other studies.

Research Design

Research design is a detailed account of how the research is carried out. It entails how data was collected, the instruments used in the process of data collection, how these instruments will be deployed or put to use, and how the data collected was be analyzed. Since all the articles being studied are qualitative research, more than one research design method was used in the collection and analysis of data. The research design methods used in this study are ones that best captured the scope and goals of each study. From the articles, there are two fundamental questions that the studies seek to give solutions to through research design (Fletcher, 2017). The first question is about what is happening (descriptive research) and why is it happening (explanatory research) (Ledford, & Gast, 2018). The descriptive part of the research is concerned with what is going on, which in this case is the impact of telemedicine on health outcomes. This part gives an in-depth analysis of the situation by describing it in great detail. For example, this part seeks to find out if telemedicine has any impact on health/patient outcomes. To accurately and effectively capture the experiences of the participants, the phenomenology research method was employed. Phenomenology is the process of investigating and studying people’s personal experiences to get a detailed account of the issue being investigated (Department of Veterans Affairs, 2018). To give valid meaning and interpretation to the experiences of the participants, going out to the field to collect information was crucial to the process of data collection.

The other research design method employed in this research is the case study. The case study is a research method that uses an up-close and detailed study of the subject of discussion. Using a case study in research was important because it helped researchers narrow down the scope of the research. This research method was chosen for two major reasons. One of the advantages of this research design method is that it is comprehensive. This method offers a holistic review approach to the study, unlike stand-alone research methods which only give snapshots to a study. A case study allows researchers to use an array of tools in single studies, which means researchers have space and time to come up with a detailed background to a study (Marczyk, 2017). Secondly, a case study is critical because it reduces biases. Case studies allow researchers to approach a study from different perspectives rather than from a single view which limits the researcher’s options (Creswell, & Creswell, 2017). Approaching a research study from many perspectives gives researchers a deeper understanding of the subject matter. The research articles for this study were done through interviews, online surveys, and experiments. The answers received from the said respondents contained lived experiences as well as personal experiences which puts into perspective the phenomenon of telemedicine.

Findings

The overall finding from the sampled studies is that virtual visits and treatment were beneficial to people with mobility problems. Overall, virtual visits were less effective compared to in-person visits, however, virtual visits enabled more frequent patient engagement compared to in-person visits. Another advantage presented by the virtual visit is that there was a high level of patient satisfaction. Concerning providers, there was an overwhelming consensus that telemedicine is a critical tool in diagnosing and treating patients especially now that there is a need for social distancing and curfews on mobility due to the COVID-19 pandemic (Smart et al., 2021). Out of the 141 scheduled in-person visits, 120 were done through virtual AD visits. This is equivalent to a 74% retention rate for the diabetes patients being monitored.

Secondly, telemedicine leads to better patient outcomes. Patient monitoring, diagnoses, and treatment have a direct impact on a patient, the intervention method chosen, the treatment plan, the provision of quality care, and the overall outcome. Through CPRS, the chances of medical errors are very minimal because of the accuracy it confers in capturing patient data. Further, CPRS promotes interprofessional cooperation of different health professionals which improves the quality of care given to patients. This project (CPRS) can improve patient safety, precision in diagnosis, communication, and overall effectiveness of patient care. For example, in the past, the facility that I am proposing this project to has witnessed a few cases of patient misdiagnosis due to incorrect capture of information, or other factors. In one case, the hospital misdiagnosed a patient with Parkinson’s disease when the patient was suffering from a case of a traumatic head injury.

Diabetes patients require frequent observation because of the nature of the disease. There is a high level of efficacy and feasibility in using telehealth to monitor and treat diabetes patients. For example, through telemedicine, the majority of participants greatly improved in terms of taking medicine. The monitoring tools alerted them when to take medicine and when the situation changed so that immediate care is taken before things got out of hand. Out of the 17 particular diagnoses, no differences were observed in the labs ordered (Wang et al., 2020). However, two of the diagnoses indicated some differences in images ordered. Additionally, there were four recorded differences in the prescriptions (Jabour et al., 2017). The overall observation was that more labs were recorded (0.16 virtual, 0.33 in-person p<0.0001) as well as in the images ordered (0.07 virtual, 0.16 in-person, p<0.0001) for in-person visits (Lyer et al., 2021). These differences were major because of the general medical exam visits that the patients had to do physically. There was also the issue of repeat visits that became necessary after the initial in-person visits (19% virtual, 38% in-person, p<0.0001) (Horrell et al., 2020). From the experiment, 10 out of 17 diagnoses indicated differences in the frequency of visits modalities. Visits for both diabetes (5.3x, p<0.0001) and anxiety (5.1x, p<0.0001) were much more frequent in the virtual conditions.

Strengths and Limitations

From the reviewed studies, the major strength is that the researchers succeeded in proving the efficacy of telemedicine. Based on the findings, adequate evidence was adduced to prove that telemedicine plays a critical role in improving health outcomes especially for patients with mobility problems. However, the major weakness of telemedicine is that it is still less effective compared to in-person visits. This is because in-person examination and diagnoses of patients are still the best way of accurately assessing patients and prescribing treatment. However, the research shows that telemedicine is mostly effective for follow-up where an initial in-person visit had been done.

Another limitation of the review is that it does indicate the differences between labs ordered in virtual visits and in-person visits. For instance, the study by McGonigle (2017) showed that there are increased orders for in-person visits for tests and diagnoses among diabetes patients (McGonigle, 2017). Further, the research indicates that there were no differences between prescriptions, lab, and images produced in in-person visits and virtual visits. This is contradictory because, in the conclusion section, the researchers conclude that many patients still preferred in-person visits because it is more efficient compared to virtual visits. While it may be difficult to subjectively deduce the reason for the observe disparity, it is likely that preference for in-patient visits is a factor of access to telemedicine technology, doubts on the reliability of such technology or simply the need for physical interaction with the care provider.

Discussion of Conclusions Drawn from the Review

Caring for people with diabetes disease is costly as one hundred percent of cases of advanced diabetes end up in death since there is no cure for the disease. Over five million Americans and thirty-five million people worldwide have diabetes disease which means that all of these people require some form of caring whether formally or informally. Caring for people with Diabetes is one of the difficult tasks and yet most people do not even have basic information on how to take care of people suffering from the disease.

While this study appears inadequate in the area of statistical power which could pose problems of efficacy to the research, I believe that this research has been successful in providing an alternative method for providing information and education to caregivers of people suffering from Diabetes, especially the informal caregivers. Drawing from previous findings, I believe this study has successfully demonstrated that online facilitation of caregivers can help them to acquire functionalities such as personalization, flexibility, socialization, and dynamism which are all important qualities in a caregiver given the stress levels associated with diabetic patient care. Furthermore, the researchers conclude that there was very limited acceptance of the online Diapason program by caregivers which is a pointer to the fact that the program needs to be rolled out in a structural manner that allows the caregivers to be able to interact with other professionals as well as the broader online community.

The articles analyze the efficacy and acceptability of web-based educational and telehealth programs intended for informal caregivers to people with diabetes using methods of research analysis. The studies asserts that there is a substantial growth in the aging population which has also seen cases of dementia and diabetes grow to the astronomical figure of 35.6 million people annually (Mosier, 2017). All of these people require round-the-clock care just to get by. By the year 2012, Diabetes Association indicated that over 12 million caregivers gave more than 17.5 billion hours of care (unpaid) which was equivalent to USD 216 billion (Mosier, 2017). Presently, majority of people with diabetes are cared for at home by their relatives which has also seen the emergence of chronic stress in such caregivers.

