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Annotated Bibliography on Acute Asthma Management Sample

Introduction

Severe acute asthma is a clinical emergency that can easily be managed by various clinical therapies. However, if poorly managed, it can invariably lead to death by cardiorespiratory collapse. Typically, therapeutic management of severe asthma targets to increase air passage through bronchodilators dilation and oxygen supplementation. Ultimately, these therapies should stabilize the patient.

The available treatment options for children with severe acute asthma refractory to SAMA/LAMA combination are limited because the remaining ones are either not safe or are expensive. Nonetheless, the patients must the treated and therefore alternatives such as IV steroids with or without heliox are often used as the most feasible options. Against this backdrop, there are various pieces of research evidence that have confirmed the role of IV methylprednisolone as well as that of heliox in improving severe asthma. However, evidence on the latter is a bit controversial due to its side effects and availability. The current study seeks to unravel the available evidence on the use of IV methylprednisolone or a combination of IV methylprednisolone and heliox in the treatment of severe acute asthma in children between the age of 5-15 years old.

The study takes the form of an annotated bibliography; evaluating the quality of evidence in 8 peer reviewed journal articles. The review will summarize the content of each journal article in terms of its purpose, findings and implications of those findings to the management of severe acute asthma. It is worth noting that all the journal articles have been published within the past five years.

Article 1

Henderson, M. B., Schunk, J. E., Henderson, J. L., Larsen, G. Y., Wilkes, J., & Bratton, S. L.

(2018). An assessment of asthma therapy in the pediatric ICU. Hospital pediatrics, 8(6), 361-367. DOI: https://doi.org/10.1542/hpeds.2017-0003

Henderson et al. (2017) argue that asthma is one of the most common chronic respiratory condition in children affecting millions of children and continues to be a common cause of Intensive Care Unit (ICU) admission. Bearing this in mind, the authors conducted a study on asthma therapy in pediatric ICU, describing asthma management, evaluating practice evaluation, and describing the resource use during asthma management at the pediatric ICU.

Being a retrospective study single-center cohort study, it involved 262 children of age 2 to 18 years in pediatric ICU treated with asthma from 2008 to 201;1 with data collected through intermountain Healthcare Enterprise Data Warehouse. Majority of the participants only received only the first tier of recommended therapy (inhaled short-acting b-agonists, pre-hopsitalization inhaled ipratropium bromide, systemic corticosteroids and oxygen), while 70% of them did not receive any further respiratory support beyond non-breather mask or nasal cannula mask including inhaled nitric oxide, IV b-agonists, intravenous (IV) magnesium sulfate, inhaled heliox. While heliox were rarely used before or after pediatric ICU, no adverse event was reported on its use.

The study results indicated that most of the patients with severe asthma were treated with only the minimum interventions (i.e. first-tier medication, none-breather or nasal canular mask). These treatments minimized the pediatric ICU length of stay and thus reduced expenses involved in asthma care. these findings confirm that heliox can be used as a treatment therapy for asthma in pediatric ICU with no side effects. Its methodology was effective, and the resultant evidence can be useful in comparing the use of heliox versus the use of a combination of heliox and IV methylprednisolone.

However, the fact that this study was a single-hospital cohort study limits the generalization of its findings. Furthermore, the generalization of the study finding is also limited by the fact that it did not consider specific factors such as patient ethnicity, which was not a representative of the US population.

Article 2

Doymaz, S., Ahmed, Y. E., Francois, D., Pinto, R., Gist, R., Steinberg, M., & Giambruno, C.

(2020). Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter?. Journal of Asthma, 1-10. https://doi.org/10.1080/02770903.2020.1870130

The study by Doymaz et al. (2020) was inspired by the statistics that asthma is a chronic

childhood illness that affects at least 6 million children and by 2017, it was responsible for 863 per every 100,000 deaths in the United States. Furthermore, the authors were motivated by the fact that whereas various intravenous IV corticosteroids are available of the treatment of acute severe asthma, the choice of IV corticosteroids largely depends on physician’s preferences or institution. Against this background, the researchers conducted a study to compare the efficacy of IV methylprednisolone, dexamethasone and hydrocortisone during pediatric ICU admission.

The study took the form of a randomized clinical trial that enrolled patients of 1-12 years old requiring continuous beta-2 agonist treatment.

The randomization was done in three groups: IV Dexamethasone group, IV Hydrocortisone and IV Methylprednisolone. The researchers measured primary outcomes based on durations of beta-2 agonist continuous nebulization treatment. On the other hand, the secondary outcomes were measured by pediatric asthma severity score, maximum dose of beta-2 agonist treatment, need for mechanic ventilation and pediatric ICU and hospital length of stay.

