The Dual Nature Of Informatics

The Dual Nature of Informatics

 

Informatics can be used for improving health outcomes not only for individual patients, but also for whole groups of patients with similar conditions. This is often referred to as the dual nature of informatics. Technologies, such as electronic health records (EHRs) and clinical decision support (CDS) systems, can provide insights and guidance for health care professionals at the point of care. In addition, data warehousing and mining allow health care organizations to use the vast amount of information stored in EHRs to make predictions and diagnoses for other patients with similar conditions.

 

In this Discussion, you examine the dual nature of informatics. First, you review a scenario and consider the patient information to be collected and recorded at the point of care. Then, you decide how this information could be aggregated for population health and future use.

 

Consider the following scenario:

 

Mrs. Jones has come into your office stating that she has been experiencing frequent dizzy spells. She also reports that she has been unable to eat anything substantial over the last few days due to extreme nausea. The last time Mrs. Jones was in your office, the physician had suggested she start walking around the block or bicycling around the neighborhood to get her activity level up. Mrs. Jones admits that she did very little of that after a “ flip-flop” feeling of her heart scared her. You know that her symptoms could be a result of many conditions. Following the prompts on your informatics system, you begin to gather more specific information about Mrs. Jones’ symptoms and health history.

 

To prepare:

 

  • Based on the scenario, what information would you want to immediately gather about Mrs. Jones?
  • With that in mind, compile a list of patient questions you would like an EHR documentation screen to have.
  • How might the information derived from these questions help you provide high-quality care to Mrs. Jones?
  • Once this information is collected, what alerts might be critical to the evaluation of Mrs. Jones?
  • Review this week’s media presentation, Dual Nature of Informatics Systems, and reflect on the movement towards more transparent data and meaningful use. How might the data entered about an individual patient help to build preventative care and treatment for whole populations?
  • Refer back to your list of patient questions. Of these questions, which would generate data that could be aggregated for use with a larger group of patients? (Note: When developing your questions, consider the whole patient.)

 

Post on Tuesday 06/06/2016 a minimum of 550 words in APA format with 4 references

 

1) A description of the ideal EHR documentation screen that you would like to have at the point of care for all patients and why.

 

2) Explain how information gathered at the point of care with an individual patient can be aggregated to help provide high quality care to a larger population of patients.

 

Required Resources

 

Readings

 

  • Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
    • Chapter 1, “Historical Perspectives of Nursing Informatics”

      In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records.

  • Liaw, S.-T., & Boyle, D. I. R. (2010). Primary care informatics and integrated care. Studies in Health Technology and Informatics, 151, 255–268.
    Retrieved from the Walden University databases.

    This article discusses how the health care field can be reformed by increasing access to information across organizations and professionals. The authors of the article justify the need for this reform and provide guidance on how it can be achieved.

  • Mitchell, J. K. (2011). Nursing informatics 101: Using technology to improve patient care. ONS Connect, 26(4), 8–12.
    Retrieved from the Walden Library databases.

    The emergence of nursing informatics in health care is the main topic of this article. New trends in informatics are discussed, as well as the certification process, nurse education, and the implementation of new systems to support patient care.

  • Morath, J. (2011). Nurses create a culture of patient safety: It takes more than projects. Online Journal of Issues in Nursing16(3).
    Retrieved from the Walden Library databases.

    The author of this article emphasizes the need for nurses to develop skills for improving care and embracing new health care innovations. The author also describes the connection between individual nursing practice and the system-wide success of informatics.

  • Reiner, B. I. (2011). Improving healthcare delivery through patient informatics and quality centric data. Journal of Digital Imaging, 24(2), 177–178.
    Retrieved from the Walden Library databases.

    In this article, the author analyzes the impact of the movement towards digitized medical data on patient care. The author discusses how this movement places more responsibility and empowerment on the patient.

    Media

  • Laureate Education, Inc. (Executive Producer). (2012b). Dual nature of informatics systems. Baltimore: Author.

    Note: The approximate length of this media piece is 7 minutes.

    In this week’s media presentation, Gail Latimer, Dr. Patricia Button, and Dr. Roy Simpson discuss one of the most important aspects of informatics: the collection and aggregation of health information. The electronic health record (EHR) is discussed, as well as the nurse’s roles in working with EHR systems.

Systems Theory

Application: Systems Theory

 

As noted in the Learning Resources, systems theory provides a meaningful and beneficial means of examining challenges in health care organizations. To do this effectively, however, it is essential to assess all system components, as some may be relatively healthy while others are problematic.

 

For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)

 

To prepare:

 

  • Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
  • Reflect on your organization or one with which you are familiar ( Refer to the first discussion you did for me, My organization is a hospital University of Maryland Medical center) . Within a particular department or unit in this organization, identify a problem the staff is encountering.
  • Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
  • Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
  • Research professional standards that are pertinent to your identified problem.
  • Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)

 

To complete:

 

Write a 4- to 5-page paper (page count does not include title and reference page) that addresses the following:

 

  • (1) Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.
  • (2) Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).
  • (3) Based on this information, explain how you would address the problem as follows:

 

(a) Formulate a desired outcome.

 

(b) Identify goals and objectives that would facilitate that outcome.

 

(c) Translate those goals and objectives into policies and procedures for the department or unit.

 

(d) Describe relevant professional standards.

 

  • (4) Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

 

 

 

Guidance for Application Assignments:

 

 

 

Application Assignments require a title page, introduction, body of the paper, conclusion, and reference page. The title page needs to follows APA style and includes a title, student name, course number and section, and date. An abstract is not required. APA style headings are to be used appropriately to separate and organize sections of the paper. The use of direct quotes is discouraged and should only be used when the source material uses language that is particularly striking or notable. The introduction should provide an overview of the topic, the purpose of the paper, and topics that will be addressed. The body of the paper needs to address all required topics. The conclusion ought to provide closure for the reader, synthesize the content, and tie everything together to help clarify the main points of the paper. The reference page should include all references cited in the assignment in correct APA format.. Credible sources include scholarly peer-reviewed journal articles, evidence based resources, and professional (.org), educational (.edu), and government websites (.gov). Commercial websites (.com) are not considered credible sources. Please note: When selecting articles for course assignments, you are advised (unless you are referencing seminal information) to focus on work published within the past five years.

 

 

 

 

 

 

 

 

 

 

Required Resources

 

 

 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

 

 

 

Readings

 

 

 

  • Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
    • Review Chapter 7, “Strategic and Operational Planning”

      See especially Figure 7.1 on page 147.

    • Chapter 8, “Planned Change”
      • Organizational Change Associated With Nonlinear Dynamics (pp. 172–176)

        Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.

    • Chapter 12, “Organizational Structure”
      • “Organizational Culture” (pp. 274–276)

        There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.

  • Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

    This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.

  • Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal 4 (1) [2].

    Except from Abstract: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enables everyone to flourish. When units within health care organizations recognize their interdependence, they can create an interdisciplinary practice through systems integration.

  • Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.
    Retrieved from the Walden Library databases.

    In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.

 

 

 

Optional Resources

 

 

 

Discussion: Decision Making When Treating Psychological Disorders

PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:

1). ZERO (0) PLAGIARISM

2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS

3).  PLEASE SEE THE ATTACHMENT FOR RUBRIC DETAILS.

4). Please review and follow the grading rubric details well, and include each component in the assignment as required. Also, follow the APA writing rules and style

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.  For this Discussion, you will select an interactive media piece to practice decision-making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare
  • Review this week’s interactive media pieces and select one to focus on for this Discussion.
  • Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

 

Adult/Geriatric Depression
Hispanic Male With MDD

Hispanic male

BACKGROUND INFORMATION

The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Decision Point One

Decision Point One

Select what you should do:

Begin zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Reports a 25% decrease in symptoms
  • Client is concerned over the new onset of erectile dysfunction

Decision Point One

Begin Effexor XR 37.5 mg orally daily

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client reports that there is no change in depressive symptoms at all

Decision Point One

Begin Phenelzine 15 mg orally TID

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client reports that he was rushed to the Emergency Room 2 weeks ago after collapsing at the warehouse where he works. He was taken by ambulance to the local community hospital. He was diagnosed with postural hypotension
  • Client was treated with fluid bolus and told to stop taking his phenelzine and to follow up with his primary care provider within one week, and you within that same time frame.

 

Decision Point Two

Select what you should do next:

Decision Point Two

Restart Phenelzine and counsel client on dietary choices and importance of hydration

RESULTS OF DECISION POINT TWO

  • Client reports that although he had no more episodes of passing out, he has been dizzy when he gets up at night to use the bathroom
  • Client also reports that at various times throughout the day when he goes from a sitting to a standing position, he feels light-headed

Decision Point Two

Phenelzine is not reinitiated. Instead, we began therapy with Lexapro 20 mg orally daily after an appropriate “wash out” period (5 half-lives).

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client had no more syncopal episodes or episodes of orthostatic hypotension
  • Client reports a decrease in depressive symptoms by approximately 25 percent on the MADR scale

Decision Point Two

Re-start Phenelzine 7.5 mg orally TID

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reported that he still has a little dizziness
  • Client also reports that that his depression has improved greatly (a 35% decrease in MADR scale from 51 to 33)

Decision Point Three

Select what you should do next:

Decision Point Three

Continue current drug dose and counsel client on dietary modifications and orthostatic hypotension safety

Guidance to Student
The initiation of an SSRI or SNRI should not begin until an adequate “wash out” period of MAOI- this is generally defined as the time it takes for 5 half-lives of the drug to be metabolized. Co-administration of SSRI, SNRI, or TCA with MAOI is contraindicated as it can cause serotonin syndrome and can actually be fatal. You can continue the current dose and counsel client as to dietary modifications as well as orthostatic hypotension safety, however, it should be remembered that he works in a warehouse and may be at risk for falls/injury due to orthostatic hypotension. A “watch and wait” approach may be appropriate if the client has failed all other antidepressants. Increasing the dose back to 15 mg orally TID is not indicated as his orthostatic hypotension will likely worsen.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6521_Week8_Discussion_Rubric

 

Excellent Good Fair Poor
Main Posting Points: Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Feedback: Points: Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Feedback: Points: Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Feedback: Points: Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Feedback:
Main Post: Timeliness Points: Points Range: 10 (10%) – 10 (10%) Posts main post by day 3 Feedback: Points: Points Range: 0 (0%) – 0 (0%) Feedback: Points: Points Range: 0 (0%) – 0 (0%) Feedback: Points: Points Range: 0 (0%) – 0 (0%) Does not post by day 3 Feedback:
First Response Points: Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Feedback: Points: Points Range: 15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Feedback: Points: Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Feedback: Points: Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Feedback:
Second Response Points: Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Feedback: Points: Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Feedback: Points: Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. . Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Feedback: Points: Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Feedback:
Participation Points: Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days. Feedback: Points: Points Range: 0 (0%) – 0 (0%) Feedback: Points: Points Range: 0 (0%) – 0 (0%) Feedback: Points: Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days Feedback:

Show Descriptions Show Feedback

Main Posting–

Levels of Achievement: Excellent 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Good 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Fair 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Poor 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Feedback:

Main Post: Timeliness–

Levels of Achievement: Excellent 10 (10%) – 10 (10%) Posts main post by day 3 Good 0 (0%) – 0 (0%)   Fair 0 (0%) – 0 (0%)   Poor 0 (0%) – 0 (0%) Does not post by day 3 Feedback:

First Response–

Levels of Achievement: Excellent 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Good 15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Fair 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Poor 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Feedback:

Second Response–

Levels of Achievement: Excellent 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Good 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Fair 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. . Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Poor 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Feedback:

Participation–

Levels of Achievement: Excellent 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days. Good 0 (0%) – 0 (0%)   Fair 0 (0%) – 0 (0%)   Poor 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days Feedback:

Total Points: 100

Name: NURS_6521_Week8_Discussion_Rubric

PSYCHOPHARMACOLOGY. Respond To This Discussion Post

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

• Metformin 500mg BID 

• Januvia 100mg daily 

• Losartan 100mg daily 

• HCTZ 25mg daily 

• Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

By Day 3 of Week 7

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Respond to the these discussions. All questions need to be addressed.