Summary

The best method for determining the impact of evidence-based practice clinical guidelines is through scientific measurement of patient outcomes. The implementation of EBPCG works best when it is practiced by both nurses and patients. The impact factor, in this case, is measured based on the number of citations present in the research or paper. In this work, such metrics provide a reliable and effective method of measuring the impact that clinical guidelines have on scientific research on evidence-based practice. However, the AHA and ACC point out that the growth of analytical tools used in harvesting information from online databases has helped the research on evidence-based practice clinical guidelines to take a multi-disciplinary approach such as sociological approach, scientific approach, structural approach, and technological approach.

References

• Cristancho-Lacroix, V., Wrobel, J., Cantegreil-Kallen, I., Dub, T., Rouquette, A., & Rigaud, A. S. (2017). A web-based psychoeducational program for informal caregivers of patients with Diabetes disease: a pilot randomized controlled trial. Journal of Medical Internet Research, 17(5).
• Creswell, J. W., & Creswell, J. D. (2017). Research design: A qualitative, quantitative, and mixed method approaches. Sage Publications.
• Horrell, L. N., Hayes, S., Herbert, L. B., MacTurk, K., Lawhon, L., Valle, C. G., & Bhowmick, A. (2021). Telemedicine Use and Health-Related Concerns of Patients With Chronic Conditions During COVID-19: Survey of Members of Online Health Communities. Journal of Medical Internet Research, 23(2), e23795.
• Department of Veterans Affairs. (2018). Lean processes cut wait time. Accessed 24th March2021 From https://www.research.va.gov/pubs/varqu/fall2016/16.cfm
• Jabour, S. M., Chander, G., Riekert, K. A., Keruly, J. C., Herne, K., Hutton, H., Beach, M. C., Lau, B., Moore, R. D. & Monroe, A. K. (2021). The Patient Reported Outcomes as a Clinical Tool (PROACT) Pilot Study: What Can be Gained by Sharing Computerized Patient-Reported Mental Health and Substance Use Symptoms with Providers in HIV Care? AIDS and Behavior. https://doi.org/10.1007/s10461-021-03175-2
• McGonigle, D. (2017). Nursing Informatics and the Foundation of Knowledge. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9781284142990/ https://doi.org/10.1016/j.outlook.2008.09.010

Case Study: An Elderly Iranian Man with Alzheimers Disease – NURS 6521

Neurologic and Musculoskeletal Disorders and Opioids Example 1

The patient in this case study is Mr. Akkad, a 76-year-old Iranian male brought to the clinic by his eldest son due to strange behavior. Mr. Akkad’s son reported that his father’s personality had changed, and he had been demonstrating unusual thoughts and behaviors for the past two years. Additionally, during the clinical interview, Mr. Akkad experienced memory loss, difficulty finding the right words, and exhibited confabulation.

He scored 18 out of 30 on the Mini-Mental State Exam, indicating moderate dementia. In Decision Point One, it was decided to begin treatment with Aricept (donepezil) at a dose of 5 mg orally at bedtime. However, when Mr. Akkad returned to the clinic after four weeks, there was no improvement in his condition. Confabulation persisted, and he scored the same on the MMSE.

In Decision Point Two, the dosage of Aricept was increased to 10 mg orally at bedtime. Four weeks later, Mr. Akkad’s son reported that his father was tolerating the medication well but showed no significant improvement. Although Mr. Akkad started attending religious services with the family, his disinhibited behaviors and easily amused nature persisted. In Decision Point Three, it was decided to continue Aricept at 10 mg orally at bedtime and gradually increase the dosage. The dosage was increased to 15 mg orally at bedtime for six weeks and then further increased to 20 mg orally at bedtime. There is no information available regarding the outcome of this decision.

Aricept (donepezil) is a commonly prescribed medication for Alzheimer’s disease, aiming to improve cognitive symptoms (Larkin, 2022). The initial decision to start Aricept at a dose of 5 mg orally at bedtime aligns with standard practice. Increasing the dosage to 10 mg orally at bedtime is also a reasonable step, as it is a common dosage adjustment for patients who do not show significant improvement with the lower dose. However, it is challenging to make a definitive judgment without more information on the patient’s specific clinical profile, response to treatment, and side effects.

Additionally, the case study does not provide information on the subsequent decision to continue Aricept at the current dosage or to switch to Namenda (memantine). To make a comprehensive evaluation of the decisions made, it is crucial to consider the patient’s individual characteristics, clinical guidelines, and the broader body of evidence-based literature (Larkin, 2022). Consulting professional medical resources, such as clinical practice guidelines and peer-reviewed literature, would be beneficial in assessing the appropriateness of the decisions made in this case.

The decisions recommended for the patient case study were aimed at managing the symptoms of a major neurocognitive disorder, presumptively due to Alzheimer’s disease. The primary goal was to potentially slow down the progression of cognitive decline, improve cognitive function, and enhance the patient’s overall quality of life. Aricept (donepezil) is one of the commonly prescribed medications for Alzheimer’s disease, targeting the cholinergic system and aiming to enhance cognitive function. Studies have shown its potential benefits in improving cognition, global function, and activities of daily living in patients with Alzheimer’s disease (Choi et al., 2021).

The decision to increase the dosage of Aricept from 5 mg to 10 mg orally at bedtime was based on the notion that higher doses may offer greater clinical benefits. Some studies have suggested that higher doses of donepezil may lead to additional cognitive benefits in patients with Alzheimer’s disease (Larkin, 2022). However, it is important to note that the response to donepezil can vary among individuals, and decisions regarding dosage adjustments should be made based on careful clinical evaluation and consideration of potential side effects.

The expected outcomes of Decision Points One and Two in the exercise were to see improvements in Mr. Akkad’s condition, including a reduction in disinhibited behaviors, increased interest in religious activities, and improvements in cognitive deficits.

However, the actual results did not align with these expectations. Despite the medication, Mr. Akkad’s symptoms persisted, including disinhibited behaviors, disinterest in religious activities, and confabulation. This suggests that the initial treatment approach with Aricept did not yield the desired results. Further adjustments or alternative treatment options may be necessary to address Mr. Akkad’s ongoing symptoms (Rosenthal & Burchum, 2021).

References

Choi, G. W., Lee, S., Kang, D. W., Kim, J. H., & Cho, H. Y. (2021). Long-acting injectable donepezil microspheres: Formulation development and evaluation. Journal of Controlled Release, 340, 72-86. https://doi.org/10.1016/j.jconrel.2021.10.022

Larkin, H. D. (2022). First donepezil transdermal patch approved for Alzheimer disease. JAMA, 327(17), 1642-1642. https://doi.org/10.1001/jama.2022.6662

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Examine Case Study An Elderly Iranian Man With Alzheimers

You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, there will be three decisions. I will choose one out of the three and give the outcome. At each decision point, these are the thoughts to ponder:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources Examine Case Study: An Elderly Iranian Man With Alzheimer’s

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

***Also include how ethical considerations might impact your treatment plan and communication with clients.***

Finally: 1. Complete the decision tree (keep track of what you selected. Come up with a rational reason why you chose it. Come up with a patient-specific rational reason behind not choosing the other two options not chosen).