The study findings indicated no difference in efficacy of dexamethasone, hydrocortisone and IV methylprednisolone when used in appropriate doses to treat pediatric asthma. This was demonstrated by a no difference in the various outcome measurements such as B2 agonist maximum dose, pediatric asthma severity score, pediatric ICU length of stay and need for mechanic ventilation.  While the generalization of these study findings is affected by the small sample cohort, it produces useful evidence to support the use of IV methylprednisolone in the management of pediatric severe asthma.

Article 3

Fishe, J. N., Gautam, S., Hendry, P., Blake, K. V., & Hendeles, L. (2019a). Emergency medical services administration of systemic corticosteroids for pediatric asthma: A statewide study of emergency department outcomes. Academic Emergency Medicine, 26(5), 549-551. https://doi.org/10.1111/acem.13660

Systemic corticosteroids have always been administered to children with asthma admitted in the emergency department with the aim of reducing their length of stay. However, as per Fishe et al. (2019a), there is a paucity of research examining the improvement effect of   corticosteroids on patient outcomes. In response, the researchers conducted a state-wide study to investigate the emergency department outcomes upon the use of corticosteroids on paediatric asthma.

The retrospective observational cohort study relied on patients whose records remained in Florida’s EMS Tracking and Reporting System with information on emergency department’s outcome of patients between 2011 – 2016. The inclusion criteria were children of age 2-18 admitted in the emergency department with respiratory distress, whose acute asthma exacerbation was indicated by their receipt of albuterol. The study found that the administration of IV methylprednisolone was associated with decreased odds of emergency department discharge. Fishe et al. (2019a) attributed these results to a few reasons. For instance, IV methylprednisolone was only reserved for patients with more severe asthma.

The findings of this study are especially useful in understanding not only the effects of IV methylprednisolone as an emergency department intervention for severe asthma in children, but also the role of severity as a factor to consider when using IV methylprednisolone on pediatric asthma. Nonetheless, this study had several methodological limitations that must be pointed out. For instance, the study only focused on one state and this affects its generalizability to other areas of the United States. Furthermore, only on third of the patients had identifiable emergency department outcomes. More importantly, the researchers did not have any prior knowledge of any medications the patients had taken before their arrival at the emergency departments, affecting validity of the study.

Article 4

Fishe, J. N., Palmer, E., Finlay, E., Smotherman, C., Gautam, S., Hendry, P., & Hendeles, L.

(2019). A statewide study of the epidemiology of emergency medical services’ management of pediatric asthma. Pediatric Emergency Care. doi: 10.1097/PEC.0000000000001743

Fishe et al. (2019b) argued that at least ten percent of all pediatric emergency department patients use emergency medical services for transport and prehospital management. While studies show that the most frequently used medication was albuterol, there is a paucity of research evidence on pediatric emergency medical services experiences with respiratory distress or asthma. Therefore, the researchers set out to investigate the relevant clinical, geographic, demographic and characteristics of pediatric asthma treated in the emergency medical services in a state with the fourth-largest pediatric population to examine the current emergency medical services treatment practices.

The retrospective observational cohort study relied on patients whose records remained in Florida’s EMS Tracking and Reporting System with information on emergency department’s outcome of patients between 2011 – 2016. The inclusion criteria were children of age 2-18 admitted in the emergency department with respiratory distress, whose acute asthma exacerbation was indicated by their receipt of albuterol. The study found that in practice, IV methylprednisolone is reserved for the small percent of patients with generally more severe asthma. However, they are more liberally administered in the emergency department because they are of benefit to those with moderate and severe asthma exacerbations.

These findings are important to the study of IV methylprednisolone as a treatment therapy for pediatric asthma in the emergency department because it explores the general practice and how IV methylprednisolone is used. However, it has several methodological limitations that limits its generalizability. For instance, the study only focused on one state and this affects its generalizability to other areas of the United States. Furthermore, the EMS Tracking and Reporting System does not distinguish ground versus air transport, and therefore some emergency medical service users might have been omitted.

Article 5

Leung, J. S. (2021). Paediatrics: how to manage acute asthma exacerbations. Drugs in Context,

10. 10. doi: 7573/dic.2020-12-7

Leung (2020) considers asthmas one of the most common chronic illnesses in children and a major contributor of child death globally. As such, the researcher conducted a review of literature to investigate the various medications used in treating acute asthma exacerbations and their efficacy. The review presented the evidence in the context of a stepwise management of acute asthma exacerbations and provided several recommendations for practice based on his findings.

