Soap Note 1 “ADULT”  Wellness check up (10 points) 

What steps do you take to locate primary and peer-reviewed research articles when performing a literature search?

What resources are available to you to engage in a meaningful and successful literature search?

As you have explored throughout this course, Walden University provides vast resources for student support to ensure success in their academic program of study. When it comes to research and using Library resources, several support mechanisms are available to you as well.

Taking the first step to think about a research topic or area of interest and filtering that topic using a series of keywords and operations will be a fundamental component for performing a literature search in Walden Library’s databases. While the ultimate goal is to produce a set or results that match your search criteria, you must keep in mind that that the quality of the research articles obtained will likely vary. Thus, you must critically examine and analyze the aims of the research produced and how it aligns, confirms, or negates your topic or area of research. As you develop proficiency in this area, you will discover that you can extract content themes and frameworks to enhance future research and the need to identify additional research support.

For this Assignment, consult the Walden Library webinars and resources provided. These resources serve as a general good first step for performing literature searches and engaging with the databases of research available to you. Think about a research topic or area of interest to focus on for this Assignment. Then, search the Walden Library to locate and retrieve peer-reviewed research articles that pertain to your topic or area of interest. 

6-paragraph assignment in which you do the following:

•  a 1-pararaph introduction of how you conducted your literature search and the databases consulted in your search in relation to your practice area or area of interest. Be specific and provide examples.
• a 1-paragraph summary of each of the articles you have selected (a total of 3 paragraphs).
•  1 paragraph that synthesizes the three articles using a scholarly voice.
•  a final paragraph in which you discuss the differences between summarizing and synthesizing research. Be specific and provide examples.

• Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measureLinks to an external site.. Implementation Science, 9(7), 1–15.
• Walden University. (2021). DNP capstone resources NURS 8702 and NURS 8703Links to an external site.. Office of Research and Doctoral Studies. https://academicguides.waldenu.edu/research-center/program-documents/dnp-8702-8703
• Walden University. (n.d.). Subject research: Nursing.Links to an external site. Walden Library. https://academicguides.waldenu.edu/library/subject/nursing
• Walden University. (n.d.). Using evidence: Synthesis.Links to an external site. Writing Center. https://academicguides.waldenu.edu/writingcenter/evidence/synthesis
• Westlake, C. (2012). Practical tips for literature synthesis. Clinical Nurse Specialist,Links to an external site. 26(5), 244–249. https://doi.org/10.1097/NUR.0b013e318263d766

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an alternative approach to the ethical issue described by your colleague. use 2 reference for each. Less than 1 page

1.Organizations use professional ethics to provide a framework for what behaviors are accepted and expected.  Professional ethics can be defined as “rules of acceptable conduct that members of a given profession are expected to follow” (American Psychological Association, n.d.).  As a doctorally prepared nurse, it is critical to understand the impact that an organization’s professional ethics can have on the success of an organization as well as patient outcomes.  A recent study conducted by Torkaman et al. (2020) investigated the relationship between professional ethics and organizational commitment and was able to show a positive correlation between professional ethics and nurses’ commitment to their organization.   A DNP-prepared nurse would be able to identify the importance of leveraging professional ethics in order to increase retention rates.  The DNP-prepared nurse could offer reimbursement for staff who attend ethics-based training to highlight the organization’s emphasis on these principles, strengthening nurses’ perceptions of the value of professional ethics within their organization.

                                                                                      Autonomy

            Autonomy in healthcare refers to the notion that patients should have the right to make their own decisions about their treatment.  Ethical dilemmas may arise when patients do not have the capacity to make decisions, and others (family members, Emergency Room (ER) staff, or legal guardians) have to step in to make these critical decisions for the patient.  Rejno et al. (2020) created vignettes to examine the importance of autonomy and dignity.  In one of these vignettes, a patient named David was in a motor vehicle accident and had to be sedated and placed on a respirator.  The ER team providing care to David has no knowledge of his wishes for care and, therefore, has to use their own judgment to provide life-saving measures.  In situations like this, “healthcare professionals can find support from basic ethical values, ethical guidelines such as those provided by the ICN and from learning not to prejudge what the dignity of identity might be for David; additionally, it is essential to protect the identity of every patient, viewing each as a unique person whose life stories are acknowledged, in order to preserve their dignity” (Rejno et al, 2020).  The DNP-prepared nurse should consider creating an ethics committee to help provide support and guidance to staff who need to provide care for patients who are unable to make decisions on their own.