2. Write a paper addressing all sections listed based on the decision tree.

Case Study: Alzheimer’s Disease

(76-Year-old Iranian Male)

BACKGROUND

Mr. Akkad is a 76-year-old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including a CT scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, and cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is a 76-year-old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear and coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic.

The self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes were noted.

He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh].

Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decisions were not a good choice with in-text citations noted for each.)

Choices for Decision 1: Select what the PMHNP should do:

• Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks
• Begin Aricept (donepezil) 5 mg orally at BEDTIME
• Begin Razadyne (galantamine) 4 mg orally BID

Decision Choice Chosen: Begin Exelon (rivastigmine) 1.5 mg orally BID with an examine Case Study:

• An Elderly Iranian Man With Alzheimer’s
• Increase to 3 mg orally BID in 2 weeks

***Explain why the other two choices were rejected (not adequate choices)***

RESULTS OF DECISION POINT ONE

The client returns to the clinic in four weeks

The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Choices for Decision 2: Select what the PMHNP should do:

• Increase Exelon to 4.5 mg orally BID
• Increase Exelon to 6 mg orally BID
• Discontinue Exelon and begin Namenda (memantine) 10 mg orally BID

Decision Choice Chosen: Increase Exelon to 4.5 mg orally BID

***Explain why the other two choices were rejected (not adequate choices)***

RESULTS OF DECISION POINT TWO

The client returns to the clinic in four weeks

The client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

He states that his father is attending religious services with the family, which the son and the rest of the family are happy about. He reports that his father is still easily amused by things he once found serious

Choices for Decision 3: Select what the PMHNP should do:

• Increase Exelon to 6 mg orally BID
• Maintain current dose of Exelon
• Add Namenda (memantine) 5 mg orally per day

Decision Choice Chosen: Increase Exelon to 6 mg orally BID

***Explain why the other two choices were rejected (not adequate choices)***

Outcome: Guidance to Student at this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms.

The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.

At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks.

Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

***Write on each decision. Make sure that in each decision choice, you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least 7 References. Please use in-text citations for each section of each decision. Don’t forget the ethical considerations for this assignment. Make it a section by itself.***

***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.***

Please use the following format when formulating the paragraphs for each section. Don’t forget the in-text citations. Remember to use at least 7 references.

Introduction to Examine Case Study An Elderly Iranian Man With Alzheimers

Decision #1

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Decision #2

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Decision #3

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Ethical Considerations

Conclusion

References

CHECK OUT THE ATTACHMENT FOR MORE INFORMATION

An Elderly Iranian Man with Alzheimers’s Disease Paper Sample

Alzheimer’s disease is a lifelong neurodegenerative disorder that builds up slowly, but eventually, becomes worse. People with this disorder find it difficult to remember current events. In the course of the disorder progression, other symptoms manifest in the patient where some of them are mood swings, language, behavioral concerns, disorientation, along with motivation loss. It would also be possible to tell that a person is vulnerable to the disorder if he or she is unable to manage self-care (Kales et al., 2019).

Looking at the case study involving an 86-year- old Iranian man, his symptoms suggest that he suffers from the disorder. Even his family reported that he was fond of forgetting things and this can be confirmed by looking at the background information. Again, the subjective information, principally, the mini-mental state exam (MMSE) revealed that he had moderate dementia and this relates his mental status exam that showed that his judgment and insights were impaired. This paper presents various decisions that are aimed at promoting his cognitive functioning.

Background Information

The client in the case is a 76-year-old Iranian male identified as Mr. Akkad aged who came to the clinic being accompanied by his son following his strange behavior. The family physician ruled out potential organic basis, and the imaging along with the laboratory tests were normal. His son reported that his father acted strangely that has become intense over the two years.

He added that his father started being disengaged from the religious activities with the family and becomes critical of every member of the family. Unfortunately, what he perceives as being serious becomes his source of ridicule and amusement. His son added that it has been difficult for the client to remember current things to an extent, he finds it difficult to identify the right words in a conversation and would sometimes even change the conversation, promptly.

Decision #1

After analyzing the background, subjective, in conjunction with the objective data of the patient, the PMHNP decided to present the patient with Aricept 5mg orally BID that was to be taken prior to getting to bed. The physician opted for this medication because it is normally used as a startup medication for patients with Alzheimer’s disease and so it is considered as a startup medication alongside being used as a progressive medication.

After subjecting the patient to this decision, the PMHNP hoped to see a slight improvement in the health of the patient in the sense the medication has been designed to reduce the disorder symptoms (Kales et al., 2019). In contrary to the anticipated results, four weeks after adhering the decision, the patient was accompanied by his son back to the clinic who reported that he had not noticed any improvement in his father. His son stated that his father was still disengaged from religious activities.

Furthermore, the confabulation of the patient read 18 out of 30 in the MMSE the same results he scored before being engaged in the decision. Certainly, the patient did not respond to the medication which suggests nonalignment between the anticipated results with the real outcome.

Decision #2

Following the results of the previous decision, it would be necessary for the physician to introduce the patient to a new decision which, specifically, entailed increasing the Aricept dosage to Aricept 10mg orally BID. So, in this decision, the physician augmented the drug dosage for the patient to Aricept 10mg orally BID that was to be taken prior going to bed. By increasing the drug dosage, I hoped the health condition of the patient would improve gradually as the patient may even stay for some months for him to recover from the illness (Nowrangi, Lyketsos, & Rosenberg, 2015).

This nearly matched the real results because the outcome showed that the patient is tolerating the medication only that his son is still not comfortable with the condition of his father. Nevertheless, his son reports that the patient has started attending religious services, an act that makes his family happy. This suggests that the patient has started responding to the medication.

Decision #3

After learning about the potentiality of the previous decision, I felt that it is necessary to maintain the same approach and this will entail maintaining Aricept 10mg orally BID for the patient. When using Aricept pharmacological agent to treat a patient, the physicians are recommended to present a maximum of Aricept 10mg orally BID as no piece of evidence has confirmed about the potentiality of Aricept on a patient when its dosage exceeds Aricept 10mg orally BID.

Increasing the dosage beyond the recommended drug dosage may see the patient suffer some side effects associated with the drug (Berry & Amp, 2017). After adhering this decision, I hoped to see further improvement in the health condition of the patient. This would be by hearing from his son about his increased engagement in religious activities. Certainly, this nearly matched the real results where the response of the patient to the medication was positive, though, it gradual.

Ethical Considerations

The physicians, especially, those who deal with their patients vulnerable to various cognitive health complications usually face a hard time in the course of dealing with their patients. As a way of managing such constraints, ethical considerations have been developed and then, the physicians are challenged to engage these considerations when dealing with their patients. Proper administration is the first ethical consideration where the physicians are advised to adhere to the directives that have been set for them when prescribing medications to their patients.

Proper prescription is another ethical consideration where the physician is advised to prescribe the right drug dosage to the patient (Heneka et al., 2015). Based on this consideration, a physician is encouraged to modify the drug dosage based on how the patient responds to the medication. To be specific, it may be necessary for the physician to augment the drug dosage if the patient is responding positively and reduce the drug dosage or even change the medication if the patient suffers side effects associated with the medication.