The study found that in children, IV methylprednisolone is a recommended oral medication that may however be safe due to concerns associated with vomiting. Furthermore, Leung (2020) observed that there is a paucity of data supporting that IV methylprednisolone can provide additional efficacy benefits over other oral formulas. Furthermore, the study did not find any evidence of increased intramuscular corticosteroids have better benefits that oral corticosteroids.

The findings of this study are useful in having a better understanding of IV methylprednisolone as a corticosteroid used to treat acute asthma exacerbations. It compares IV methylprednisolone with other therapies to give a better comparison of evidence on the treatment of acute asthma exacerbations in children. However, because the study relied on secondary data, the generalizability of study is affected by the literature search and selection bias.

Article 6

Batabyal, R. A., & O’Connell, K. (2018). Improving Management of Severe Asthma: BiPAP and

Beyond. Clinical Pediatric Emergency Medicine, 19(1), 69-75. https://doi.org/10.1016/j.cpem.2018.02.007

Pediatric emergency departments encounter unique challenges with acute asthma exacerbations. Whereas most children respond well to treatments such as systemic corticosteroids, ipratropium, and inhaled ?2-agonists, some children may require adjunct treatments. As such, Batabyal and O’Connell (2018) conducted a literature review study to investigate the various guidelines on the management of severe asthma exacerbations in pediatric emergency departments.

The review covers both the use of heliox as well as the use of Corticosteroids such as IV methylprednisolone. Reviewed evidence indicate that early use of IV methylprednisolone is important and even a slight delay can increase the chances of hospital admission. Another important finding of this review is that whereas one would want to administer more doses of IV methylprednisolone to mitigate inflammation, there is no evidence supporting greater doses of more than 2mg/kg even in the case of acute asthma; and therefore, higher doses is not recommended.

On heliox, the study revealed variable efficacy of heliox as a therapy for acute severe asthma exacerbations among the Pediatric population.  However, the reviewed evidence also shows that some guidelines (e.g. NAEPP) recommend the administration of inhaled beta agonists with heliox in patients whose asthma exacerbations is life threatening. Similarly, as per Batabyal and O’Connell (2018), the GINA guidelines recommend heliox for acute severe asthma for patients who do not respond to conventional treatment.

Practice guidelines are integral part of evidence-based practice because they reveal the generally accepted practices backed by evidence. As such, the study by Batabyal and O’Connell (2018) is useful in studying the use of IV methylprednisolone and or heliox in the management of acute severe asthma in children because it compares various guidelines on the same. However, the study is limited by the fact that it relies on secondary material, which is susceptible to selection and inclusion bias.

Article 7

Indinnimeo, L., Chiappini, E., & Del Giudice, M. M. (2018). Guideline on management of the

acute asthma attack in children by Italian Society of Pediatrics. Italian Journal of Pediatrics, 44(1), 1-10. https://doi.org/10.1186/s13052-018-0481-1

Indinnimeo et al. (2018) opined that it is important to deliver appropriate care to children with asthma considering its life-threatening risk and its high prevalence on children. In the spirit of evidence-based practice, they conducted a study to guide the management of asthma attack in children. The study relied on Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. They also conducted a literature search on Cochrane library to retrieve Italian journal articles on children of age 2 years and above.

One of the most relevant recommendation given by Indinnimeo et al. (2018) is that heloix can be given to children with life-threatening asthma attack, especially for those not responding to alternative treatment. The study further explained that heloix can improve ventilation and reduce respiratory failure in patients experiencing airway obstruction.  This study gives important insights that are useful in answering some of the background questions of the study such as those concerning the therapeutic options of severe asthma.

Article 8

Seliem, W., & Sultan, A. M. (2018). Heliox delivered by high flow nasal cannula improves

oxygenation in infants with respiratory syncytial virus acute bronchiolitis?. Jornal de Pediatria, 94, 56-61. https://doi.org/10.1016/j.jped.2017.04.004

The study by Seliem & Sultan (2018) evaluates how heliox delivered through high flow nasal canula can improve oxygenation in children with respiratory syncytial virus acute bronchitis/asthma. It took the design of a randomized control trial that included 48 patients. The treatment group received heliox (70:30) while the control group received air-oxygen mixture through high flow nasal cannula at 8 L per minute continuously for 24 hours. After two hours of treatment with heliox, the treatment group registered a more significant improvement compared to the control group of 98.3% versus 92.9% respectively.