 

Discussion 2 Me

Treatment of a Patient with Insomnia       

The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: Metformin 500mg BID, Januvia 100mg daily, Losartan 100mg daily, HCTZ 25mg daily, and Sertraline 100mg daily. Current weight: 88 kg. Current height: 64 inches. Temp: 98.6 degrees F. BP: 132/86 (Walden University).

Question number one, what brings you in today? By asking an open-ended question, the patient is more willing to share information with the provider (Stern, 2016). Another question that would be of beneficial knowledge during the interview is, do you consume caffeine? If so, how much caffeine do you consume in a day? Caffeine consumption close to bedtime contributes greatly to insomnia (Farazdaq et al., 2018). Lastly, the third question that should be asked is, do you suffer from Gastro Esophageal Reflux Disease (GERD). According to Farazdaq, Andrades, and Nanji, (2018) GERD is a contributing factor to insomnia in elderly patients. By asking the above questions, the provider can rule out environmental factors while assessing the patients concerns with open-ended questions.

People in the patient’s life that could provide further information is children or caretakers. Questions that would be appropriate to ask the patient’s children or caretaker would be if there is a recent decrease in her appetite, energy, mood, or interests. By asking about these areas of the patient’s life will provide external information that the patient might be withholding or may be unaware of.

Insomnia relies heavily on self-report for a diagnosis (Levenson et al., 2015). Also, a physical exam could be performed with the order of blood testing to rule out thyroid problems. According to Dr. Abhinav Singh (2021), hyperthyroidism results in nervousness from overactivity of this hormone, and insomnia is often a symptom. Administering the Hamilton Anxiety Rating Scale (HAM-A) would assess the severity of the patient’s anxiety. The HAM-A results would aid with further treatment of the patient’s insomnia, if related to anxiety (Psychiatry & Behavioral Health Learning Network, 2021). Another appropriate scale to administer to this patient is the Hamilton Depression Rating Scale (HDRS). HDRS is an assessment that focuses on feelings of guilt, mood, suicidal ideation, activities, weight, various stages of insomnia, and many more important areas (Hamilton, 1960).

The patient presents with a previous diagnosis of depression. The differential diagnosis for this patient is Generalized Anxiety Disorder (GAD), secondary to husband’s death. There are many possible changes within the living dynamics, such as financial burdens, fear of her own death, and suddenly sleeping alone.  Changes within this patient’s routine may be a cause of reported insomnia.

Temazepam is FDA approved for insomnia, and used off-label for anxiety disorders, acute mania, psychosis, and catatonia (Puzantian & Carlat, 2020). Temazepam is generally effective in the treatment of insomnia, by enhancing widespread inhibitory activity of GABA (Levenson et al., 2015). Temazepam is metabolized through the liver without CYP450 (Puzantian & Carlat, 2020). Another good sleep aid choice is Trazodone. Trazodone is widely used for insomnia (Levenson et al., 2015). Trazodone is FDA approved for the treatment of major depression and used off-label for insomnia and anxiety (Puzantian & Carlat, 2020). Trazodone inhibits serotonin reuptake, alpha-1 adrenergic receptor antagonist, and serotonin 5-HT2A and 5-HT2C receptor antagonist (Puzantian & Carlat, 2020). And Trazodone is metabolized primarily through CYP3A4 to active metabolite mCPP, that is metabolized by 2D6, inducing P-glycoprotein (Puzantian & Carlat, 2020). Trazodone, however, carries the side effect of daytime somnolence and dizziness (Puzantian & Carlat, 2020).

The favorable medication for this patient, is Temazepam. Temazepam is a safer medication to use in elderly patients because of the lack of active metabolites, its short half-life and absence of drug interactions (Puzantian & Carlat, 2020). The patient is currently taking Metformin, Januvia, Losartan, HCTZ, and Sertraline. Based on the current medications, the patient is being treated for diabetes mellitus, hypertension, and depression. Adding Temazepam to the patient’s medication regimen would not result in toxicity of other medications. Sleep is heritable and regulated by numerous genes. A genome wide association study found numerous single-nucleotide polymorphisms (SNPs) significantly associated with insomnia symptoms. The most significant SNPs occurred within genes involved in neuroplasticity, stress reactivity neuronal excitability, and mental health (Rajib, 2020).

The starting dose of Temazepam is lower in the elderly population (Puzantian & Carlat, 2020). The proper dose to begin with this patient, is Temazepam 7.5mg tab PO QHS. At the 4-week checkup, the expected outcome would be an increased ability to sleep, and reduced anxiety. If these results have not been achieved, Temazepam 15mg tab PO Q HS would be ordered. Temazepam does have the risk of weakness and dizziness, so great care and caution would need to be taken when increasing the dose. There needs to be an evaluation of the effects at week 8, or sooner if needed. The maximum dose of Temazepam is 30mg PO Q HS, and even lower in the elderly (Puzantian & Carlat, 2020).

References

Farazdaq, H., Andrades, M., & Nanji, K. (2018, December 31). Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382090/.

Hamilton, M. (1960). Hamilton Rating Scale for Depression. PsycTESTS Dataset23, 56–62. https://doi.org/10.1037/t04100-000

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The Pathophysiology of Insomnia. Chest147(4), 1179–1192. https://doi.org/10.1378/chest.14-1617

Puzantian, T., & Carlat, D. J. (2020). Medication fact book for psychiatric practice. Carlat Publishing, LLC.

Rajib, D. (2020). Do genes matter in sleep? -A comprehensive update. Journal of Neuroscience and Neurological Disorders4(1), 014–023. https://doi.org/10.29328/journal.jnnd.1001029

Singh, A. (2021, March 8). Could Your Thyroid be Causing Sleep Problems? Sleep Foundation. https://www.sleepfoundation.org/physical-health/thyroid-issues-and-sleep.

Stern, T. A. (2016). Massachusetts General Hospital: psychopharmacology and neurotherapeutics (1st ed.). Elsevier.

Walden University. (n.d.). Treatment for a Patient with a Common Condition. https://class.content.laureate.net/14884e77402afe219224c67c4f0463b3.html.

ISBAR Approach

Description: Presentation (500 words + 10minutes)

Percentage: 40%

Word Count: 10 minutes

Submission: Via Learnline

Relevance Using communication to provide safe care is an integral component of nursing. The national standards that govern the provision of care in acute and aged care centre around communication and ensuring safe and effective care is delivered. The use of ISBAR to communicate and share key information has been shown to be effective in managing and minimising harm in healthcare. ISBAR is a standard communication tool used to share information in acute deterioration. All nurses and training nurses must be aware of this process.

Learning Outcomes

  • Identify verbal and non-verbal communication strategies and standards that enable therapeutic communication and interprofessional relationships
  • Explain how cultural sensitivity and cultural safety aid in the establishment of effective communication with Aboriginal and Torres Strait Islander people and other multicultural communities
  • Demonstrate a high level of written and spoken English according to academic conventions and professional nursing standards.
  • Demonstrate effective communication through clinical handover and the legal documentation of essential information in healthcare records to ensure patient safety

Task Instructions

Develop and present a 10-minute digital presentation that address the following questions:

  1. Discuss how the ISBAR approach to handover aligns to communicating for safety national standards that govern acute and aged care
  2. Use literature (journal articles, textbooks, research publications and national standards) to support the content
  3. Narrate and elaborate upon the presentation using appropriate literature to support your points
  4. Put the citation on the slides and include a reference list
  5. Use PowerPoint to present the content
  6. Load your Microsoft PowerPoint presentation file onto Learnline, AND
  7. Submit a maximum 500 words script summary
  8. Load your script summary Word Document or PDF file with your Powerpoint presentation onto Learnline

Please note: It is a student’s responsibility to ensure that the narrated presentation plays and that the audio is clear. The presentation is not to exceed 10 minutes in duration. The presentation should draw on your knowledge of communication and culture you learn from this unit. The word counts of your script summary include the script and your presentation, except the reference list.

Marking Instructions: Please access the marking rubric to ensure that you are maximising your marks in your submission.

Guideline for Assessment 2: Presentation (500 words + 10 mins)

 

The presentation should include the following components:

1. Title Page

2. Presentation Objectives

3. Discuss how the ISBAR approach to handover aligns to communicating for safety

national standards that govern acute and aged care

4. Conclusion and Summary

5. Reference list (You are required to use current and relevant literature to support

each strategy that you are presenting. Literature should be within 10 years)

Your recorded presentation should not exceed 10 minutes.Total word counts is 500 words, including the word count of the presentation and the summary of your presentation script.

 

Useful Information for your presentation preparation

You can get more ideas for your presentation preparation from the following links: Record a presentation – PowerPoint (microsoft.com)

Recording a PowerPoint Presentation with Voice-Over Narration and Saving it as a Movie File –

YouTube

NUR1102 Course: Assignment 2 Oral Presentation – Bing video

Therapeutic Communication in Nursing – Bing video

Note: The examples of powerpoint presentation are only for your reference. You should follow the guideline for the content of your presentation.

 

Evidence Based Practice: For Nurses, Will The Use Of De-Escalation Techniques As Compared To No Use Of De-Escalation Techniques Reduce Workplace Violence?

Need to complete assignment attached using both research and non-research articles (also attached).

 

Research:  Literature Synthesis: Patient Aggression Risk Assessment Tools in the Emergency Department

Non-research: Ensuring Workplace Safety: Evidence Supporting Interventions for Nurse Administrators.

Only use template provided (APA format)

not including cover page, 4-5pgs

 

Must include.

Recommended Practice Change

·  Be sure you include your recommendation for your practice change, using your EBP question (remove the comparison)

·  Next, State how the research article supports this practice change recommendation, then include the in-text citation at the end of the statement

Example: The research article demonstrated use of Pilates increased strength, balance, and reduced falls among participants (Smith, 2020).

·  Finally, state how the non-research articles supports this practice change recommendation, then include the in-text citation at the end of the statement

·  All of these elements must be included for this section to pass

5.  Key Stakeholders

·  State 3 stakeholders (by their position- wound nurse, nurse educator, nurse administrator, etc) and state their role in helping get the practice change started. They each need a different role (job)

1

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C361 – MLM1 – Performance Assessment 1

 

 

Put your name here

 

College of Health Professions, Western Governors University

 

C361: Evidence-Based Practice and Applied Nursing Research

 

Instructor’s Name

 

Assignment Due Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C361 – MLM1 – Performance Assessment 1

 

Impact of the Problem on the Patient

 

Impact of the Problem on the Organization

 

Identify the PICO components

P – Nurses

I – De-escalation techniques

C – No De-escalation techniques

O – Reduce workplace violence

Evidence Based Practice Question

For nurses will use of de-escalation techniques as compared to no use of de-escalation techniques reduce workplace violence?