Conclusion

Alzheimer’s is a neurodegenerative disorder that advances slowly but, becomes potential over time. People with the disorder find it difficult to recall current events. Some symptoms evident in such people are mood swings, motivation loss, and being disoriented among other disorder symptoms. While various medications have been designed to treat the disorder, the physicians are encouraged to stick to Aricept following its potentiality in relieving the disorder symptoms (Heneka et al., 2015).

However, they should not introduce a higher drug dosage to the patient as it may predispose the patient to serious side effects that may affect the health of the patient, potentially. That said, the physician should subject their patients to a low drug dosage when introducing them to such drugs to find out how their bodies respond to the medication.

References

Heneka, M. T., Carson, M. J., El Khoury, J., Landreth, G. E., Brosseron, F., Feinstein, D. L., … &amp; Herrup, K. (2015). Neuroinflammation in Alzheimer&#39;s disease. The Lancet

Neurology, 14(4), 388-405. behavioral control in Alzheimer&#39;s. Social Science &amp; Medicine, 188, 51-59. https://doi.org/10.1016/S1474-4422(15)70016-5

Berry, B., &amp; Apesoa-Varano, E. C. (2017). Berry, B., & Apesoa-Varano, E. C. (2017).

Medication takeovers: Covert druggings and behavioral control in Alzheimer’s. Social Science & Medicine, 188, 51-59. https://doi.org/10.1016/j.socscimed.2017.07.003

Kales, H. C., Lyketsos, C. G., Miller, E. M., & Ballard, C. (2019). Management of behavioral and psychological symptoms in people with Alzheimer’s disease: an international Delphi consensus. International Psychogeriatrics, 31(1), 83-90. https://doi.org/10.1017/S1041610218000534

Nowrangi, M. A., Lyketsos, C. G., & Rosenberg, P. B. (2015). Principles and management of neuropsychiatric symptoms in Alzheimer’s dementia. Alzheimer’s research & therapy, 7(1), 12. https://doi.org/10.1186/s13195-015-0096-3

Nurs 6521 Week 8: Pharmacology for Psychological Disorders

INTRODUCTION

Woohoo! You just completed your mid-term exam! Please take a brief moment to listen to the valuable advice and inspiration from faculty and a proud graduate of the MSN program who is using her Education for Good.

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

LEARNING OBJECTIVES

Students will:

• Evaluate patients for treatment of psychological disorders
• Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
• Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
• Evaluate patients for treatment of generalized anxiety disorder
• Analyze decisions made throughout the diagnosis and treatment of patients with generalized anxiety disorder

LEARNING RESOURCES

Required Readings

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.
  • Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
  • Chapter 27, “Antidepressants” (pp. 214–226)
  • Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
  • Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
  • Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
  • Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media

• Walden University, LLC. (Producer). (2019a). Adult geriatric depressionLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

• Walden University, LLC. (Producer). (2019c). Attention deficit hyperactivity disorderLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

• Walden University, LLC. (Producer). (2019d). Bipolar therapyLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

• Walden University, LLC. (Producer). (2019g). Generalized anxiety disorderLinks to an external site.[Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

• Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, Barbiturates, Hypnotics (Made Easy)Links to an external site.[Video]. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s

Note: This media program is approximately 8 minutes

Week 8: Discussion COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history with GAD.

BY DAY 3 OF WEEK 8

Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

BY DAY 6 OF WEEK 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients diagnosed with GAD. In addition, suggest different treatment options you would suggest to treat a patient with the topic of discussion.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

Also Read: Discussion Filtered information and unfiltered information

Evidence-Based Project Proposal Evaluation Plan Expected Outcomes

After implementing the evidence-based project, I anticipate results not differing from other previous pieces of research done on the same project.  I expect nurses to implement the skills and knowledge gained to adhere to daily bathing of the central line with chlorohexidine in ICU patients. As a result, I expect a decrease in the rate of central line-associated bloodstream infections (CLABSI).  According to Arunga et al.(2021), reduced CLABSI would decrease hospital stays, reduce the cost of care, improve patient satisfaction, reduce rehospitalization, and improve patient outcomes.

Data collection Tools, Research Design, and Statistical test

This research project adopted a prospective cohort study design, a quantitative design. Nurses will be trained on how to do daily chlorhexidine bathing in ICU patients. Patients will be grouped into cases and control. Patients in the study group will be bathed with chlorhexidine, while those in the control group will receive a normal saline infusion. All standards of care will be observed with the patient’s interests prioritized. Follow-up will be done to determine the rates of CLABSI among the study groups.

Data will be collected using questionnaires, interviews, and laboratory tests, including blood cultures, temperature measurements, and medical health records. I will prefer to use a questionnaire for data collection in this project. Questionnaires are valid, reliable, and applicable in this project as they have been used before with higher success rates (Hammoudeh et al., 2018).

Questionnaires are standardized and hence valid to provide accurate data from the project. In addition, questionnaires are reliable as they can provide the same results if used appropriately in repeated trials. In addition, a questionnaire will address various aspects of the project; hence it is applicable to provide extensive data (Haddadin et al., 2021).  Finally, Questionnaires are preferable because they are cheap to use and can be used to collect extensive data that can easily be analyzed.

After collecting data, a Chi-square test will be used to analyze categorical variables. The Chi-square test is helpful in hypothesis testing while providing an association between variables (McDougle et al., 2020). Furthermore, the probability of dependence between classified variables is applicable while using a chi-square. In this project, chi-square will help determine the relationship between using normal saline or chlorhexidine in reducing the rates of central line infections.

How outcomes will be measured and evaluated

The anticipated outcome of this project is aimed at improving patient outcomes in terms of reducing central line infection through the use of chlorohexidine. Nurses are expected to adhere to the training offered and bathe daily patients with chlorhexidine. Patients will also know the importance of using chlorhexidine in addition to maintaining general hygiene to prevent CLABSI.

Once nurses have mastered the technique of daily bathing, the rate of CLABSI will reduce. As a result, patients will have improved outcomes in terms of reduced hospital stay, reduced cost of care, improved quality of care, reduced readmission rate, and reduction in mortality and morbidity (Frost et al., 2018). Furthermore, there will be reduced exposure of patients to long-term antibiotics, resulting in antibiotic resistance.

Healthcare providers will also learn about different monitoring strategies to suspect CLABSI while ordering specific tests to assess patients.  Likewise, the institutional expenditure on caring for patients will reduce, and the cash could be used to improve other patient care sectors (Arunga et al., 2021). Finally, the knowledge gained in this project will be spread by nurses to other institutions that will adopt the same practice. As a result, patient care across the institutions will improve with better patient outcomes.

Strategies to be taken if outcomes do not provide positive results.

I believe the steps I have in this project will yield the expected results. However, if the expected outcomes are not achieved, I will be obliged to review the whole process. Reviewing the process will include assessing the availability of resources and personnel used during the entire process while identifying gaps that would have led to deviation from the expected results. Furthermore, I will gain more insight from the champion nurses regarding the implementation process while gathering views regarding their perception of the evidence-based project.

In addition, I will improve on the strategies of training nurses and encouraging them to adhere to the process. Finally, if all the interventions fail to yield the results, I will consider starting the whole process afresh. However, more strategies will be implemented to cover the gaps identified during the initial process.

Plan to maintain, Extend, or Revise, Discontinue a Proposed Solution.