Seliem & Sultan (2017) concluded that transient improvement of oxygenation can be achieved in children with respiratory syncytial virus acute bronchitis if heliox is used so that other therapeutic agents can find more time to work on the disease and resolve it naturally. However, this study has a few limitations. First, the randomization was not blinded due to an existing discrepancy between the delivery systems of both gases.  Furthermore, the small sample size hindered discrimination between clinical phenotypes based on chest radiology.

References

• Batabyal, R. A., & O’Connell, K. (2018). Improving Management of Severe Asthma: BiPAP and Beyond. Clinical Pediatric Emergency Medicine, 19(1), 69-75. https://doi.org/10.1016/j.cpem.2018.02.007
• Doymaz, S., Ahmed, Y. E., Francois, D., Pinto, R., Gist, R., Steinberg, M., & Giambruno, C. (2020). Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter?. Journal of Asthma, 1-10. https://doi.org/10.1080/02770903.2020.1870130
• Fishe, J. N., Gautam, S., Hendry, P., Blake, K. V., & Hendeles, L. (2019a). Emergency medical services administration of systemic corticosteroids for pediatric asthma: A statewide study of emergency department outcomes. Academic Emergency Medicine, 26(5), 549-551. https://doi.org/10.1111/acem.13660
• Fishe, J. N., Palmer, E., Finlay, E., Smotherman, C., Gautam, S., Hendry, P., & Hendeles, L. (2019b). A statewide study of the epidemiology of emergency medical services’ management of pediatric asthma. Pediatric emergency care. doi: 10.1097/PEC.0000000000001743
• Henderson, M. B., Schunk, J. E., Henderson, J. L., Larsen, G. Y., Wilkes, J., & Bratton, S. L. (2018). An assessment of asthma therapy in the pediatric ICU. Hospital pediatrics, 8(6), 361-367. DOI: https://doi.org/10.1542/hpeds.2017-0003
• Indinnimeo, L., Chiappini, E., & Del Giudice, M. M. (2018). Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics. Italian Journal of Pediatrics, 44(1), 1-10. https://doi.org/10.1186/s13052-018-0481-1
• Leung, J. S. (2021). Paediatrics: how to manage acute asthma exacerbations. Drugs in Context, 10. doi: 10.7573/dic.2020-12-7
• Seliem, W., & Sultan, A. M. (2018). Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis?. Jornal de pediatria, 94, 56-61. https://doi.org/10.1016/j.jped.2017.04.004

Ankle Pain Discussion Responses

Discussion Responses

Hello Olugemo, I have gone through your post on ankle pain concerning your case study of F. F., a 46-year-old female who presented with bilateral ankle pains and here are responses. You explored the ankle pain very well in your history but don’t you think knowing if the pain is radiating, its relieving factors and the timing (if it is constant or intermittent) would have been an important part of your pain history. Still in your history it would be of significance to rule out history of complicating conditions of ankle injury such as diabetes, arthritis and connective tissue disorders.

Your evaluation of the patient in terms of physical assessment was well done as it confirmed that the right ankle was severely injured compared to the left. The presence of ecchymosis and a higher pain grading scale on the right all support this. The ankle is prone to injury because of its complexity. The injuries range from ankle ligament injuries to fractures to fracture subluxation and dislocation. Grade I and II ankle injuries cause stretching or microscopic tears of the stabilizing ligaments while Grade III ankle sprain may interfere with syndesmotic structures. Moreover, the highest energy incidents may disrupt the tendons and cause fractures. With ankle sprain the most commonly involved structure is anterior talofibular ligament and or calcaneofibular ligament (Melanson & Shuman, 2020).

Information about the diagnostic tests such as the need for X-ray and specific evaluations for ankle injury were well captured. In addition, it would have been necessary to do a Kleiger test to rule out injury to the deltoid ligament (Larkins, Baker & Baker J., 2020) and inversion stress maneuver to assess the integrity of calcaneofibular ligament. Am also in agreement with your assessment differential diagnosis as F.F is likely to have bilateral lateral ankle sprains based on her presentation, Further, it appears that her ankles were forcefully rolled out of their normal position during the exercise, hence stretching them. Generally, your diagnostic formulation was fine all the way from history to differential diagnosis. Thank you.

References.