 

Research Article

Background Introduction

Methodology

Level of Evidence

Data Analysis

 

Ethical Considerations

Quality Rating

Analysis of the Results / Conclusions

 

Non-Research Article

Background Introduction

Type of Evidence

Level of Evidence

Quality Rating

Author’s Recommendations

 

Recommended Practice Change

Key Stakeholders

Barrier to Implementation

Strategy to Overcome the Implementation Barrier

Indicator to Measure the Outcome

 

 

 

 

 

 

 

 

 

 

 

C L I N I C A L

Natalie Cal Indiana Uni

Angie Lewi Indianapolis

Scott Showe Health, Ind

Norma Hal Indianapolis

For correspo Methodist H E-mail: ncal

J Emerg Nu Available on 0099-1767

Copyright © All rights re

http://dx.do

January 2

LITERATURE SYNTHESIS: PATIENT AGGRESSION RISK ASSESSMENT TOOLS IN THE EMERGENCY

DEPARTMENT

Authors: Natalie Calow, BSN, RN, Angie Lewis, BSN, RN, Scott Showen, BSN, RN, and Norma Hall, DNP, RN, Indianapolis, IN

M ultiple risk assessment tools have been developed to prevent violent behavior of patients. The purpose of a risk assessment tool is to prevent

injury to health care workers, prevent suicide, and de- escalate a patient before a violent act occurs. A risk assessment tool can be used by nurses to identify interventions and to protect themselves or their organiza- tion from potential poor decision making and poor outcomes when a violent event occurs.1

Risk assessment tools have been developed specifically for the emergency department and psychiatric, medical-surgical, and critical care units. Some adaptation of risk assessment tools has happened over the years depending on the setting in which the tool was used, inpatient versus outpatient. An important factor to consider when choosing a risk assessment tool is a review of the literature to determine the validity of the risk assessment tool because often there is no evidence that a particular tool is valid.1 A non-valid risk assessment tool can actually do more harm than good because the tool might give a worker a false sense of security.1

Aims and Objectives

Nurses play a vital role in controlling and de-escalating violent behavior in the emergency department. Evidence-

ow, Member, Indy Roadrunners Chapter, is LEAN Facilitator, versity Health Methodist Hospital, Indianapolis, IN.

s is Staff RN, Indiana University Health West Hospital, , IN.

n is Staff RN, Riley Hospital for Children, Indiana University ianapolis, IN.

l is Assistant Professor of Nursing, University of Indianapolis, , IN.

ndence, write: Natalie Calow, BSN, Indiana University Health ospital, 1604 N Capitol Ave, B107, Indianapolis, IN 46202; ow@iuhealth.org.

rs 2016;42:19-24. line 25 March 2015

2016 Emergency Nurses Association. Published by Elsevier Inc. served.

i.org/10.1016/j.jen.2015.01.023

016 VOLUME 42 • ISSUE 1

based risk management should be emphasized to assess and reduce violent behavior, but there appears to be a noticeable lack of assessment tools and interventions available.2 In addition, few programs are based on a systematic evaluation of outcomes, and there is little information available to support health care providers in choosing one program over another.3

The purpose of this systematic review of the literature was to evaluate the use of aggression risk assessment tools regarding workplace violence (WPV) in the emergency department and the reduction of the future risk of violence toward ED health care staff. The research question addressed in this systematic review was as follows: Does the use of an aggression risk assessment tool reduce the future risk of violence toward the health care worker? The focus was on reduction of potential violence toward staff in the ED setting.

Methods

Evaluation of the evidence was completed using a 7-step systematic review method.4 The 7 steps are formulating a research question, developing a research protocol, com- mencing a literature search, performing data extraction, conducting a quality appraisal, performing data analysis and reviewing the results of the included studies, and interpret- ing the results.4

The initial search inquiry used 3 electronic databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text, Medline, and PsycINFO. Limitations were set to include only research conducted in the period from January 2009 through September 2014, English-language studies, and research published in peer- reviewed journals. In an effort to gain the greatest depth of knowledge, the following search terms were used in multiple combinations: WPV, violence, patient aggression, patient assault, aggression risk assessment tool, violence risk assessment tool, predicting violent behavior, nursing, and emergency department. The initial search using the combination of search terms yielded 589 research journal

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CLINICAL/Calow et al

articles. Internet searches of government Web sites and professional organizations were also conducted, producing position statements, toolkits, and discussion papers regarding WPV in the emergency department. In addition, references of articles were scanned to identify additional relevant articles. A preliminary review of the literature for inclusion was conducted by reviewing the title of the article for relevancy (N = 589). A further review of the literature for inclusion was conducted by reviewing the abstract of the article (N = 56). Our final review of the literature for inclusion was conducted by a full review of the article (N = 13).

INCLUSION AND EXCLUSION CRITERIA

Articles included in the synthesis of the literature were original research studies of any research design, written in the English language, published between the years 2009 and 2014, and published in peer-reviewed journals. Articles were also chosen based on answering the research question specifically addressing WPV in the ED setting and use of an aggression risk assessment tool. Because of the limited amount of research in the literature specific to violence risk assessment tools in the emergency department, the search was expanded to include violence risk assessment tools in the inpatient setting, including psychiatric and medical-surgical units.

Because the nature of this synthesis of the literature was to apply findings specifically to clinical practice in the ED and inpatient setting, research conducted in outpatient and extended-care facilities was excluded. Although multiple articles were available related to WPV in the ED setting, articles were excluded if they did not discuss the specific use of a tool to assess the risk of violent behavior from a patient toward a health care worker.

An exception to the inclusion criteria was the use of articles published in 2007 specific to the Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing (STAMP) violence risk assessment framework.5 Several studies following the 2007 publication of research related to the STAMP violence risk assessment framework have cited STAMP as foundational work regarding violence risk assessment specific to the emergency department.

LITERATURE SYNTHESIS

The literature showed that violence risk assessment tools have been implemented in various health care settings (Appendix Table). In total, the use of 9 different violence risk assessment tools emerged from the literature across the various settings, 3 in emergency departments, 4 in psychiatric settings, and 2 in medical-surgical inpatient units. Although one specific violence risk assessment tool

20 JOURNAL OF EMERGENCY NURSING

was not consistently implemented across the literature, variations of the STAMP violence assessment framework emerged in 3 articles specific to the emergency depart- ment,5–7 variations of the Brøset Violence Checklist (BVC) emerged in 2 articles specific to psychiatric units,8,9 and a variation of the M55 Violence Risk Assessment Tool emerged in 2 studies in medical-surgical areas.10,11

ED SETTING

Three violence risk assessment tools implemented in the ED setting emerged from the literature: (1) STAMP violence assessment framework5–7; (2) Assessment, Behavioral indicators, and Conversation (ABC) of violence risk assessment at triage12; and (3) five attributes of caring to avert violence (being safe, being available, being respectful, being supportive, and being responsive).13

Themes that emerged from the use of violence risk assessment tools in the ED setting are early identification of high-risk behaviors and use of de-escalation techniques that could avert violence and protect staff and patients from potential injury in the emergency department. Behaviors identified as high risk for escalation to a violent event are as follows: staring/glaring at the caregiver, tone/increased volume, anxiety, mumbling, pacing, aggressive statements, belligerence, clenched fists, demanding attention, irritabil- ity, and hostility. Behaviors identified as effective de-escala- tion skills portrayed by caregivers are expressing empathy, using clear communication skills, being safe, being calm, being available, being respectful, being supportive, and being responsive. Violence risk assessment tools in the emergency department focus on the current assessment of the behaviors of the individual and do not require knowledge of a history of violence.

The STAMP violence assessment framework has been shown to be an effective tool in the early identification of violent behavior. The ABC of violence risk assessment at triage has shown potential to be an effective tool; however, clear validity and reliability are uncertain and need further validation. Although the five attributes of caring to avert violence are effective de-escalation behaviors and have been shown to reduce escalation of violence when used in nursing practice, the focus is on nurse behaviors rather than on identification of the risk that patients may have to become violent and, thus, could use further validation.

INPATIENT UNIT SETTING

Six violence risk assessment tools implemented in the inpatient setting (inpatient psychiatric and medical-surgical

VOLUME 42 • ISSUE 1 January 2016

 

 

Calow et al/CLINICAL

units) emerged from the literature: (1) BVC (6-item tool used to assess confusion, irritability, boisterousness, physical threat, verbal threat, and attack on objects)8,9; (2) Phillips Aggression Screen Tool (PAST) (screens for previous aggressive behavior, screens for psychological trauma, and observed patient behavior)14; (3) Risk of Harm to Others Clinical Assessment Protocol (ROH CAP) (decision tree that incorporates the presence of acts of aggressive behaviors in the past 3 days, extreme behavior, violent acts, intimidation, and/ or ideation in combination with other mental health symptoms such as psychosis)15; (4) Hospital Aggressive Behaviour Scale–Users (HABS-U) (10-item tool used to assess non-physical and physical potential of aggression)16; (5) M55 Violence Risk Assessment Tool (11-item tool used to assess confusion/cognitive impairment, drug/alcohol intoxication, agitation, shouting/demanding, history of physical aggression, withdrawn behavior, threatening to leave, physically aggressive/threatening behavior, verbally hostile/threatening behavior, suspiciousness, and presence of auditory/visual hallucinations)10; and (6) Aggressive Behavior Risk Assessment Tool (ABRAT) (10-item tool incorporating 6 items from M55 Violence Risk Assess- ment Tool and 3 items from STAMP violence assessment framework and adding history of signs and symptoms of mania).11

Themes that emerged from the use of violence risk assessment tools in the non-ED setting are early identification of aggressive/violent behavior and use of early restraint and/or seclusion that could avert violence and protect staff and patients from potential injury. Behaviors identified as high risk for escalation to a violent event are similar to behaviors identified for violence risk assessment tools used in the emergency department (staring/glaring at the caregiver, tone/ increased volume, anxiety, mumbling, pacing, aggressive statements, belligerence, clenched fists, demanding attention, irritability, and hostility); however, an additional assessment factor related to a recent history of violence in the days or weeks leading up to hospitalization was identified. In the inpatient setting, violence risk assessments of every patient were completed on admission to assess for early signs of aggression and the need for early intervention.

The BVC is the most prevalent violence risk assessment tool noted in the literature and shows the best validity and reliability. The additional violence risk assessment tools PAST, ROH CAP, HABS-U, and ABRAT have been shown to be effective tools in the early identification of violent behavior; however, further validation and reliability testing are recommended. The M55 Violence Risk Assessment Tool showed initial reliability and validity; however, one study has shown that this tool only predicted a small percentage of patients identified as at risk of becoming violent compared

January 2016 VOLUME 42 • ISSUE 1

with those who actually became violent, demonstrating the need for further evaluation prior to generalization.

Results

The STAMP tool was found to be used most frequently in the literature to identify patient behaviors leading up to a violent act in the ED setting.5–7 The BVC or a modification of the BVC was found to be the risk assessment tool most commonly used on the inpatient side of the hospital.8,9

Inpatient risk assessment tools were included in this literature review because of the adaptability of the tools to the ED patient population. Questions related to patient history of violence toward others might require further investigation on arrival to the emergency department if the inpatient risk assessment tools are implemented in the ED setting.