                                                                      Issues in My Own Practice

            Over the years, I have worked in many different inpatient psychiatric settings, one being a consistently nationally-ranked hospital by US News and World Report.   One of the main differences that I observed in this organization was a strong emphasis on professional ethics.  Staff members took great pride in the fact that they were providing evidence-based best patient care in an organization that set forth professional expectations, which, for the most part, staff strived to follow.  When staff are provided with clear expectations, they feel more supported, are better equipped to deliver quality care, and are more invested in the organization.

            In the inpatient psychiatric setting, autonomy is an issue that we deal with quite regularly.  Oftentimes, patients are so mentally ill that they do not want to take medications that would help them to stabilize.  When this is the case, the Psychiatrist has to petition the court to have the patient committed and medicated against their will.  Staff members have to physically restrain these patients and provide intramuscular medications to them against their will.  As you can imagine, this frequently brings up ethical questions of patient autonomy.  In order to provide support, ethics committees are a valuable tool to help staff process complex patient cases.

  References

American Psychological Association. (n.d.) Dictionary of Psychology. https://dictionary.apa.org/professional-ethicsLinks to an external site.

Rejno, A., Ternestedt, B.-M., Nordenfelt, L., Silfverberg, G., & Godskesen, T. E. (2020). Dignity at stake: Caring for persons with impaired autonomy.Links to an external site.Links to an external site. Nursing Ethics, 27(1), 104–115. https://doi.org/10.1177/0969733019845128

Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics & History of Medicine, 13(17), 1–10.

2.   Ethics are one of the main pillars of nursing care and uphold the quality and integrity of interventions delivered. Ensuring that ethical considerations are taken when constructing the framework for a healthcare organization can ensure that those involved feel connected to a deeper and valuable meaning within their work and are also meeting the ethically based qualifications to deliver said care (Torkaman et al., 2020).

            Along with ensuring the providers are qualified to deliver appropriate care, the setting must also be appropriate for the level of patient acuity. Telehealth has undoubtedly increased access to care, providing resources to individuals who may not have sought psychiatric support prior to virtual appointments. An ongoing assessment by federal and state regulators has been the appropriateness of prescribing certain medications, including buprenorphine products for medication-assisted treatment (MAT) in the use of substance use disorders. Additionally, fully virtual psychiatric providers have also experienced the need to carefully screen the mental health symptoms for severity and ensure a patient is appropriate for telehealth level of care (LOC).

            The Doctor of Nursing practice (DNP) is a change agent supportive of guiding these processes not only at their but as regulations change and adapt. The DNP can play an integral role in collecting new data on care outcomes and translating this data into information that can be disseminated to and understood by non-healthcare professionals. Doing so can promote the ongoing availability of telehealth measures, with focus on increasing access to care. The DNP serves as an expert reviewer to examine outcomes with particular attention to interventions that provide therapeutic outcomes and assessing for gaps in practice. This is of particular concern with telepsychiatry, as progressive steps have been implemented over time to proactively identify individuals who may be at risk for self-harm or are experiencing high-acuity symptoms out of reasonable scope of telehealth care (Fiorini et al., 2020).

            Much like general psychiatry services, there are even fewer psychiatric providers providing specialty substance use disorder treatment. Throughout the pandemic, access was increased to MAT treatment and the previous requirement for a specialty waiver and training to prescribe buprenorphine was waived and consolidated by the Omnibus bill (SAMHSA, 2023). This allows all prescribers with schedule III authority to prescribe buprenorphine products to their patients with opiate use disorder, pending state law allowability. Prescribers have also been permitted to prescribe to patients via telehealth, given all other aspects of MAT treatment are completed including urine drug screening and engagement in psychotherapy per state requirements Mahmoud et al., 2022). These permissions may not continue if they are not continuously extended, and the patients utilizing the prescribers who are available in their area due only to telehealth will be without a MAT prescriber once they end. DNPs can present and advocate for ongoing advancements in safe but broadened prescribing practices for MAT, with respect for the seriousness of buprenorphine prescribing and also the management and severity of opiate use disorder in the United States.