• Larkins, L. W., Baker, R. T., & Baker, J. G. (2020). Physical examination of the ankle: A review of the original orthopedic special test description and scientific validity of common tests for ankle examination. Archives of Rehabilitation Research and Clinical Translation, 2(3), 100072. https://doi.org/10.1016/j.arrct.2020.100072
• Melanson, S. W., & Shuman, V. L. (2020). Acute ankle sprain. In StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459212/

Application of Theory Paper NR501

Application of Theory Paper NR501

Guidelines & Scoring Rubric

Purpose:

The purpose of this assignment is to synthesize one strategy for the application of a specific nursing theory to resolving a problem or issue of nursing practice in nursing leadership, nursing education, nursing informatics, or health policy.

Course Outcomes

Through this assignment, a student will demonstrate the ability to:

(CO#1) Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO1)

(CO#3) Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO3, 7, 10)

(CO#4) Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO4, 7)

Due Date: Sunday 11:59 PM MT at the end of Week 6

Total Points Possible:  325

Also Read:

Chamberlain NR501 Jean Watsons Theory of Human Caring Presentation

Requirements:

Description of the Assignment: 

Content

1. Introduction to the paper includes a few general statements on the idea of nursing theory being applied to solve problems/issues in nursing practice, regardless of the specialty area of practice. For example, why would one pick a nursing theory to solve a practice problem? Would a grand, middle-range, or practice theory be best? Does the writer have any experience in using nursing theory this way? In addition, a brief one-paragraph summary of a specific nursing theory and information on the sections of the paper are provided. The selected nursing theory can be a grand theory, a middle-range theory, or a practice theory.
2. Description of the problem/issue for which strategies will be developed. The problem to be resolved must be in nursing leadership, nursing education, nursing informatics, or health policy. Scholarly evidence (in the form of a literature review) supporting the issue is included. The problem/issue could be local to one’s specific practice setting. For example, the setting might be a nursing unit, a nursing-education program, an informatics department, or a health-policy unit of a consulting firm. The problem/issue needs to be something that a nursing theory can impact, whether it solves the actual problem/issue or enables people affected by the problem/issue to deal with it. It is best if the problem/issue is from real life – something the writer of the paper has dealt with or is currently engaged in.

Some examples (these are fictitious examples)

1. A nursing unit has experienced rapid turnover of professional staff, including several nurse managers. A new nurse manager from outside of the nursing unit is appointed.
2. Informatics nurse specialists face a lot of resistance from all healthcare professionals to implementation of a computer-based order entry program. The implementation date will not be changed.
3. A nurse educator is assigned to take over a large class of undergraduate nursing students, with a mix of young adults and adults returning for a second degree. The subject is difficult, students have not been doing well, and frustration and tempers are impeding group work.
4. A health-policy nurse specialist works for a consulting firm that lobbies on behalf of many healthcare professions. Within the specialist’s work unit, there is much debate over the pros and cons of various policies being proposed for attention in the coming year.

3. Applying concepts and principles from the selected theory, one strategy for resolving the identified issue is described in depth. Details on how the theory would be applied are included (consider: who, what, when, where, and how). Rationales for the strategy as well as evidence from scholarly literature are included. One ethical and/or legal aspect of the strategy is discussed. Expected outcome(s) from implementing the strategy are proposed.
4. Concluding statements include new knowledge about applying nursing theory gained by writing the paper

Format and Special Instructions

1. Paper length: 6 pages minimum; 8 pages maximum, excluding title page and reference page. Points will be deducted for not meeting these requirements.
2. The textbook required for this course may not be used as a reference for this assignment.
3. A minimum of 3 scholarly references are used. References must be current – no older than 5 years, unless a valid rationale is provided. Consult with the course instructor about using an older source.
4. Title page, body of paper, and reference page(s) must be in APA format as presented in the 6th edition of the manual
5. Ideas and information from readings and other sources must be cited and cited correctly.
6. Grammar, spelling, punctuation, and citations are consistent with formal academic writing as presented in the 6th edition of the APA manual

References

Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Retrieved 8 September 2019 from

https://www.google.co.ke/url?sa=t&source=web&rct=j&url=https://pdfs.semanticscholar.org/8871/eb88fb06168bb31e20e9c54e57920e575a47.pdf&ved=2ahUKEwje0JrqscHkAhVClFwKHYXzAgsQFjAQegQICRAB&usg=AOvVaw0CEuuz-eqnIwVMqcmUI55E

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. Doi: 10.12968/joan.2019.8.4.177

Schmidt, L.A., Nelson, D. & Godfrey, L. (2003). A clinical ladder program based on Carper’s fundamental patterns of knowing in nursing. JONA, 33(3), 146-152. Doi: 10.1097/00005110-200303000-00005

Quaglietti, S., Blum, L. & Ellis, V. (2004). The role of the adult nurse practitioner in palliative care. Journal of Hospice and Palliative Nursing, 6(4), 209-214. Doi: 10.1097/00129191-200410000-00009

Directions and Grading Criteria

CategoryPoints%DescriptionIntroduction6019Introduction to the paper includes all of the following:

·       General statements on the idea of nursing theory being applied to solve problems/ issues in nursing practice, regardless of the specialty area of practice.