The inpatient risk assessment tools focused more on the reduction of seclusion and restraint use in patients, whereas the ED risk assessment tools focused on the identification of risk factors leading up to a violent act to reduce injury to staff. One inpatient study found the M55 tool unreliable at predicting patient aggression because the tool only identified a minority of the violent patients.10 The 12 other studies found their tools to be useful at predicting patient aggression and mitigating staff injury.

Limitations

A small sample size was noted for all the ED studies (N = 196) compared with the inpatient studies (N = 19,372). The reason for the small sample size in the ED studies is unknown, and further research in the ED setting studying the usefulness of risk assessment tools is recommended. Family members and non-psychiatric patients were not prevalent subject matters in this literature review but can be the source of violent acts. More research on this topic is suggested, and suggested interventions to mitigate violence would be useful.

Discussion

The findings suggest that the STAMP tool and the BVC are the most prevalent risk assessment tools used in the hospital to reduce violence toward staff members, which is consistent with previous research articles. No studies were found to dispute the validity or sensitivity of these 2 tools in our literature review. The STAMP tool and the BVC have distinctive observational behaviors to identify the potential for patient violence. Once a patient has been identified as at risk of being violent on arrival to the emergency department, interventions can be implemented to mitigate

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CLINICAL/Calow et al

the risk of violence toward staff members. De-escalating techniques were noted to be the most common interven- tions used with aggressive patients.

The STAMP tool was developed specifically for ED nursing practice, and the BVC can be easily modified to adapt to the ED setting. More research is needed on the use of the inpatient tools in the ED setting. Knowing the violent history of patients is a limitation to using the BVC, although some hospitals might have access to the violent history of patients. A recommendation would be for hospitals to document violent behavior of patients in the patient’s medical history record. A history of violence is an indication of a patient’s tendency toward violence.

Using a risk assessment tool is imperative for emergency nurses in recognizing behaviors that proceed to violent behaviors and often lead to staff injury. The increase in ED violence in recent years has led nurses to want to take precautionary steps to protect themselves and others from injury. Hospitals need to implement violence prevention training to educate staff on the observational behaviors of patient aggression and the de-escalating techniques used to calm patients before violent acts occur. A risk assessment tool can be used to help identify patients at risk of being violent and provide staff with reminders on possible interventions to use with patients while providing care.

Conclusions

Violence toward health care workers in the emergency department is growing at an alarming rate, causing safety and financial concerns to health care organizations. The evidence from this literature synthesis supports the use of a standardized violence risk assessment tool to help in early identification of aggressive behavior. Few violence risk assessment tools have been discussed in the literature specific to the emergency department; however, violence risk assessment tools from inpatient settings may be adaptable to the ED setting. Use of a standardized violence risk assessment for early identification of aggressive behavior, paired with early de-escalation interventions and/or seclu- sion, could reduce escalation to violent behavior, decreasing the risk of injury to health care workers.

REFERENCES 1. Brown S, Langrish M. Evaluation of a risk assessment tool to predict

violence behaviour by patients detained in a psychiatric intensive care unit. J Psychiatr Intensive Care. 2011;8(1):35-41.

22 JOURNAL OF EMERGENCY NURSING

2. Fluttert F, Van Meijel B, Webster C, Nijman H, Bartels A, Grypdonck M. Risk management by early recognition of warning signs in patients in forensic psychiatric care. Arch Psychiatr Nurs. 2008;22(4):208-16.

3. Farrell G, Cubit K. Nurses under threat: a comparison of content of 28 aggression management programs. Int J Ment Health Nurs. 2005;14(1):44-53.

4. Wright R, Brand R, Dunn W, Spindler K. How to write a systematic review. Clin Orthop Relat Res. 2007;455:23-29.

5. Luck L, Jackson D, Usher K. STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments. J Adv Nurs. 2007;59(1):11-19.

6. Wilkes L, Mohan S, Luck L, Jackson D. Development of a violence tool in the emergency hospital setting. Nurse Res. 2010;17(4):70-82.

7. Pich J, Hazelton M, Sundin D, Kable A. Patient-related violence against emergency department nurses. Nurs Health Sci. 2010;12(2):268-274.

8. van de Sande R, Noorthoorn E, Wierdsma A, et al. Association between short-term structured risk assessment outcomes and seclusion. Int J Ment Health Nurs. 2013;22(6):475-484.

9. Clarke D, Brown A, Griffith P. The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting. J Psychiatr Ment Health Nurs. 2010;17(7):614-620.

10. Ideker K, Todicheeney-Maanes D, Kim S. A confirmatory study of violence risk assessment tool (M55) and demographic predictors of patient violence. J Adv Nurs. 2011;67(11):2455-2462.

11. Kim S, Ideker K, Todicheeney-Mannes D. Usefulness of aggressive behaviour risk assessment tool for prospectively identifying violent patients in medical and surgical units. J Adv Nurs. 2011;68(2):349-357.

12. Sands N. An ABC, approach to assessing the risk of violence at triage. Australas Emerg Nurs J. 2007;10(3):107-109.

13. Luck L, Jackson D, Usher K. Conveying caring: nurse attributes to avert violence in the ED. Int J Nurs Pract. 2009;15(3):205-212.

14. Jayaram G, Samuels J, Konrad S. Prediction and prevention of aggression and seclusion by early screening and comprehensive seclusion documentation. Innov Clin Neurosci. 2012;9(7–8):30-38.

15. Neufeld E, Perlman C, Hirdes J. Predicting inpatient aggression using the InterRAI risk of harm to others clinical assessment protocol: a tool for risk assessment and care planning. J Behav Health Serv Res. 2012;39(4):472-480.

16. Waschgler K, Ruiz-Hernandez J, Llor-Esteban B, Garcia-Izquierdo M. Patients’ aggressive behaviours towards nurses: development and psychometric properties of the Hospital Aggressive Behaviour Scale- Users. J Adv Nurs. 2012;69(6):1418-1427.

17. Gates D, Gillespie G, Smith C, Rode J, Kowalenko T, Smith B. Using action research to plan a violence prevention program for emergency departments. J Emerg Nurs. 2011;37(1):32-39.

18. The Joanna Briggs Institute. New JBI Levels of Evidence. Published 2014. http://joannabriggs.org/assets/docs/approach/JBI-Levels-of- evidence_2014.pdf. Accessed October 26, 2014.

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APPENDIX TABLE Highlights of evidence synthesis

(Continued) Objectives LOE a Sample Setting ED tool Non-ED

tool Major findings

Gates et al17

Violence prevention and management interventions

Level 5N = 97 3 Midwestern US hospitals

Haddon Matrix

•Majority of planned strategies supported by all participants

•Before assault •During assault •After assault

Pich et al7 Literature review exploring patient- related violence against nurses/ focus on emergency department

Level 5N = 53 ED/mental health facilities in Australia

STAMP •Abuse against nurses accepted part of job

•Under-reporting of violence

•Control of access •Education and training •Environmental design of emergency department

•Patient management plans •Debriefing

Luck et al5

Components of observable behavior that indicate potential for patient violence in emergency department

Level 4N = 3 33-bed emergency department in public hospital in Australia

STAMP •Observation and interviews confirmed assessment components and associated cues as indicators of potential for violence

Waschgler et al16

Development and testing of Hospital Aggressive Behaviour Scale

Level 4 N = 1,489 11 public hospitals in Spain

Hospital Aggressive Behaviour Scale

•Statistically significant correlations between Hospital Aggressive Behaviour Scale and job satisfaction, burnout, and psychological well-being

Kim et al11

Evaluate usefulness of ABRAT for identifying violent patients

Level 3 N = 2,063 6 medical-surgical units in California

ABRAT •10 items selected for ABRAT tool from 3 sources

•3% of patients admitted to medical-surgical units were found to be violent

Jayaram et al14

Identification of potential aggressors among patients and development of documentation tool

Level 3N = 229 Psychiatric unit Phipps Aggression Screening Tool

•Highly significant differences between aggressive/non-aggressive groups for LOS, cost, and illness complexity

•Seclusion decreased

Appendix

(continued at the next page)

Calow et al/CLINICAL

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Appendix Table (Continued)

Objectives LOE a Sample Setting ED tool Non-ED tool

Major findings

Wilkes et al6

Creation of violence assessment tool

Level 5N = 23 Nurses in emergency department or academics

Violence assessment tool for emergency department

•Delphi technique to refine violence assessment tool

•17 items chosen •Feedback obtained from experts

Neufeld et al15

Examination of risk assessment algorithm in predicting patient aggression

Level 4 N = 6,425 Mental health facility

RHO CAP •Moderate- and high-risk patients identified

•Patients at high risk were 2 times more likely to display physical aggression

Ideker et al10

Violence risk assessment tool usefulness

Level 3N = 2,063 Medical-surgical unit

Violence Risk Assessment Tool (M55)

•M55 not a useful tool for identifying violent patients

•Only minority of violent patients identified

van de Sande et al8

Investigate validity of observation tool to aid in clinical decision making pertaining to violent patients

Level 3N = 301 4 acute psychiatric wards

BVC and Kennedy Axis V

•Various factors related to seclusion of patients, both dynamic and static

Clarke et al9

Trial of violence checklist

Level 3N = 48 11-bed psychiatric ICU

BVC •Use of seclusion decreased during study

•Tool has been implemented as a routine part of patient care

Luck et al13

Nurse attributes to avert violence in emergency department

Level 4N = 20 33-bed Australian emergency department

5 attributes to reduce violence

•5 attributes to avert, reduce, and prevent violence: being safe, available, respectful, supportive, and responsive

Sands12 Use of violence risk assessment strategy in triage

Level 5 ED triage in Australia

ATS •Best strategy for managing aggression is prevention

•Structured behavior observations at triage

•De-escalation •Security •Debriefing

Highlights of evidence synthesis. ABRAT, Aggressive Behaviour Risk Assessment Tool; ATS, Australasian Triage Scale; BVC, Brøset Violence Checklist; ICU, intensive care unit; LOE, level of evidence; LOS, length of stay; RHO CAP, Risk of Harm to Others Clinical Assessment Protocol; STAMP, Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing.

a Joanna Briggs Institute Criteria18

• Level 1: Experimental Designs • Level 2: Quasi-Experimental Designs • Level 3: Observational – Analytical Designs • Level 4: Observational – Descriptive Designs • Level 5: Expert Opinion and Bench Research

CLINICAL/Calow et al

24 JOURNAL OF EMERGENCY NURSING VOLUME 42 • ISSUE 1 January 2016

 

  • Literature Synthesis: Patient Aggression Risk Assessment Tools in the Emergency Department
    • Aims and Objectives
    • Methods
      • Inclusion and exclusion criteria
      • Literature synthesis
      • ED setting
      • Inpatient unit setting
    • Results
    • Limitations
    • Discussion
    • Conclusions
    • References

      Author Affiliations: Clinical Nurse Educator (Dr Bromley), University Hospitals Cleveland Medical Center; and Lead Faculty (Dr Painter), Family Systems Psychiatric Mental Health Program, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

      The authors declare no conflicts of interest. Correspondence: Dr Bromley, University Hospitals Cleveland

      Medical Center, 11000 Euclid Ave, Cleveland, OH 44106 (gailbromley@yahoo.com).

      Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonajournal.com).