The outcome of the project will determine its fate and application. The project will be maintained and extended in clinical practice if the expected outcomes are achieved. Maintenance and extension will be done through continuous training and educating nurses on daily bathing and its importance (McDougle et al., 2020). The benefits can be extended to other centers through information sharing and training.

However, if the expected outcomes are not achieved, the project may be revised. The revision will include identifying gaps and improving in those particular areas to increase the efficiency of the project. Nonetheless, if the risks of the intervention outweigh its benefit, the project may be discontinued, and the whole process rewritten and started again. The ultimate goal is to ensure that the project improves clinical outcomes and enhanced decision-making.

References

• Arunga, S., Mbarak, T., Ebong, A., Mwesigye, J., Kuguminkiriza, D., Mohamed-Ahmed, A. H. A., Hoffman, J. J., Leck, A., Hu, V., & Burton, M. (2021). Chlorhexidine gluconate 0.2% as a treatment for recalcitrant fungal keratitis in Uganda: a pilot study. BMJ Open Ophthalmology, 6(1), e000698. https://doi.org/10.1136/bmjophth-2020-000698
• Frost, S. A., Hou, Y. C., Lombardo, L., Metcalfe, L., Lynch, J. M., Hunt, L., Alexandrou, E., Brennan, K., Sanchez, D., Aneman, A., & Christensen, M. (2018). Evidence for the effectiveness of chlorhexidine bathing and healthcare-associated infections among adult intensive care patients: a trial sequential meta-analysis. BMC Infectious Diseases, 18(1), 679. https://doi.org/10.1186/s12879-018-3521-y
• Haddadin, Y., Annamaraju, P., & Regunath, H. (2021). Central line associated bloodstream infections. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430891/
• Hammoudeh, S., Gadelhaq, W., & Janahi, I. (2018). Prospective cohort studies in medical research. In Cohort Studies in Health Sciences. InTech. https://doi.org/10.5772/intechopen.76514
• McDougle, J., Sabirovic, M., Pietropaoli, S., & Hamilton, K. (2020). The gulf between emergency plans and the resources needed: a global review: -EN- -FR- Le fossé entre les plans d’urgence et les ressources nécessaires: un examen au niveau mondial -ES- El abismo que media entre los planes de emergencia y los recursos necesarios: panorámica mundial. Revue Scientifique et Technique (International Office of Epizootics), 39(2), 373–384. https://doi.org/10.20506/rst.39.2.3088

Examining Methodology and Design Nursing Discussion

Examining Methodology and Design Nursing Discussion

The DNP must have a basic knowledge of quantitative methodology and design as it contrasts with qualitative and mixed methods. With this knowledge, the DNP can differentiate between methods and designs used to evaluate the evidence. This assignment includes comparing methodology and design while examining three projects or studies’ external and internal validity.

Examining Methodology and Design Nursing Discussion General Requirements:

Use the following information to ensure the successful completion of the assignment:

• Before beginning this assignment, review the following three articles provided as topic materials:
• Refer to the “Comparison Table of Methods and Designs”
• Doctoral learners must use the APA style for writing assignments (APA 7 format and scholarly articles within four years).
• This assignment uses a rubric. Review the rubric before beginning the assignment to familiarize yourself with the expectations for successful completion.

(1) A Mental Health Home Visit Service Partnership Intervention on Improving Patients’ Satisfaction

(2) Chronic Drug Treatment Among Hemodialysis Patients: A Qualitative Study of Patients, Nursing, and Medical Staff Attitudes and Approaches

(3) Factors Influencing Hand Hygiene Practice of Nursing Students: A Descriptive, Mixed-Methods Study.

Examining Methodology and Design Nursing Discussion Directions:

Write a 2,000-2,500 word scholarly paper comparing the methods and designs of the three articles. Include the following in your paper:

• Discussion of the characteristics associated with the method and design of each article.
• Discussion of the reliability and validity issues associated with each methodology and design.
• Summary of how the methods and designs compare to each other.
• Comparison table of methods and designs, using correct APA format. Provide the table as an Appendix to the paper.
• You are required to complete your assignment using a real-world application. The real-world application requires using evidence-based data, contemporary theories, and concepts presented in the course.

ORDER THROUGH BOUTESSAY

Examining Methodology and Design Nursing Discussion Instructions:

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.

Examine Uustals Nine Step Decision-Making Model

Examine Uustals Nine Step Decision-Making Model

Uustal (1993) proposed a decision-making model that provides concrete steps in which to arrive at a morally acceptable solution when faced with an ethical dilemma.

What type of an ethical dilemma have you encountered in the clinical setting?

How can the decision-making model identified by Uustal’s 9 steps be applied to this situation? Be specific when describing each of the nine steps.

© BrainMass Inc. brainmass.com March 22, 2019, 12:30 am ad1c9bdddf
https://brainmass.com/health-sciences/health-care-ethics/uustal-s-nine-step-decision-making-model-503358

Examine Uustals Nine Step Decision-Making Model Preview

I have encountered an ethical dilemma in the clinical setting in which I had to make a decision as to which patient would be treated first in a situation in which I could only treat one patient at a time, although both patients had arrived for treatment at the same time.

Step one would be to clearly define the objective that is to be achieved, and in this case the objective was to ensure that both patients received the treatment that they needed based on the priority of their medical conditions. Step two would be to identify and understand all of the options that are …

Examine Uustals Nine Step Decision-Making Model Instructions

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.

Exercise For the Middle-Aged Adult Paper

For the Middle-Aged Adult, Exercise Can Reduce the Risk of Various Health Problems

The sophisticated and multifactorial pathophysiology of the vast majority of health problems has led to the development of advanced therapeutic options including the likes of stem cell transplantation, newer pharmacologic agents, complex surgical procedures, radiation therapy and organ transplants. Nevertheless, general measures form part of treatment plan of most medical disorders.

A well documented general measure with significant health benefits is physical activity. Ruegsegger and Booth (2018) recognizes exercise as a powerful tool capable of promoting a longer life span and delaying the onset of more than 40 chronic diseases. Ruegsegger and Booth (2018) further acknowledges that physical training is complex and tends to invoke polygenic interactions within cells, tissues and organs. In this piece of paper, the role of exercise in minimizing the risk of cardiovascular events and diabetes will be discussed alongside the prevalence of the two health problems.

Cardiovascular health issues

The cardiovascular events such as heart attack and coronary artery disease are among the leading causes of death worldwide. However, there is overwhelming evidence of reduced incidence of these events in actively exercising individuals compared to those living sedentary lifestyle. Lear et al. (2017) concluded that both recreational and non recreational exercises significantly lowered the risk of mortality and heart diseases in low income and middle income as well as high income countries. Cardiovascular events are modified by risk factors such as diabetes such as high blood pressure, diabetes, high blood cholesterol and obesity (CDC, 2020b).

Physical activity is associated with elevated levels of high-density lipoprotein and low levels of cholesterol in addition to decreased blood pressure and decreased body mass index (Nystoriak & Bhatnagar, 2018). Also, it is associated with cardiac adaptations, blood vasculature modifications and decreased insulin resistance (Nystoriak & Bhatnagar, 2018) all favoring decreased incidence of coronary artery disease and heart attack. However, the underlying complex molecular mechanisms for these actions are beyond the scope of this paper.