·       A brief one-paragraph summary of a specific nursing theory

·       Information on the sections of the paper

Problem/ Issue8526The problem/issue is substantively discussed.

 

The problem is clearly in nursing leadership, nursing education, nursing informatics, or health policy.

 

Scholarly evidence supporting the issue is included.

Strategy10030All of the following are present:

 

·       One strategy for resolving the identified issue is discussed substantively

 

·;

·       Rationale(s) for the strategy are evident

 

·       Evidence from the scholarly literature supports the discussion

 

·       At least one ethical and/or legal aspect of the strategy is discussed.

Conclusion4013Concluding paragraph(s) clearly show new knowledge about applying nursing theory gained from writing this paper

 

Paper Requirements103All of the following requirements are met:

 

Paper meets length requirements

 

Minimum of 3 scholarly references

 

Textbook not used as a reference

 

References are current – within a 5-year time frame unless a valid rationale is provided for use of older references

 

APA Format103Title page, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section or topic of the paper.Citations in Text103Ideas and information that come from readings must be cited and referenced correctly.Writing Mechanics103Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal written work as found in the 6th edition of the APA manual.Total 325100A quality assignment will meet or exceed all of the above requirements.

Grading Rubric

Assignment CriteriaA

(100 – 92%)

Outstanding or highest level of performance

B

(91-84%)

Very good or high level of performance

C

(83-76%)

Competent or satisfactory level of performance

F

(75-0%)

Poor or failing or unsatisfactory level of performance

Content

Possible Points = 285 Points

 

 

 

 

  

 

Introduction60-56 Points55-50 Points49-46 Points45-0 PointsIntroduction to the paper includes all of the following:

·       General statements on the idea of nursing theory being applied to solve problems/ issues in nursing practice, regardless of the specialty area of practice.

·       A brief one-paragraph summary of a specific nursing theory

·       Information on the sections of the paper

Introduction to the paper includes only 2 of the following:

·       General statements on the idea of nursing theory being applied to solve problems/issues in nursing practice, regardless of the specialty area of practice.

·       A brief one-paragraph summary of a specific nursing theory

·       Information on the sections of the paper

Introduction to the paper includes only 1 of the following:

·       General statements on the idea of nursing theory being applied to solve problems/issues in nursing practice, regardless of the specialty area of practice.

·       A brief one-paragraph summary of a specific nursing theory

·       Information on the sections of the paper.

Introduction to the paper includes none of the following:

·       General statements on the idea of nursing theory being applied to solve problems/issues in nursing practice, regardless of the specialty area of practice.

·       A brief one-paragraph summary of a specific nursing theory

·       Information on the sections of the paper

Problem/Issue85-78 Points77-71 Points70-65 Points64-0 PointsThe problem/issue is substantively discussed.

 

The problem is clearly in nursing leadership, nursing education, nursing informatics, or health policy.

 

Scholarly evidence supporting the issue is included.

The problem/issue is superficially discussed.

 

The problem is clearly in nursing leadership, nursing education, nursing informatics, or health policy.

 

Scholarly evidence supporting the issue is included

The problem/issue is superficially discussed.

 

·       It is not clear if the problem belongs to nursing leadership, nursing education, nursing informatics, or health policy

 

OR

 

·       Scholarly evidence supporting the issue is not included

The problem/issue is superficially discussed.

 

·       It is not clear if the problem belongs to nursing leadership, nursing education, nursing informatics, or health policy

 

AND

 

·       Scholarly evidence supporting the issue is not included

Strategy100-92 Points91-84 Points83-76 Points75-0 PointsAll of the following are present:

 

·       One strategy for resolving the identified issue is discussed substantively

 

·;

·       Rationale(s) for the strategy are evident

 

·       Evidence from the scholarly literature supports the discussion

 

·       At least one ethical and/or legal aspect of the strategy is discussed.