      DOI: 10.1097/NNA.0000000000000807

      JONA � Vol. 49, No. 11 � November 2019

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      JONA Volume 49, Number 11, pp 525-530 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

      T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N

      Ensuring Workplace Safety

      Evidence Supporting Interventions for Nurse AdministratorsGail Bromley, PhD, RN Susan Painter, DNP, PMHNP-BC

       

      Healthcare workplace violence is a growing concern among nurses; however, nurse administrators and man- agers may not be fully aware of the level, frequency, or extent of the trauma that staff nurses experience. This information gap is influenced by nurses’ failure to report violent incidents, their belief that they are expected to care for violent/assaultive patients, time required for extensive documentation about these incidents, and perceptions that minimal follow-up to mitigate future episodes will occur. This article describes the evidence- based structures, processes, and practices supported to minimize organizational risk and protect nurses and other staff from being physically or emotionally injured and/or traumatized in the workplace.

      Prevalence of violence and acts of aggression in health- care are increasing, with 80% of nurses reporting that they have been victims of verbal or physical assaults.1

      Because of assaults, nurses become distracted and stressed and are more likely to make errors. Workplace violence prevention strategies based on empirical evi- dence and tailored to the hospital’s needs can effec- tively minimize assaults. These strategies along with productive open communication, reinforcement of attitudes about the importance of a safe environment, an infrastructure that decreases work stress, and

      er H

      vigilance to sustain a respectful work culture contrib- ute to the success of interventions.2 The purpose of this article is to describe the evidence-based struc- tures, processes, and practices supported to mitigate or- ganizational risk and protect nurses and other staff members from being physically or emotionally in- jured and/or traumatized in the workplace.

      Healthcare workplace violence, primarily perpe- trated by patients, is substantial with 7.8 cases of serious workplace violence per 10 000 full-time employees.3

      Currently, data about workplace violence in healthcare do not provide a complete picture of the problem. Na- tional employer data are currently based on reported employee injuries where a minimum of a 1-day absence occurred.4 These data provide inadequate details for employers to benchmark the nature and types of vio- lence, threatening behaviors, and trauma that nurses experience because of exposure to workplace violence.5

      Challenges persist in accessing meaningful data, and a negligible number of rigorous studies report effective interventions that minimize assaults and promote a safe healthcare environment.6 Victims of workplace injuries7 understand the urgency and necessity to imple- ment violence prevention strategies for the workplace. In- cidents of nurses being assaulted by patients and visitors report injuries so extreme that careers have ended whereas othershavelosttheirlives.8 Theimplicationsareextraordi- nary given the demanding healthcare environment and a future projected 1.1 million nurse shortage.9

      The paucity of empirical evidence about effective measures to reduce the incidence of workplace violence poses an organizational dilemma. Violence prevention training and physical plant safety improvements are costly. Compelling rationale is essential when proposing capital and operational dollars to address workplace violence.

      Few published studies consider the multidimen- sional factors that impact workplace safety. A review of the literature reported an organizational study

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      conducted in a large midwestern hospital that exam- ined variables correlated to violence reduction. Arnetz and colleagues10 studied organizational determinants of workplace violence including healthcare climate, nurse competencies in handling challenging interactions, types of workplace violence prevention interventions, and tracking of severity, frequency, and types of violence. These structural, organizational, and educational inter- ventions were identified as enhancing coworker rela- tionships, promoting work efficiency, and emphasizing administrative promotion of the institution’s violence prevention climate. Findings reported interpersonal con- flict asarisk factorforverbal violence, low work efficiency is a risk factor for physical violence, and poor violence prevention climate is a risk factor for verbal and physi- cal violence. Such findings lend credibility to implemen- tation of ongoing staff education to preempt violence.

      Lending further support for violence-free health- care environments are national professional and health- care organizations that strongly advocate for safer organizations. The 2015 American Nurses Association position paper on workplace violence11 underscores the importance of a safe environment for staff and patients. A zero harm climate is reflected in standards of both Magnet® certification12 and The Joint Commission.13

      Serious healthcare assaults have come to the attention of politicians as well. Representative Joe Courtney (D-CT) introduced the Workplace Violence Prevention for Health Care and Social Service Workers Act, H.R. 7141.14 The act specifies a standard for the Occupational Safety and Health Administration and requires healthcare and social service employers to have workplace violence prevention plans that ensure employee protection from violent incidents; address the need to implement standards in all healthcare set- tings with protective service staff, as well as workplace violence education and training; provide improve- ments in the physical environment; ensure detailed re- cord keeping of violent incidents and protection for staff reporting to organization and law enforcement; and establish minimum requirements for workplace violence prevention plans based on employee input, specific to the unit with prevention components.15

      Assessing the Prevalence and Exposure of Workplace Violence Conducting a gap analysis of incidents and risk of workplace violence is an initial step in assessing work- place violence. Areas of focus include: 1) inadequately or nonmonitored entrances and exits; (2) hallways and rooms with unattended facility, dietary, or housekeep- ing carts with sharp and heavy objects; and 3) depart- ments with high levels of stress and volume such as emergency departments (EDs) and labor and delivery

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      units.16 These baseline measures provide data to use for comparison following recommended safety interventions.

      A thorough internal assessment of the organi- zation based on current practices entails a broad organizational commitment with multidisciplinary participation. The review should include clinical and administrative policies, procedures, communication processes, data analysis of violent incidents, detailed staff injury reports, lost work days, analysis of debriefings, and staff safety recommendations, among other ele- ments (Figure 1).17

      Best Practices to Ensure a Safe Workplace Best practices for a safe workplace encompass clinical competencies, a culture committed to critical examina- tion, open communication, professional development, and benchmarking to ensure continuous improvement.18

      Patients with a history of violence, substance abuse, a trauma history, and known perpetrators should be flagged in the electronic medical record to alert staff to a possible risk situation to preempt incidents. These alerts should include clinical interventions that trig- gered or mitigated violence.

      Open dialogue promoted through shared gover- nance structures may be an avenue for staff to discuss violent episodes and generate recommendations to minimize future episodes. Self-care among nurses is a best practice that promotes resilience, reduces stress, and is a critical component to ensure a safe workplace.19

      Specialty Units Safety, particularly in EDs as well as geriatric and psychi- atric units, is challenging given the risk and prevalence of patients with a history of violence or assault.20 Staff in these patient care areas identify the need to develop and refine assessment skills and de-escalation techniques to preempt violent episodes specific to their exposure.21

      SAFER Strategies Safe patient-staff culture is inherently a continuous commitment that involves critical examination and evaluation of violent incidents. Staff and leaders gain meaningful insights into the care environment when they become active, with 5 evidence-based priorities incorporated into ongoing SAFER strategies.20 SAFER strategies are based on an ongoing review conducted by administrators to evaluate the institutional workplace violence prevention safety scorecard to monitor suc- cessful interventions and identify opportunities to improve the culture (Figure 2).22

      Reporting Misperceptions and assumptions by nurses about pa- tient violence impede the achievement of best practices. Nurses identify violent episodes in various reporting

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      Figure 1. Aspects of an organizational safety assessment.

      forms. These include institutional incident reports and employee injury reports in addition to communiqués and reports to supervisors and concerns about patients shared during daily/shift safety huddles. Cumbersome incident reports and employee injury reports are onerous and time consuming. Other factors interfere with documenting violent incidents. Staff perceive violence related to a patient’s illness as “part of their job.”23

      Underreporting of incidents or not reporting inci- dents can be attributed to a perception that “nothing will be done anyway.”24

      Recommendations For staff nurses, administrators, and nurse managers to have a shared understanding of the healthcare

      Figure 2. SAFER strategies.

      JONA � Vol. 49, No. 11 � November 2019

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      environment, transparency regarding the definition and expectations associated with a safe workplace is essential. Leadership presence on the units as vio- lent episodes occur, or after incidents, provides con- text and shared observations. Nurses perceive a level of support when their peers, nurse managers, and administrators facilitate a debriefing, review inci- dent reports with feedback, offer verbal support and validation for effective crisis interventions, and see the implementation of organizational initia- tives to prevent future high-risk incidents (Supple- mental Digital Content 1, available at http://links. lww.com/JONA/A720). This level of commitment on the part of nursing leaders is identified by staff nurses as important and reinforces best practices.25

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      Didactic and experiential sessions that demon- strate verbal and physical interventions to preempt assaults and enhance clinical competencies for the as- sessment of early signs of escalating behaviors require practicing team skills. These team skills, analogous to best practices of rapid response teams and emergency codes when applied to violent episodes, have been shown to minimize risks.26

      Self-care Measures for Nurses Self-care practiced by nurses and selected based on individual preference has been shown to improve well-being.27 Nursing leaders should review mea- sures including staff morale, job satisfaction, and turnover rates as important metrics in monitoring staff retention. Self-care literature about nurses sup- ports monitoring of nurse attitudes, behaviors, and resilience as mindfulness and meditation techniques that promote focus, improve staff satisfaction, improve retention, and prevent/minimize workplace violence.28

      Electroniccopingtoolssupport mindfulnesspractices.29-31

      As an example, Mindfulness-Based Stress Reduction is an evidence-based self-care program with techniques to enhance coping skills in stressful environments.32

      This intensive program offers effective self-care tech- niques and practices for coping with stress to enhance functioning and ensure a clear focus.

      Employee assistance programs within healthcare organizations refer staff to or offer self-care techniques and encourage supportive services for nurses to cope with the trauma of violent episodes.33 Employee assis- tance program counseling services and nurse peer group support influence staff coping particularly related to violence and stressful interactions. The cycle of vio- lence will continue unless organization leaders invest the time commitment and improves communication with staff.

      Workplace Violence Prevention Programming Optimal staff education focused on workplace violence prevention delivered with a combination of didactic and interactive sessions can assist nurses to refine skills.34

      Workplace violence prevention education should be ini- tiated in orientation. Nurses must develop or enhance skills and competencies regarding escalating patient be- haviors including confusion, suspicions, and verbal and physical threats, which when assessed early on, preempt patient violence.35 Proficiency in recognizing these be- haviors allows nurses to assess patients and share this critical information during handoff to promote continu- ity of care about high-risk patients.

      Code violet/rapid response teams for behavioral episodes serve to augment staff de-escalation with pa- tients. These teams of clinical experts trained in crisis intervention, de-escalation, and effective teamwork

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      are summoned to units to respond to the continuum of violent patient episodes, provide nursing staff the support during an incident, and facilitate the debriefing with staff and patients. Trained teams are composed of clinicians and protective service staff who implement communication and intervention techniques based on the philosophy of the education program selected by the healthcare organization and policies. These patient-centered, clinically focused programs embrace a philosophy that emphasizes least restrictive interven- tions and approaches. During preemptive education, nurses practice verbal and paraverbal/nonverbal ap- proaches that do not retraumatize patients and encour- age patients to gain control and/or take medications to treat their symptoms of agitation. Administrators and nurse managers who have attended these sessions are better able to reinforce violence prevention techniques and support effective debrief sessions.

      Critical Issues When violent occurrences are unaddressed by leaders, staff nurses believe their professional work is devalued and they are demoralized. Nurse retention and team performance are negatively impacted if leaders are perceived as unsupportive, unconcerned, unaware of safety concerns, and not openly discussing violent ep- isodes and assaults with staff.36 Staff concerns about violent episodes have led healthcare organizations to institute remedial actions, improved entrance and egress safety mechanisms, random visible presence of police/ protective service officers on patient care units, weapons checks, support for nurses traumatized by violent incidents, and policies enforced when staff are injured.37,38

      Healthcareorganizationswhoadvocateonbehalfofnurse victims ensure ongoing dialogue about violent incidents, monitor these incidents, and implement strategies that minimize violent incidents.