Heart disease was the leading cause of death in the USA before emergence of COVID 19 with a mortality 655 000 per year (CDC, 2020b). About 18.2 million Americans older than 20 years have coronary artery disease with a mortality annual rate of 365 914 in 2017(CDC, 2020b). In the USA still heart attack is as common as 1 in every 40 seconds. Annual incidence of heart attack in the USA is about 805 000 (CDC, 2020b) with 605 000 experiencing the initial attack and 200 000 having another episode.

Diabetes Mellitus

Physical activity has been shown to play a crucial role in reducing the incidence of diabetes as well as micro and macrovascular complications associated with diabetes. The American Diabetes Association recommends both aerobic and strength training exercises to control diabetes (Ruegsegger & Booth, 2018). Type 2 diabetes is mostly associated with sedentary life style and physical activity has been shown to increase insulin secretion and sensitivity and lower body mass index (Cannata et al., 2020).

Similarly, exercise has been shown to reduce glucose levels in chronic hyperglycemia and increase resistance to illness by reducing the immunosuppression effects of diabetes. Furthermore, the muscle tone is also increased (Cannata et al., 2020). The exact mechanisms underlying this action farther on than this discussion.

The prevalence of diabetes in the USA is 34.2 million (which equals 10.5% of the US populations) as of 2018 (CDC, 2020). Of this value, 34.1 million were adults aged 18 and above (this value represents 13% of all US adults). However, 7.3 million adults aged above 18 years had undiagnosed diabetes (CDC, 2020). The percentage of adults with diabetes increased with age and it was at 26.8% among those aged 65years and above. 38% of all those who had diabetes (CDC, 2020) were physically inactive.

Conclusion

Despite the overwhelming evidence of the importance of physical activity in reducing the incidence of health-related issues, it is astonishing that many individuals still choose to live a sedentary lifestyle at the expense of their health. The high morbidity and mortality associated with physical inactivity has attracted attention of medical researchers and practitioners coining phrases like “exercise is medicine.”

References

• Cannata, F., Vadalà, G., Russo, F., Papalia, R., Napoli, N., & Pozzilli, P. (2020). Beneficial effects of physical activity in diabetic patients. Journal of Functional Morphology and Kinesiology, 5(3), 70. https://doi.org/10.3390/jfmk5030070
• CDC. (2020a, June 11). What is Diabetes? Cdc.Gov. https://www.cdc.gov/diabetes/basics/diabetes.html
• CDC. (2020b, September 9). Heart disease facts. Cdc.Gov. https://www.cdc.gov/heartdisease/facts.htm
• Lear, S. A., Hu, W., Rangarajan, S., Gasevic, D., Leong, D., Iqbal, R., Casanova, A., Swaminathan, S., Anjana, R. M., Kumar, R., Rosengren, A., Wei, L., Yang, W., Chuangshi, W., Huaxing, L., Nair, S., Diaz, R., Swidon, H., Gupta, R., … Yusuf, S. (2017). The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet, 390(10113), 2643–2654. https://doi.org/10.1016/s0140-6736(17)31634-3
• Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular effects and benefits of exercise. Frontiers in Cardiovascular Medicine, 5, 135. https://doi.org/10.3389/fcvm.2018.00135
• Ruegsegger, G. N., & Booth, F. W. (2018). Health benefits of exercise. Cold Spring Harbor Perspectives in Medicine, 8(7), a029694. https://doi.org/10.1101/cshperspect.a029694

Failing to take responsibility for injurious practices nursing essay

Failing to take responsibility for injurious practices nursing essay

The topic is based on nursing practice: Failing to take responsibility for injurious practices.

Create a presentation of 10-15 slides or screens, excluding the title and references. Your slides/screen should include titles, main ideas, bullet points, and relevant images, charts, graphs, etc. In your presentation:

• Describe an ethical situation, based on the chosen topic, that can get in the nurse’s way of practicing ethically.
• Describe the situation clearly and concisely.
• Identify how this situation relates to one provision within the Code of Ethics for Nurses.
• Identify two ethical principles that may arise when facing this situation.
• Discuss how a nurse might lessen the impact of the situation on the nurse’s practice.
• In addition to the course texts, cite and reference a minimum of two (2) additional scholarly sources to support your work.
• Close with a summary of your topic, and APA formatted reference slide(s).
• Audio is optional.

Create a presentation of 10-15 slides or screens excluding the title and references. Your slides/screen should include titles, main ideas, bullet points, and relevant images, charts, graphs, etc. In your presentation:

• Describe an ethical situation, based on the chosen topic, that can get in the nurse’s way of practicing ethically. Describe the situation clearly and concisely.
• Identify how this situation relates to one provision within the Code of Ethics for Nurses.
• Identify two ethical principles that may arise when facing this situation.
• Discuss how a nurse might lessen the impact of the situation on the nurse’s practice.
• In addition to the course texts, cite and reference a minimum of two (2) additional scholarly sources to support your work.
• Close with a summary of your topic, and APA formatted reference slide(s).
• Audio is optional.

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Nancy Jackson-Davis Full Medical Record DQ

Family Health Concept and Health Promotion Discussion

Family Health Concept and Health Promotion Discussion

Family health concept

The health and wellness of individuals always begin from the family. The execution of health activities, roles, and responsibilities occur at home. Family health is significant to the family members because when one individual is sick, all family members are affected.

Family history and genetics influence an individual’s health status because there are hereditary diseases that affect the family members, such as sickle cell disease, diabetes, and cardiovascular diseases (Green, 2018). Understanding the family health concept and family history is essential in identifying the health risks that increase individuals’ potential for developing certain illnesses such as hypertension.

Health promotion is an effective public health strategy for ensuring healthy people within the family and community at large. Health promotion measures such as educating the family, screening, conducting health campaigns, and developing health awareness programs help build family capacity and enhance behavior modification and environment modification (Whitney, 2018). 

Providing health information helps improve the health outcome of the family members through health behaviors such as physical exercise, healthy eating, and avoiding a sedentary lifestyle. Apart from enhancing health behavior modification, family education helps improve health-seeking behaviors and self-care activities, which further help prevent diseases. 

A nurse can determine the effectiveness of a strategy in meeting the needs of a particular family through family and patient assessment to identify the needs of the family. Assessing individuals’ needs entails effective interaction and communication with people to help in understanding the unique needs of the person and the family (Green, 2018). The nurse should identify the available family resources that can be used to achieve health and wellness among the family members.

Family Health Concept and Health Promotion Discussion References

• Green, S.Z. (2018). Understanding families and health promotion. In Grand Canyon University?(Ed.),?Health promotion: Health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1
• Whitney, S., (2018), Health promotion Health and wellness Across the Continuum Retrieved from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php

Health Promotion and Disease Prevention Example

Health promotion and disease prevention are crucial in improving public health outcomes and reducing the burden of illness on individuals and communities.  There has been a growing recognition of the significance of evidence-based interventions in the design and implementation of effective health promotion and disease prevention strategies in the recent past.  According to Tomlinson et al. (2019), evidence-based interventions offer proven effectiveness, resource optimization, accountability, replicability, scalability, and opportunities for continuous improvement in health prevention and promotion.  This paper explores the importance of evidence-based interventions and their impact on health promotion and disease prevention effectiveness.