Only 4 of the following are present:

 

·       One strategy for resolving the identified issue is discussed substantively

 

·       Concepts and principles from the selected nursing theory are clearly applied

 

·       Rationale(s) for the strategy are evident

 

·       Evidence from the scholarly literature supports the discussion

 

·       At least one ethical and/or legal aspect of the strategy is discussed

Only 3 of the following are present:

 

·       One strategy for resolving the identified issue is discussed substantively

 

·       Concepts and principles from the selected nursing theory are clearly applied

 

·       Rationale(s) for the strategy are evident

 

·       Evidence from the scholarly literature supports the discussion

 

·       At least one ethical and/or legal aspect of the strategy is discussed

2 or fewer of the following are present:

 

·       One strategy for resolving the identified issue is discussed substantively

 

·       Concepts and principles from the selected nursing theory are clearly applied

 

·       Rationale(s) for the strategy are evident

 

·       Evidence from the scholarly literature supports the discussion

 

·       At least one ethical and/or legal aspect of the strategy is discussed

Conclusion40-37 Points 33-30 Points29-0 PointsConcluding paragraph(s) clearly show new knowledge about applying nursing theory gained from writing this paper

 

NAConcluding paragraph(s) does not clearly show new knowledge about applying nursing theory gained from writing this paper

 

Concluding paragraph(s) are missing

 

Content Subtotal _____of  285 pointsFormat

Possible Points =  40 Points

 Paper Requirements10-9 Points8 Points7 Points6-0 PointsAll of the following requirements are met:

 

Paper meets length requirements

 

Minimum of 3 scholarly references

 

Textbook not used as a reference

 

References are current – within a 5-year time frame unless a valid rationale is provided for use of older references

 

Only 2 of the following requirements are met:

 

Paper meets length requirements

 

Minimum of 3 scholarly references

 

Textbook not used as a reference

 

References are current – within the 5-year time frame  unless a valid rationale is provided for use of older references

Only 1 of the following requirements is met:

 

Paper meets length requirements

 

Minimum of 3 scholarly references

 

Textbook not used as a reference

 

References are current – within the 5-year time frame  unless a valid rationale is provided for use of older references

None of the following requirements are met:

 

Paper meets length requirements

 

Minimum of 3 scholarly references

 

Textbook not used as a reference

 

References are current – within the 5-year time frame  unless a valid rationale is provided for use of older references

APA Format10-9 Points8 Points7 Points6-0 PointsThere are 0 – 2 APA format errors in the text, title page and reference page(s)There are 3 – 5 APA format errors in the text, title page and/or reference page(s)There are 6 – 8 APA format errors in the title page, running head, or reference page (s).There are 9 or more APA format errors in the title page, running head, or reference pages(s).

 

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Antisocial Personality Disorder Study Guide

Antisocial Personality Disorder

Introduction

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classifies the ten personality disorders into three clusters: A, B and C. Antisocial personality disorder lies within cluster B, besides histrionic, narcissistic and borderline personality disorders (American Psychiatric Association, 2013). Class B disorders are characterized by unpredictable, emotional and dramatic interactions between the individual and other persons. The clinical features include a pervasive pattern of disregard for and violation of the rights of other persons, beginning from above the age of fifteen years. The individual performs acts that serve as grounds for arrest by resisting social norms pertaining to expected lawful behavior. They may also engage in repeated lying, acts of deception and using aliases or conning others for monetary gain or pleasure. Other features include impulsivity/failure to plan, aggressiveness and irritability, often involving assaults and physical fights and consistent irresponsibility marked by failure to maintain reliable work behavior or honest monetary obligations. The person may also exhibit lack of remorse, indifference or rationalize hurting or mistreating other individuals. The person should be at least eighteen years old and the disorder’s onset should be before fifteen years whereas the antisocial behavior ought not to be exclusively within schizophrenia or bipolar disorder.

Figure 1: DSM 5 Criteria for Classifying Personality Disorders

Differential Diagnoses

Paraphilias, Posttraumatic Stress Disorder, Schizophrenia, Schizoaffective disorder, Schizophreniform disorder, Social phobia, Alcoholism, Anxiety Disorders, Brief Psychotic Disorder, Bulimia Nervosa, Depression, Dissociative Disorders, Ganser Syndrome, Illness Anxiety Disorder (also known as hypochondriasis), Marrow Failure Syndromes.