      Organizational Infrastructure to Promote Workplace Safety Healthcare institutions’ interprofessional committees should meet regularly to monitor and recommend systematic approaches to reduce the incidence of workplace violence.39 Committee membership requires inclusivity with active participation by decision-makers, support personnel, and direct caregivers. Key commit- tee members selected to drive the workplace violence agenda include senior level managers, risk managers, human resources directors, protective service managers, accreditation directors, frontline managers, psychiatric staff, quality team managers, and educators. The pur- pose and function of such an interprofessional com- mittee is to provide oversight, and collect and review data to promote safety and alignment with regulatory

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      Figure 3. Workplace violence prevention committee priority agenda items.

      safety standards (Figure 3). Workplace violence pre- vention committee members assume significant re- sponsibility in the formulation and implementation of measurable initiatives. On an annual basis, members should review and evaluate the institution’s policies and procedures, ensure the delivery of evidence-based workplace violence prevention education, review ag- gregate data of incident reports including workers’ compensation reports, and continually benchmark and identify best practices.

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      Conclusion

      Florence Nightingale in Notes on Hospitals remarks: “It may seem a strange principle to enunciate as the very 1st requirement in a Hospital that it should do the sick no harm.”40 So too, hospitals cannot tolerate an environment that harms nurses. Organizational commitment to ensure zero tolerance of workplace violence is critical as it directly impacts patient experi- ence, patient care quality, and nurse safety.

      References

      1. National Institute for Occupational Safety and Health (NIOSH). Violence in the workplace: central intelligence bulletin 57. 2013. https://www.cdc.gov/niosh/docs/96-100/introduction.html. Accessed May 3, 2019.

      2. Arnetz JE, Hamblin L, Russell J, et al. Preventing patient- to-worker violence in hospitals: outcome of a randomized con- trolled intervention. J Occup Environ Med. 2017;59(1):18-27.

      3. Guidelines for Preventing Workplace Violence. 2016. Occupa- tional Safety and Health Administration (OSHA). https://www. osha.gov/Publications/osha3148.pdf. Accessed May 3, 2019.

      4. Pekurinen V, Willman L, Virtanen M, Kivimäki M, Vahtera J,

      Välimäki M. Patient aggression and the wellbeing of nurses: a cross-sectional survey study in psychiatric and non-psychiatric settings. Int J Environ Res Public Health. 2017;14(10):1245.

      5. Rosenthal LJ, Byerly A, Taylor AD, Martinovich Z. Impact and prevalence of physical and verbal violence toward healthcare workers. Psychosomatics. 2018;59(6):584-590.

      6. Workplace violence in healthcare: understanding the challenge. https://www.osha.gov/Publications/OSHA3826.pdf. Accessed May 3, 2019.

      7. Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016;374(17):1661-1669.

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      8. Bureau of Labor Statistics. Employer-reported workplace inju- ries and illnesses (annual). https://www.bls.gov/news.release/ osh.toc.htm. Accessed May 3, 2019.

      9. Bureau of Labor Statistics employer-reported workplace injury and illnesses, 2017. https://www.bls.gov/news.release/osh.nr0. htm. Accessed May 3, 2019.

      10. Arnetz J, Hamblin LE, Sudan S, Arnetz B. Organizational de- terminants of workplace violence against hospital workers. J Occup Environ Med. 2018;60(8):693-699.

      11. American Nurses Association. Incivility, Bullying and Work- place Violence. July 22, 2015. https://www.nursingworld. org/practice-policy/nursing-excellence/official-position- statements/id/incivility-bullying-and-workplace-violence/. Accessed May 3, 2019.

      12. American Nurses Credentialing Center’s Magnet Recognition Program® Manual 2019 (Magnet Standard EP15EO).

      13. The Joint Commission. https://www.jointcommission.org/ standards_information/standards.aspx. Accessed June 6, 2019.

      14. Violence Prevention for Health Care and Social Service Workers Act, H.R. 7141. https://www.congress.gov/bill/115th-congress/ house-bill/7141 Congress.Gov. Accessed June 6, 2019.

      15. H.R.5223—Health Care Workplace Violence Prevention Act 115th Congress, 2017-2018. https://www.congress.gov/bill/ 115th-congress/house-bill/5223. Accessed June 6, 2019.

      16. AONE/ENA Guiding principles for mitigating violence in the workplace, January 13, 2015. http://www.aone.org/ resources/mitigating-workplace-violence.pdf. Accessed May 3, 2019.

      17. Preventing violence in healthcare gap analysis, Minnesota Department of Health, 2015. https://www.mnhospitals. org/Portals/0/Documents/ptsafety/workplace%20violence %20prevention/Preventing%20Violence%20in%20Health- care%20Gap%20Analysis.pdf. Accessed May 3, 2019.

      18. Toolkit for mitigating violence in the workplace. 2015. http:// www.aone.org/resources/mitigating-workplace-violence- toolkit.pdf. Accessed May 3, 2019.

      19. Janssen M, Heerkens Y, Kuijer W, Van Der Heijden B, Engels J. Effects of Mindfulness-Based Stress Reduction on employees’ mental health: a systematic review. PLoS One. 2018;13(1): e0191332.

      20. Ferri P, Silvestri M, Artoni C, Di Lorenzo R. Workplace vi- olence in different settings and among various health profes- sionals in an Italian general hospital: a cross-sectional study. Psychology Research and Behavior Management. 2016;9: 263-275.

      21. Taking threats seriously: establishing a threat assessment team and developing organizational procedures. 2002. Crisis Pre- vention Institute website. https://www.crisisprevention.com/ Blog/April-2011/Taking-Threats-Seriously-Establishing-a- Threat-Ass. Accessed May 3, 2019.

      22. Bromley G. SAFER Model for nurses. 2018. 23. “It’s just part of the job”: the dangerous perceptions and reali-

      ties of workplace abuse for nurses. June 22, 2017. https://www. legalnursepdx.com/its-just-part-of-the-job-the-dangerous- perceptions-and-realities-of-workplace-abuse-for-nurses/. Accessed May 3, 2019.

      24. Wolf LA, Delao AM, Perhats C. Nothing changes, nobody

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      cares: understanding the experience of emergency nurses phys- ically or verbally assaulted while providing care. J Emerg Nurs. 2014;40(4):305-310.

      25. Drennan VM, Halter M, Gale J, Harris R. Retaining nurses in metropolitan areas: insights from senior nurse and human re- source managers. J Nurs Manag. 2016;24(8):1041-1048.

      26. Crisis Prevention Institute. CPI’s Top 10 deescalation tips. Milwaukee, WI: Crisis Prevention Institute; 2016. https:// www.crisisprevention.com/Blog/October-2017/CPI-s-Top- 10-De-Escalation-Tips-Revisited. Accessed May 3, 2019.

      27. Foster K, Cuzzillo C, Furness T. Strengthening mental health nurses’ resilience through a workplace resilience programme: a qualitative inquiry. J Psychiatr Ment Health Nurs. 2018; 25(5–6):338-348.

      28. Slatyer S, Craigie M, Heritage B, Davis S, Rees C. Evaluating the effectiveness of a brief Mindful Self-Care and Resiliency (MSCR) intervention for nurses: a controlled trial. Mind. 2018; 9(2):534-546.

      29. The best meditation apps of 2019. https://www.healthline.com/ health/mental-health/top-meditation-iphone-android-apps. Accessed May 3, 2019.

      30. Managing stress in health care with meditation: got a minute? October 2017. https://www.americannursetoday.com/managing- stress-health-care-meditation/. Accessed May 3, 2019.

      31. University of Massachusetts. Center for Mindfulness MBSRonline live. 2019. https://www.umassmed.edu/cfm/mindfulness-based- programs/mbsr-courses/mbsr-online/. Accessed May 3, 2019.

      32. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pract. 2003;10: 144-156.

      33. Holbrook CM, Bixler DE, Rugala EA, Casteel C. The Em- ployee Assistance Program (EAP) and its role in the manage- ment of workplace threats. In: Holbrook CM, Bixler DE, Rugala EA, Casteel C, eds. Workplace Violence: Issues in Threat Management. New York, NY: Routledge; 2018:68-73.

      34. Crisis Prevention Institute (CPI). CPI training: an experience to remember—a training you will use by Robert Rettmann. Robert explores the history of training technology at CPI. https://www.crisisprevention.com/Resources/Research. Accessed May 3, 2019.

      35. Crisis Prevention Institute. Simple skills for assessing, man- aging, and responding to risk behavior. 2018. https://www. crisisprevention.com/What-We-Do/Nonviolent-Crisis- Intervention/Course-Topics. Accessed May 3, 2019.

      36. Boyle MJ, Wallis J. Working towards a definition for workplace violence actions in the health sector. Safety Health. 2016;2(1):4.

      37. Massachusetts Nurses Association. The Brigham and Women’s nurses. https://www.massnurses.org/news-and-events/p/ openItem/10103. Accessed May 3, 2019.

      38. Vogus TJ, Singer SJ. Creating highly reliable accountable care organizations. Med Care Res Rev. 2016;73(6):660-672.

      39. Daigle S, Talbot F, French DJ. Mindfulness-based stress reduc- tion training yields improvements in well-being and rates of perceived nursing errors among hospital nurses. J Adv Nurs. 2018;74(10):2427-2430.

      40. Nightingale F. Notes on Hospitals. London, England: Longman, Roberts, and Green; 1863.

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References

Suresh, B. S., De Oliveira, G. S., & Suresh, S. (2015). The effect of audio therapy to treat postoperative pain in children undergoing major surgery: a randomized controlled trial. Pediatric Surgery International31(2), 197-201. https://doi.org/10.1007/s00383-014-3649-9

Question 5

Open and read the attached files…

  • Assignment: Patient Education for Children and Adolescents

    Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

    For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.

    The Assignment

    In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.

    TOPIC OF CASE STUDY

    General Anxiety disorder in childhood and adolescents.

     

    Assignment: Patient Education for Children and Adolescents

     

    Patient education is an effe

    ctive tool in supporting compliance and treatment for a diagnosis. It is

    important to consider effective ways to educate patients and their families about a diagnosis

    such as

    coaching, brochures, or videos

    and to recognize that the efficacy of any material

    s may differ based on

    the needs and learning preferences of a particular patient. Because patients or their families may be

    overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly

    outline the information that p

    atients need to know.

     

    For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked

    with explaining important information about an assigned mental health disorder in language

    appropriate for child/adolescent patients and/or their care

    givers.

     

     

    The Assignment

     

    In a 300

     

    to 500

    word blog post written for a patient and/or caregiver audience, explain signs and

    symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and

    appropriate community resources and referrals.

     

     

    TOPIC OF CASE STUDY

     

    General

    Anxiety disorder in childhood and adolescents.

     

     

    Assignment: Patient Education for Children and Adolescents

    Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is

    important to consider effective ways to educate patients and their families about a diagnosis—such as

    coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on

    the needs and learning preferences of a particular patient. Because patients or their families may be

    overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly

    outline the information that patients need to know.

    For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked

    with explaining important information about an assigned mental health disorder in language

    appropriate for child/adolescent patients and/or their caregivers.

    The Assignment

    In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and

    symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and

    appropriate community resources and referrals.