References

Fiorini, R. A., De Giacomo, P., & L’Abate, L. (2020). Towards resilient telehealth support for clinical psychiatry and psychology: a strategic review. Studies in Health Technology and Informatics, 213, 275–278.

Mahmoud, H., Naal, H., Whaibeh, E., & Smith, A. (2022). Telehealth-based delivery of medication-assisted treatment for opioid use disorder: a critical review of recent developments. Current Psychiatry Reports, 24(9), 375–386. https://doi.org/10.1007/s11920-022-01346-z

Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Waiver elimination (MAT Act). https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act

Torkaman, M., Heydari, N., & Torabizadeh, C. (2020). Nurses’ perspectives regarding the relationship between professional ethics and organizational commitment in healthcare organizations. Journal of Medical Ethics and History of Medicine, 13(17), 1–10. https://doi.org/10.18502/jmehm.v13i17.4658

  

Instructions: Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide citations/references for your answers in APA format with scholarly references no older than 5 years. 

CASE STUDY: Active Labor: Susan Wong 

Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of abnormal alpha-fetoprotein levels at 16 weeks of pregnancy. 

She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal problem, so they felt they did not want this information

. Reflective Questions 

1. As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs? 

2. How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views? 

3. With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future? 

Hospitals have noises that are buzzing day and night. Emergency Rooms, ICU’s and monitored patient floors to mention a few, have high rates of noise saturation. The most common attribution to the noise is alarms. Alarms are designed to alert staff of a change or potential change in patient status (Hebda et al., 2019). Often, the alarm going off is false or has no patient threat. This is due to parameters not being set, patches not sticking, or positioning of a sensor. This can cause alarm fatigue, “The desensitization of a clinician to an alarm stimulus that results from sensory overload causing the response of an alarm to be delayed or missed” (West et al., 2014).

The result of alarm fatigue can lead to harmful patient situations. For example, if a nurse on a busy med-surg floor has several patients on beds with alarms, patients with IV pumps infusing and on telemetry monitoring, the alarm noise from all the devices could cause the nurse to tone out some of the sounds. If one of her patient’s bed alarms continues to go off repeatedly and every time she enters the patient’s room, finds the patient in bed, she determines the sensor is set to sensitive for the patient. But if the sensor is not reset, and the alarm continues to go off, the nurse may start to ignore the alarm. The last time the alarm sounds, the patient does get out of bed and falls, injuring his hip. This can turn into a legal issue as the safety measure was in place to protect the patient from harm, but due to a failure to change the bed setting, and the nurse’s desensitization of the alarm, the patient had a poor outcome. There is an ethical responsibility for the nurse to assess the injured patient, report the fall to appropriate change according to hospital policy and discuss the incident with the patient or family members. According to Kadivar et al., (2017), that despite measures put into place in the health care setting, there are still numerous threats posed to patient safety.

Evidence suggests that alarm fatigue is a patient safety and quality concern. As health care delivery becomes more digitalized, it is increasingly important to develop a safety culture to address alarm fatigue. The research suggests establishing safe alarm management and response processes. The use of multilevel sharing practices and prevention strategies is also a way to collaborate with multidisciplinary teams on strategies for reduction in alarm fatigue (Winter et al., 2021). By decreasing the number of false alarms with use of proper management, nurses can better care for patients needs without disruptions. Thus, reduce potential missed or ignored alarms resulting in poor patient outcomes.

 

References:

Kadivar, M., ManooKian, A., Asgharican., & Zarvani, A. (2017). Ethical and legal aspects of patient's safety: A clinical case report.
Journal of Medical Ethics and History of Medicine,
10, 15.

 

Winters, B., Slota, J., & Bilimoria, K. (2021). Safety Culture as a Patient Safety Practice for Alarm Fatigue.
Journal of the American Medical Association,
326(12), 1207-1208.

https://doi.org/chamberlainuniversity.idm.oclc.org/10.1001/jama.2021.8316

Links to an external site.

 

Hebda, T., Hunter, K., & Czar, P. (2018). Handbook of Informatics for Nurses & Healthcare Professionals (6th ed.). Pearson Learning Solutions.

https://ambassadored.vitalsource.com/books/9781323903148

Links to an external site.

 

West, P., Abbott, P., & Probst, P. (2014). Alarm fatigue: A concept analysis.
Online Journal of Nursing Informatics,
18(2), 1.

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