Figure 2: Differential Diagnoses of Antisocial Personality Disorder

Epidemiology

The lifetime prevalence of ASPD is estimated at 1 to 4 % within the general population. Males have a likelihood of thrice to five times of being diagnosed with ASPD than females, having incidences of 6 % and 2 % respectively. Reliable studies reveal decreasing prevalence rates with increasing age, attributable to personality trait changes with age and increasing mortality with individuals having the antisocial personality disorder. Cultural considerations for personality disorders are founded on the social-historical concepts of personality, developmental processes and neurobiology.  Western cultures encouraging individualism and independence may be reflected in self-reported psychological stress among persons endeavoring to establish a “goodness of fit” between their style and the immediate society.

Psychotherapy is the mainstream treatment for antisocial personality disorder. The therapist focuses on changing the patient’s thinking process (cognitive therapy) and encouraging socially acceptable behavior (behavioral therapy). Family therapy increases the understanding among family members of the person with the condition whereas group therapy should be coutured to meet the needs of individuals with the disorder. Group therapy encourages the person to share his/her experience with other persons having the disorder. Medication is helpful in stabilizing mood swings or treating the distressing symptoms such as impulsivity and violent aggressiveness. Alcohol dependence is managed with nortriptyline whereas bromocriptine and nortriptyline manage anxiety. Phenytoin may decrease the frequency and intensity of impulsive acts. Figure 2: Therapy modalities for ASPD

The prognosis for ASPD is often poor. Persons with antisocial personality disorder have higher risk for substance abuse, besides higher likelihood of being imprisoned for criminal acts. They also have higher likelihood to die via violence. Since they rarely seek medical attention independently, the legal system is the main body availing treatment to them.

The diagnosis of ASPD depends primarily on complete medical history and physical evaluation. No specific laboratory tests may diagnose any personality disorder, although the doctor may use blood tests, X-rays of the chest and abdomen; and CT-scan of the head to rule out physical illnesses that could have caused the symptoms.

Co morbidities of ASPD include other mental disorders, particularly schizophrenia. ASPD manifests symptoms suggestive of psychosis and propensity for violence. Nonetheless the violence is to lesser extremes than in schizophrenia and occurs only during a manic episode, marked with agitated behavior.

The ethical and legal considerations pertaining to ASPD arises first from the fact that  the DSM criteria centers on the criminal and antisocial behavior instead of the underlying interpersonal deficits and personality structure. The conflict centers on whether the persons have medical conditions or intentionally engage in social rule breaking without remorse (Yakeley and Williams, 2018). The medical and legal disciplines are often in dilemma whether the individuals ought to be punished for their criminal acts or treated with moral re-education.

Patient education should include increasing awareness of the condition to the individual. The person should also be directed to see the detrimental effects of their irresponsible acts. Also the therapist should direct them to envisage the benefits of socially acceptable behavior (Skodol, 2020). They could be encouraged to seek employment opportunities, pay bills and loans on time and provide child support.

References

• American Psychiatric Association (2013). DSM 5. American Psychiatric Association, 70.
• Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2020 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/
• Khalifa, N., Duggan, C., Stoffers, J., Huband, N., Völlm, B. A., Ferriter, M., & Lieb, K. (2010). Pharmacological interventions for antisocial personality disorder. The Cochrane database of systematic reviews, (8), CD007667. https://doi.org/10.1002/14651858.CD007667.pub2
• Mulder, R. (2017) Cultural Aspects of Personality Disorder. The Oxford Handbook of Personality Disorders. Retrieved from doi 10.1093/oxfordhb/9780199735013.013.0013
• Skodol, A. (2020) Antisocial Personality Disorder. University of Arizona College of Medicine. Retrieved from https://www.msdmanuals.com/home/mental-health-disorders/personality-disorders/antisocial-personality-disorder
• Yakeley, J., & Williams, A. (2018). Antisocial personality disorder: New directions. Advances in Psychiatric Treatment, 20(2), 132-143. doi:10.1192/apt.bp.113.011205

Applying Duck’s Change Curve Model NUR699

NUR 699 GC Week 5 Assignment 1 Evidence-Based Practice Proposal – Section E: Change Model

Details for Applying Duck’s Change Curve Model NUR699:

In 500-750 words (not including the title page and reference page), apply a change model to the implementation plan. Include the following:

1. Roger’s diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models presented, such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model), can also be used as a framework for applying your evidence-based intervention in clinical practice.
2. Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
3. In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you designed in Topic 5 with the narrative, the conceptual model should be placed in the appendices for the final paper.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, refine “Section E: Change Model” for your final submission. This will be a continuous process throughout the course for each section.

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