     

    TOPIC OF CASE STUDY

    General Anxiety disorder in childhood and adolescents.

    RUBRIC TO FOLLOW

     

      Novice Competent Proficient New column
    In a 300- to 500-word blog post written for a patient and/or caregiver audience: • Explain signs and symptoms for the assigned diagnosis in children and adolescents. 27 (27%) – 30 (30%)

    The response accurately and concisely explains signs and symptoms of the assigned diagnosis in language and tone that are engaging and appropriate for a patient/caregiver audience.

    24 (24%) – 26 (26%)

    The response accurately explains signs and symptoms of the assigned diagnosis in language and tone appropriate for a patient/caregiver audience.

    21 (21%) – 23 (23%)

    The response somewhat vaguely or inaccurately explains signs and symptoms of the assigned diagnosis. Language and tone are mostly appropriate for a patient/caregiver audience.

    0 (0%) – 20 (20%)

    The response vaguely or inaccurately explains signs and symptoms of the assigned diagnosis. Language and tone are not appropriate for a patient/caregiver audience. Or the response is missing.

    · Explain pharmacological and nonpharmacological treatments for children and adolescents with the diagnosis. 27 (27%) – 30 (30%)

    The response accurately and concisely explains pharmacological and nonpharmacological treatments in language and tone that are engaging and appropriate for a patient/caregiver audience.

    24 (24%) – 26 (26%)

    The response accurately explains pharmacological and nonpharmacological treatments in language and tone that are appropriate for a patient/caregiver audience.

    21 (21%) – 23 (23%)

    The response somewhat vaguely or inaccurately explains pharmacological and nonpharmacological treatments. Language and tone are mostly appropriate for a patient/caregiver audience.

    0 (0%) – 20 (20%)

    The response vaguely or inaccurately explains pharmacological and nonpharmacological treatments. Language and tone are not appropriate for a patient/caregiver audience. Or the response is missing.

    · Explain appropriate community resources and referrals for the assigned diagnosis. 23 (23%) – 25 (25%)

    The response accurately and concisely explains appropriate community resources and referrals for the assigned diagnosis in language and tone that are engaging and appropriate for a patient/caregiver audience.

    20 (20%) – 22 (22%)

    The response accurately explains appropriate community resources and referrals for the assigned diagnosis in language and tone that are appropriate for a patient/caregiver audience.

    18 (18%) – 19 (19%)

    The response somewhat vaguely or inaccurately explains community resources and referrals for the assigned diagnosis. Language and tone are mostly appropriate for a patient/caregiver audience.

    0 (0%) – 17 (17%)

    The response vaguely or inaccurately explains community resources and referrals for the assigned diagnosis. Language and tone are not appropriate for a patient/caregiver audience. Or the response is missing.

    Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 (5%) – 5 (5%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

    4 (4%) – 4 (4%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

    3.5 (3.5%) – 3.5 (3.5%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

    0 (0%) – 3 (3%)

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No purpose statement, introduction, or conclusion were provided.

    Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)

    Uses correct grammar, spelling, and punctuation with no errors

    4 (4%) – 4 (4%)

    Contains one or two grammar, spelling, and punctuation errors

    3.5 (3.5%) – 3.5 (3.5%)

    Contains several (three or four) grammar, spelling, and punctuation errors

    0 (0%) – 3 (3%)

    Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

    Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list. 5 (5%) – 5 (5%)

    Uses correct APA format with no errors

    4 (4%) – 4 (4%)

    Contains one or two APA format errors

    3.5 (3.5%) – 3.5 (3.5%)

    Contains several (three or four) APA format errors

    0 (0%) – 3 (3%)

    Contains many (five or more) APA format errors

    Total Points:

     

     

     

    RUBRIC TO FOLLOW

     

     

     

     

    Novice

     

     

    Co

    mpetent

     

     

    Profi

    cie

    nt

     

     

    New column

     

    In a 300

     

    to 500

    word blog post

    written for a patient and/or caregiver

    audience:

     

     

    • Explain signs and symptoms for the

    assigned diagnosis in children and

    adolescents.

     

    27

     

    (27%)

     

     

    30

     

    (30%)

     

    The response accurately and concisely

    explains signs and symptoms of the

    assigned diagnosis in language and

    tone that are engaging and appropriate

    for

    a patient/caregiver audience.

     

    24

     

    (24%)

     

     

    26

     

    (26%)

     

    The response accurately explains signs

    and symptoms of the assigned

    diagnosis in language and tone

    appropriate for a patient/caregiver

    audience.

     

    21

     

    (21%)

     

     

    23

     

    (23%)

     

    The response somewhat vaguely or

    inaccura

    tely explains signs and

    symptoms of the assigned diagnosis.

    Language and tone are mostly

    appropriate for a patient/caregiver

    audience.

     

    0

     

    (0%)

     

     

    20

     

    (20%)

     

    The response vaguely or inaccurately

    explains signs and symptoms of the

    assigned diagnosis. Language an

    d tone

    are not appropriate for a

    patient/caregiver audience. Or the

    response is missing.

     

    · Explain pharmacological and

    nonpharmacological treatments for

    children and adolescents with the

    diagnosis.

     

    27

     

    (27%)

     

     

    30

     

    (30%)

     

    The response accurately and concisely

    explains pharmacological and

    nonpharmacological treatments in

    language and tone that are

    engaging

    and appropriate for a patient/caregiver

    audience.

     

    24

     

    (24%)

     

     

    26

     

    (26%)

     

    The response accurately explains

    pharmacological and

    nonpharmacological treatments in

    language and tone that are appropriate

    for a patient/caregiver audience.

     

    21

     

    (21%)

     

     

    23

     

    (23%

    )

     

    The response somewhat vaguely or

    inaccurately explains pharmacological

    and nonpharmacological treatments.

    Language and tone are mostly

    appropriate for a patient/caregiver

    audience.

     

    0

     

    (0%)

     

     

    20

     

    (20%)

     

    The response vaguely or inaccurately

    explains pharmacol

    ogical and

    nonpharmacological treatments.

    Language and tone are not appropriate

    for a patient/caregiver audience. Or

    the response is missing.

     

    ·

     

    Explain appropriate community

    resources and referrals for the

    assigned diagnosis.

     

    23

     

    (23%)

     

     

    25

     

    (25%)

     

    The respo

    nse accurately and concisely

    explains appropriate community

    resources and referrals for the assigned

    diagnosis in language and tone that are

    engaging and appropriate for a

    patient/caregiver audience.

     

    20

     

    (20%)

     

     

    22

     

    (22%)

     

    The response accurately explains

    app

    ropriate community resources and

    referrals for the assigned diagnosis in

    language and tone that are appropriate

    for a patient/caregiver audience.

     

    18

     

    (18%)

     

     

    19

     

    (19%)

     

    The response somewhat vaguely or

    inaccurately explains community

    resources and referrals f

    or the assigned

    diagnosis. Language and tone are

    mostly appropriate for a

    patient/caregiver audience.

     

    0

     

    (0%)

     

     

    17

     

    (17%)

     

    The response vaguely or inaccurately

    explains community resources and

    referrals for the assigned diagnosis.

    Language and tone are not ap

    propriate

    for a patient/caregiver audience. Or

    the response is missing.

     

    Written Expression and Formatting

     

    Paragraph Development and

    Organization:

     

     

    Paragraphs make clear points that

    support well

    developed ideas, flow

    logically, and demonstrate continuity

     

    of ideas. Sentences are carefully

    focused

    neither long and rambling

    nor short and lacking substance. A

    5

     

    (5%)

     

     

    5

     

    (5%)

     

    Paragraphs and sentences f

    ollow

    writing standards for flow, continuity,

    and clarity.

     

     

    A clear and comprehensive purpose

    statement, introduction, and

    conclusion are provided that delineate

    all required criteria.

     

    4

     

    (4%)

     

     

    4

     

    (4%)

     

    Paragraphs and sentences follow

    writing standards for flow, continuity,

    and clarity 80% of the time.

     

     

    Purpose, introduction, and conclusion

    of the assignment are stated, yet they

    are brief and not descriptive.

     

    3.5

     

    (3.5%)

     

     

    3.5

     

    (3.5%)

     

    Paragraphs and sentences follow

    writing standards for flow, continuity,

    and clarity 60%

    79% of the time.

     

     

    Purpose, introduction, and conclusion

    of the assignment are vague or off

    topic.

     

    0

     

    (0%)

     

     

    3

     

    (3%)

     

    Paragraphs and sentences follow

    writing standards for

    flow, continuity,

    and clarity <60% of the time.

     

     

    No purpose statement, introduction, or

    conclusion were provided.

     

    RUBRIC TO FOLLOW

     

     

    Novice Competent Proficient New column

    In a 300- to 500-word blog post

    written for a patient and/or caregiver

    audience:

     

    • Explain signs and symptoms for the

    assigned diagnosis in children and

    adolescents.

    27 (27%) – 30 (30%)

    The response accurately and concisely

    explains signs and symptoms of the

    assigned diagnosis in language and

    tone that are engaging and appropriate

    for a patient/caregiver audience.

    24 (24%) – 26 (26%)

    The response accurately explains signs

    and symptoms of the assigned

    diagnosis in language and tone

    appropriate for a patient/caregiver

    audience.

    21 (21%) – 23 (23%)

    The response somewhat vaguely or

    inaccurately explains signs and

    symptoms of the assigned diagnosis.

    Language and tone are mostly

    appropriate for a patient/caregiver

    audience.

    0 (0%) – 20 (20%)

    The response vaguely or inaccurately

    explains signs and symptoms of the

    assigned diagnosis. Language and tone

    are not appropriate for a

    patient/caregiver audience. Or the

    response is missing.

    · Explain pharmacological and

    nonpharmacological treatments for

    children and adolescents with the

    diagnosis.

    27 (27%) – 30 (30%)

    The response accurately and concisely

    explains pharmacological and

    nonpharmacological treatments in

    language and tone that are engaging

    and appropriate for a patient/caregiver

    audience.

    24 (24%) – 26 (26%)

    The response accurately explains

    pharmacological and

    nonpharmacological treatments in

    language and tone that are appropriate

    for a patient/caregiver audience.

    21 (21%) – 23 (23%)

    The response somewhat vaguely or

    inaccurately explains pharmacological

    and nonpharmacological treatments.

    Language and tone are mostly

    appropriate for a patient/caregiver

    audience.

    0 (0%) – 20 (20%)

    The response vaguely or inaccurately

    explains pharmacological and

    nonpharmacological treatments.

    Language and tone are not appropriate

    for a patient/caregiver audience. Or

    the response is missing.

    · Explain appropriate community

    resources and referrals for the

    assigned diagnosis.

    23 (23%) – 25 (25%)

    The response accurately and concisely

    explains appropriate community

    resources and referrals for the assigned

    diagnosis in language and tone that are

    engaging and appropriate for a

    patient/caregiver audience.

    20 (20%) – 22 (22%)

    The response accurately explains

    appropriate community resources and

    referrals for the assigned diagnosis in

    language and tone that are appropriate

    for a patient/caregiver audience.

    18 (18%) – 19 (19%)

    The response somewhat vaguely or

    inaccurately explains community

    resources and referrals for the assigned

    diagnosis. Language and tone are

    mostly appropriate for a

    patient/caregiver audience.

    0 (0%) – 17 (17%)

    The response vaguely or inaccurately

    explains community resources and

    referrals for the assigned diagnosis.