Disease Prevention

The term “disease prevention” refers to the coordinated actions and plans to lessen the incidence and effects of illnesses in a community.  It entails measures designed to prevent the onset of diseases or minimize their progression by targeting risk factors, promoting healthy behaviors, and implementing interventions such as immunization, screening, and education (Chiu et al., 2020).  There are several different strategies for disease prevention, including primary prevention to prevent the occurrence of diseases, secondary prevention to detect and treat diseases at an early stage, and tertiary prevention to minimize complications and disability in individuals already affected by a disease.

Disease Prevention Model

An example of an existing disease prevention model is the social-ecological disease prevention model.  This model is a framework that recognizes the complex relationship between the influences of individual behaviors, social factors, and environmental in determining health outcomes (Bamuya et al., 2021).  It provides a comprehensive approach to disease prevention by addressing multiple levels of influence, including the community, systems, and individual levels of practice.

At the community level, the socio-ecological model highlights the significance of creating supportive environments that promote health and prevent disease.  This involves identifying and addressing social determinants of health, such as socioeconomic status, access to healthcare, education, and physical infrastructure (CDC, 2022).  Through a holistic focus on the community, this model promotes the creation of interventions that can target broader social and environmental factors that contribute to health disparities.

The systems’ level of practice within the socio-ecological model recognizes the influence of organizational structures and policies on individual health behaviors.  This level involves working with various systems and institutions, such as healthcare organizations, schools, workplaces, and government agencies, to implement interventions that support disease prevention (CDC, 2022).  By integrating health promotion strategies into existing systems, such as workplace wellness programs or school-based health education, the model aims to create sustainable changes that encourage healthy behaviors and reduce risk factors.

At the individual level, the socio-ecological model acknowledges that personal factors, knowledge, attitudes, and behaviors play a vital role in disease prevention.  This level focuses on empowering individuals to make informed decisions about their health and adopt healthy behaviors (CDC, 2022).  It includes health education campaigns, counseling, and skills-building programs to increase knowledge, awareness, and self-efficacy for health-promoting actions.

Socio-ecological model of disease prevention has several benefits in disease prevention.  First, it provides a holistic approach to disease prevention that has the potential to yield significant and sustainable improvements in public health (CDC, 2022).  Additionally, this model recognizes that health behaviors and outcomes at the individual level are influenced by personal factors such as knowledge, attitudes, and skills.  Furthermore, it goes beyond the individual level to acknowledge the impact of interpersonal relationships, community settings, and societal factors, which can; lead to behavior change, create supportive environments, and advocate for policy changes that improve health outcomes.

However, there are concerns associated with this model as well.  First, implementing multi-level interventions can be complex and require coordination among various stakeholders (Bamuya et al., 2021).  Addressing societal factors often involves challenging established norms and policies, which can face resistance.  Finally, the socio-ecological model requires a comprehensive understanding of the specific contexts in which interventions are being implemented, as the determinants of health can vary across different populations and settings.

Health Promotion

Health promotion is a comprehensive and holistic approach that seeks to enhance individuals’ and communities’ well-being and quality of life.  Its primary objective is to empower individuals by offering a range of interventions, enabling them to make informed decisions, embrace healthy behaviors, and establish supportive environments (World Health Organization, 2022).  These interventions address disease prevention and the underlying determinants of health, including social, economic, and environmental factors.  Additionally, health promotion endeavors to promote healthy lifestyles, increase awareness regarding health risks, disseminate education and information, and advocate for policies that uphold health and equity.

Health Promotion Model

Nola Pender’s health promotion model (HPM) is a widely recognized nursing theory that emphasizes the importance of promoting health and preventing disease at various levels: community, systems, and individual.  This model provides a framework for nurses to understand and guide health promotion interventions effectively.  According to the proponent of this health promotion model, Nola J. Pender, the primary emphasis of health promotion and disease prevention should be on healthcare (Gonzalo, 2019).  It is essential for health promotion and prevention strategies to anticipate and address potential challenges and issues proactively.  However, when these efforts fall short, providing care for those who are unwell becomes the subsequent priority.

At the community level, the health promotion model emphasizes creating supportive environments and collaborating with community leaders and organizations to address health disparities, develop programs, and advocate for policies (Gonzalo, 2019).  It recognizes social determinants of health, promotes community empowerment, and allows for addressing health issues on a broader scale.  However, challenges of this health promotion model include limited resources, political resistance, and difficulties measuring effectiveness and ensuring community engagement.

At the systems level, the model acknowledges the influence of larger systems like healthcare organizations and policies.  Nurses focus on creating supportive structures, promoting collaboration, and integrating health promotion into healthcare delivery (Gonzalo, 2019).  Benefits include a comprehensive approach, stakeholder coordination, and consistent support for individuals.  However, concerns about this model at the systems level involve complex implementation, resistance to change, and challenges in measuring the impact on individual health outcomes.

At the individual level, Pender’s health promotion model centers on understanding factors that motivate individuals, emphasizing self-efficacy, and addressing barriers to behavior change.  It respects individual autonomy, tailors interventions, and encourages sustained behavior change (Gonzalo, 2019).  However, concerns about this model include overlooking broader social and environmental factors, burdening individuals with decision-making, and the need to address motivational factors for successful interventions effectively.

Role of Evidence-Based Practice

Evidence-based practice plays a crucial role in disease prevention and health promotion success by providing a solid foundation for informed decision-making and effective interventions.  Integrating the best available evidence from scientific research, clinical expertise, and patient preferences ensures that interventions and strategies used in disease prevention and health promotion are grounded in rigorous scientific evidence (Tomlinson et al., 2019).  This approach helps to minimize guesswork and speculation, ensuring that interventions are more likely to be effective and produce positive outcomes.  By relying on evidence, community health nurses can make informed decisions about the most appropriate interventions, treatments, and preventive measures to employ, thereby maximizing the chances of success in preventing diseases and promoting overall health.

Health teaching plays a crucial role in disease prevention and health promotion, enabling individuals to participate in their health and well-being actively.  Healthcare professionals can utilize health teaching to provide individuals with the necessary knowledge, skills, and resources to make informed decisions about their health and adopt healthy behaviors.  Additionally, educating individuals about disease prevention, healthy lifestyle choices, and risk factors can help them comprehend the significance of taking preventive measures and embracing behaviors that foster good health (World Health Organization, 2022).  Furthermore, health teaching equips individuals with the tools to effectively manage their health conditions, engage in self-care practices, and identify early warning signs, thus averting disease progression and reducing the likelihood of complications.

Conclusion

Health promotion and disease prevention are integral to improving public health outcomes and reducing the burden of illness on individuals and communities.  Evidence-based interventions play a critical role in designing effective strategies, offering proven effectiveness, resource optimization, accountability, replicability, scalability, and opportunities for continuous improvement. The socio-ecological disease prevention model and Nola Pender’s health promotion model provide comprehensive frameworks that address multiple levels of influence, including the community, systems, and individual levels.  By integrating evidence-based practice and health teaching, healthcare professionals can make informed decisions, empower individuals, and promote healthy behaviors, ultimately preventing diseases and promoting health.

References

Bamuya, C., Correia, J. C., Brady, E. M., Beran, D., Harrington, D., Damasceno, A., Crampin, A. M., Magaia, A., Levitt, N., Davies, M. J., & Hadjiconstantinou, M. (2021).  Use of the socio-ecological model to explore factors that influence the implementation of diabetes structured education program (EXTEND project) in Lilongwe, Malawi, and Maputo, Mozambique: A qualitative study.  BMC Public Health, 21(1).  https://doi.org/10.1186/s12889-021-11338-y

Centers for Disease Control and Prevention.  (2022, January 18).  The social-ecological model: A framework for prevention.  Centers for Disease Control and Prevention; CDC. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

Chiu, C.-J., Hu, J.-C., Lo, Y.-H., & Chang, E.-Y. (2020). Health promotion and disease prevention interventions for the elderly: A scoping review from 2015–2019.  International Journal of Environmental Research and Public Health, 17(15), 5335.  https://doi.org/10.3390/ijerph17155335

Gonzalo, A. (2019).  Nola Pender: Health promotion model (nursing theory guide).  Nurseslabs. https://nurseslabs.com/nola-pender-health-promotion-model/

Tomlinson, M., Hunt, X., & Rotheram-Borus, M. J. (2019).  Diffusing and scaling evidence-based interventions: Eight lessons for early child development from implementing perinatal home visiting in South Africa.  Annals of the New York Academy of Sciences, 1419(1), 218–229.  https://doi.org/10.1111/nyas.13650

World Health Organization.  (2022).  Health promotion.  World Health Organization.  https://www.who.int/westernpacific/about/how-we-work/programmes/health-promotion

Falls in Dementia Sample Paper

Introduction.

Dementia can be described as a group of thinking and social symptoms that greatly interfere with the daily functioning of an individual. Patients will normally present with forgetfulness. This condition also greatly impacts both their social well-being and thought forming capabilities (Ng et al., 2019). The condition greatly impacts individuals aged sixty-five years and above mostly. Medication and therapy play a critical part in the management of this condition.

Rationale for the Specific Health Risk.

The occurrence of falls in patients with Alzheimer’s and other types of dementia is common. People with these conditions are three times more likely to experience hip fractures from a fall when compared to other people (Mosk et al., 2017). The result of these fractures is immobility and resultant surgeries. The mortality rate in people with Alzheimer’s and other types of dementia secondary to a fall is estimated to be greater than in other individuals (Jeon et al., 2019). This information clearly proves the severity of this condition and indicates the need to strongly implement interventions aimed at reducing and preventing falls in patients with dementia.

The exact number of people with dementia in Australia is currently unknown. An estimate, however, placed the number of people with dementia at a figure between four hundred thousand and four hundred and sixty thousand in 2020 (Livingston et al., 2020). This figure is expected to increase to approximately five hundred and ninety thousand people by the year 2030. These figures demonstrate the great urgency to deal with the problem of dementia.

The increased rate of fall in patients with dementia further solidifies the need to address the issue. Falls in people with dementia greatly increase the morbidity and mortality rates consequently increasing medical costs. Therefore, there is need to address this issue.

Selection of the audience

There are several risk factors associated with falls in dementia patients. Some of the commonest risk factors include physical weakness and lack of balance, impaired memory, poor judgement, pain and discomfort, a need to use the bathroom among others (Harrison et al., 2020). The reason why I selected nurses as my target audience is because they spend more time with the patients and are better placed in the formulation of interventions geared towards the prevention of falls in patients with dementia.

Nurses spend a majority of time with patients. This means that they are capable of picking up on any pain or discomfort that the patient may be feeling. As noted earlier, pain and discomfort which consequently forces patients to move is one of the commonest causes of falls (Kim et al., 2017). The nurse therefore, has ample time and ability to note any pain being experienced by patients and ensure that the situation is dealt with to prevent further crisis later on.

Nursing staff are required to assess and assist people aged 65 and over with their daily activities. This is dependent on the patient’s ability to function normally (Mailhot-Bisson, 2018). While caring for elderly, nurses are regularly involved in activities such as cleaning them and aiding them to access facilities such as the bathroom. As the target audience of the poster, nurses can fully grasp the magnitude of the ability they have in the prevention of falls in patients by constantly being available to offer help.

Nursing staff play a critical role in ensuring that patients live in organized, tidy and well-li rooms. Some of the major causes of falls include poor lighting within patients’ rooms and disorganization and clutter within those rooms. The poster describes the importance of the nurse ensuring that the room is tidy and neat and how such simple acts can go a long way in reducing the rate and incidence of falls in patients with dementia.

Relevance of selected poster features.

            I have ensured that the title of this poster “Falls in Dementia” is kept short, simple but still effective in the conveyance of the message intended without bringing any confusion. The use of clear and well labelled icons is critical in ensuring that the reader clearly understands the main message that I am trying to put across (Davis et al., 2018). The use of bright colours is critical in ensuring that I fully capture the attention of the target audience.

Contrasting colours further help to relay the message that different data is being shared on the poster. This poster had an appropriate ratio of coloured content to white-space as highlighted in the guidelines. This 30% white space in a scholarly poster ensures visual breathing room for the eyes.

The picture used in the poster, termed as “People 2-community Nurse With Patient Cartoon” is important for several reasons. The picture plays a key role in breaking the monotonous state of the poster. It also clearly demonstrates the importance of a good nurse patient relationship which is critical ins ensuring positive outcomes and vital in minimizing patient falls in this scenario.

The icons placed on both the left and right side of the title contain vital information including statistics of the issue being addressed. This is critical in capturing the target audience’s attention and highlighting the magnitude of the issue being addressed (Erkin et al., 2018). Further grouping of information into smaller subgroups including the risk factors, need to know information and necessary interventions is important.

It ensures that there is no confusion and that the target audience clearly knows that they have moved from one item to another. the bullets at the far-right side of the poster emphasize critical information regarding the situation at hand further highlighting the importance of addressing falls in dementia patients.

Implications of Nursing Care Related to Environmental Changes.

Environmental health determinants are critical in the assessment, diagnosis, intervention, planning and evaluation components of nursing practice (McKibben, 2017). Environmental changes such as reduced government funding can greatly impact the overall health of the elderly. In this scenario, lack of adequate funds to purchase equipment such as bed alarms in hospitals greatly undermines the effort to curb the occurrence of falling among patients with dementia.

Reduced human resource in nursing homes and hospitals also greatly impacts health care quality and provision. The reduction in nurses can result from government policies or staffing problems (Benton et al., 2020). The overall problem that results from this is the reduced care offered to the elderly. Reduced care and attention greatly increase the risk of falling especially in the elderly with dementia, greatly hindering progress towards reducing occurrence of these falls.

            Nursing staff have a key role to play to try and deal with the issue of falls. They must first identify and document areas that require changes and push for the changes where possible to ensure that fall rates reduce. Implementation of other key guidelines laid out in order to curb the prevalence of falls among dementia patients should also be done by the nursing staff.

Conclusion.

In conclusion, dementia is a condition that greatly affects a vast number of the population negatively impacting their daily lives. The condition greatly predisposes to falls which consequently increase morbidity and mortality rates. This is mostly prevalent among the elderly, especially those aged sixty-five years and above. A poster aimed at nurses is one way of trying to reduce the occurrence of falls in elderly patients with dementia. The poster clearly outlines the statistics, clearly showing the magnitude of the issue, risk factors and necessary intervention methods that nurses can employ to reduce and fully curb the issue of falls.

References.

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