    Language and tone are not appropriate

    for a patient/caregiver audience. Or

    the response is missing.

    Written Expression and Formatting –

    Paragraph Development and

    Organization:

     

    Paragraphs make clear points that

    support well-developed ideas, flow

    logically, and demonstrate continuity

    of ideas. Sentences are carefully

    focused—neither long and rambling

    nor short and lacking substance. A

    5 (5%) – 5 (5%)

    Paragraphs and sentences follow

    writing standards for flow, continuity,

    and clarity.

     

    A clear and comprehensive purpose

    statement, introduction, and

    conclusion are provided that delineate

    all required criteria.

    4 (4%) – 4 (4%)

    Paragraphs and sentences follow

    writing standards for flow, continuity,

    and clarity 80% of the time.

     

    Purpose, introduction, and conclusion

    of the assignment are stated, yet they

    are brief and not descriptive.

    3.5 (3.5%) – 3.5 (3.5%)

    Paragraphs and sentences follow

    writing standards for flow, continuity,

    and clarity 60%–79% of the time.

     

    Purpose, introduction, and conclusion

    of the assignment are vague or off

    topic.

    0 (0%) – 3 (3%)

    Paragraphs and sentences follow

    writing standards for flow, continuity,

    and clarity <60% of the time.

     

    No purpose statement, introduction, or

    conclusion were provided.

    LEARNING RESOURCES

     

    https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat06423a&AN=wal.EBC5108631&site=eds-live&scope=site

     

    https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf

     

    Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

    · Chapter 60, “Anxiety Disorders”

    · Chapter 61, “Obsessive Compulsive Disorder”

    · Chapter 62, “Bipolar Disorder in Childhood”

    · Chapter 63, “Depressive Disorders in Childhood and Adolescence”

     

    REQUIRED MEDIA

    https://youtu.be/tSfYXkst1vM

     

    https://youtu.be/Qg-BBKB1nJc

     

    https://www.youtube.com/watch?v=Wn4AVjMMYX4

     

    Medication Review

     

    Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

    Bipolar depression Bipolar disorder
    lurasidone (age 10–17) olanzapine-fluoxetine combination (age 10–17) aripiprazole (age 10–17) asenapine  (for mania or mixed episodes, age 10–17) lithium (for mania, age 12–17) olanzapine (age 13–17) quetiapine (age 10–17) risperidone (age 10–17)
    Generalized anxiety disorder Depression
    duloxetine (age 7–17) escitalopram (age 12–17) fluoxetine (age 8–17)

     

    Obsessive-compulsive disorder
    clomipramine (age 10–17) fluoxetine (age 7–17) fluvoxamine (age 8–17) sertraline (age 6–17)

     

     

    LEARNI

    NG RESOURCES

     

     

    https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat

    06423a&AN=wal.EBC5108631&site=eds

    live&scope=site

     

     

    https://www.ahrq

    .gov/sites/default/files/publications/files/pemat_guide.pdf

     

     

    Thapa

    r, A., Pine, D. S.,

     

    Leckman, J. F., Scott, S.,

     

    Snowling, M. J., & Taylor, E. A. (2015).

     

    Rutter’s child and

    adolescent psychiatry

     

    (6th ed.). Wiley Blackwell.

     

    ·

     

    Chapter 60, “Anxiety Disorders”

     

    ·

     

    Chapter 61, “Obsessive Compulsive Disorder”

     

    ·

     

    Chapter 62, “Bipolar Di

    sorder in Childhood”

     

    ·

     

    Chapter 63, “Depressive Disorders in Childhood and Adolescence”

     

     

     

    REQUIRED MEDIA

     

     

     

    https://youtu.be/Qg

    BBKB1nJc

     

     

    https://www.you

    tube.com/watch?v=Wn4AVjMMYX4

     

     

     

    Medication Review

     

     

    Review the FDA

    approved use of the following medicines related to treating mood and anxiety disorders

    in children and adolescents.

     

    Bipolar depression

     

    Bipolar disorder

     

    lurasidone (age 10

    17)

     

    olanzapine

    fluoxetine combination (age 10

    17)

     

     

    aripiprazole (age 10

    17)

     

    asenapine

     

     

    (for mania or mixed episodes,

    LEARNING RESOURCES

     

    https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cat

    06423a&AN=wal.EBC5108631&site=eds-live&scope=site

     

    https://www.ahrq.gov/sites/default/files/publications/files/pemat_guide.pdf

     

    Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and

    adolescent psychiatry (6th ed.). Wiley Blackwell.

     Chapter 60, “Anxiety Disorders”

     Chapter 61, “Obsessive Compulsive Disorder”

     Chapter 62, “Bipolar Disorder in Childhood”

     Chapter 63, “Depressive Disorders in Childhood and Adolescence”

     

    REQUIRED MEDIA

     

     

     

    Medication Review

     

    Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders

    in children and adolescents.

    Bipolar depression Bipolar disorder

    lurasidone (age 10–17)

    olanzapine-fluoxetine combination (age 10–17)

    aripiprazole (age 10–17)

    asenapine (for mania or mixed episodes,

Discussion Board:Applying Nursing Theorie

Select one nursing theory of professional interest to you.

  • Research this theorist and describe it to your classmates.
  • Discuss ways in which you can apply the theory in your own day-to-day practice. Provide specific examples.
  • For this post, you must show research in your writing using in-text citations and show your reference in 7th. ed. APA.

Spiritual Care

1. Use the following questions to assist in formulating your thoughts for this discussion. Describe a time spirituality was important in your life or in the life of someone you love or cared for (e.g., family member, friend or pet). Why was it meaningful in that situation? Include in the importance religious  or cultural practices or other reasons for it significance. .

2. What would you do if a patient asked you to pray with them or read the Bible or another holy book he/she might have at the bedside? How would this request make you feel? Would you experience any conflict if you were a different faith than the patient?  There is something called scripting which is having something written and memorized for difficult situations. Write a prayer or spiritual message you could use in the above situation.

Discussion Question

A nurse manager is attending a national convention and is attending a concurrent session on staffing ratios. Minimum staffing ratios are being discussed in the nurse manager’s own state. The nurse manager has a number of questions about staffing ratios that the session is covering. The nurse manager knows that evidence exists that increasing the number of RNs in the staffing mix leads to safer workplaces for nurses and higher quality of care for patients.

1. What are the three general approaches recommended by the American Nurses Association (2017) to maintain sufficient staffing?

2. Summarize the findings that are often cited as the seminal work in support of establishing minimum staffing ratio legislation at the federal or state level.

3. Analyze what proponents and critics say about whether mandatory minimum staffing ratios are needed.

APA STYLE 7 EDITION

3 PARAGRAPHS 3 SENTENCES EACH

2 REFERENCES

Chapter 10 Mandatory Minimum Staffing Ratios

 

Copyright © 2016 Wolters Kluwer Health | Lippincott Williams & Wilkins

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

RN Skill Mix

Economics as the driving concern for changes

Trend: reduction in RNs in staffing mix; replacement with less expensive personnel

Research: number of RNs in staffing mix directly affecting quality of care and patient outcomes

National movement to mandate minimum staffing ratios

As of 2017, 14 states addressed nurse staffing in hospitals in law/regulations

California is the only state that stipulates in law; regulations for required minimum nurse-to-patient ratios to be maintained at all times by unit

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Staffing Ratios and Patient Outcomes

Research findings (see Table 10.1)

Questions about cost-effectiveness of statewide mandatory nurse staffing ratios

Greater RN skill mix and fewer cases of sepsis and failure to rescue

Benchmark research

Needleman et al. (2002)

Aiken et al. (2002)

Direct link between nurse-to-patient ratios and mortality from preventable complications

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Mandatory Minimum Staffing Ratios: Needed? #1

ANA with concern related to effect of poor staffing on nurses’ health and safety and patient outcomes

Proponents

Absolutely essential for patient safety and outcomes

Use of standardized ratios for consistent approach

Critics

Exponentially increased cost with no guarantee of quality improvement or positive outcomes

AONE agrees and does not support mandated nurse staffing ratios

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Question #1

Is the following statement true or false?

Few states have enacted staffing laws.

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Answer to Question #1

False

As of 2017, 14 states addressed nurse staffing in hospitals in law/regulations.

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Mandatory Minimum Staffing Ratios: Needed? #2

Evidence of benefits mixed, contradictory

No accounting for education, experience, and skill level

Risk of actual decline in staffing—used as a ceiling or absolute criteria without accounting for patient acuity or RN skill level

Cost as the major deterrent—not financially attractive to hospitals

Mandate for specific staffing ratios and current shortage leading to reduction in hospital services, increased emergency room diversions, increased unit closures, increased expenses

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Mandatory Minimum Staffing Ratios: Needed? #3

Ohio Hospital Association: benefit of staffing ratios is mixed and sometimes contradictory

Corbridge (2017): argues that mandating inflexible nurse staffing ratios or stringent meal and rest break requirements do not improve patient care or outcomes

Silber et al (2016): better-staffed facilities had a formula for excellent value as well as better patient outcomes (see Box 10.2)

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

California Prototype #1

First state to implement mandatory minimum staffing ratios

Maximum number of patients an RN could be assigned to care for under any circumstances (see Table 10.2)

Issues in determining appropriate ratios

Lack of data about nurse staffing distribution

Patient classification system (PCS) data problematic

Unknown cost

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

California Prototype #2

Recommendation: 1 nurse to every 6 patients in med/surg units

Delays in implementation

Problems with interpreting the meaning and intent of language related to “licensed nurses”

Issues related to cutting nonlicensed staff

Questions if adequate number of RNs available to meet ratios

Emergency regulation in 2004; overturned in 2005

Hospitals and nursing unions’ responses

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

California Prototype #3

Struggle to implement

Mandate effective 1/1/2004

Larger hospitals versus smaller hospitals to meet mandate

Need for legal clarification for “at all times” (i.e., breaks, lunches)

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Question #2

Is the following statement true or false?

California implemented mandatory minimum staffing ratios fairly quickly.

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Answer to Question #2

False

There were significant delays in implementing the California mandatory minimum staffing ratios.

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

California Prototype #4

Improvement in RN staffing and patient outcomes?

Reduction in number of patients per licensed nurse

Increase in number of worked nursing hours per patient day in hospitals

No significant impact on measures of nursing quality and patient safety indicators

No increase in adverse outcomes despite increasing patient acuity

Lower risk-adjusted mortality (Aiken, 2010)

No improvement in quality of care (HC Pro, 2009)

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Similar Initiatives: Other States

Minimum standards for licensed nursing in certified nursing homes but not in acute care hospitals

Several attempts, but none enacted

Adequate numbers requirement for Medicare-certified hospitals

Many states actively pursuing minimum staffing ratio legislation

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Other Alternatives

Pursuit of alternatives to improve nurse staffing without legislated minimum staffing ratios

Lack of support for legislated minimum staffing ratios

The Joint Commission

ANA against fixed nurse–patient ratios; recommendation of three general approaches (see Box 10.3)

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Question #3

Is the following statement true or false?

The ANA supports legislation for fixed nurse–patient ratios.

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

Answer to Question #3

False

The ANA does not support fixed nurse–patient ratios but advocates for a workload system that takes into account the many variables that exist to ensure safe staffing.

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved

End of Presentation

 

Copyright © 2020 Wolters Kluwer • All Rights Reserved