Nursing Assignment

Bioethical
 Decision
 Making
 Model
 

 

1. Define
 the
 dilemma:
 Use
 your
 own
 words
 to
 describe
 the
 problem.
 State
 it
 in
 a
 way
 
that
 others
 can
 quickly
 understand
 your
 dilemma.
 Review
 
 
 
 

 

2. Identify
 the
 medical
 facts:
 Describe
 the
 facts
 that
 are
 relevant
 to
 the
 dilemma.
 
 

 

3. Remember
 that
 the
 diagnosis
 and
 prognosis
 are
 medical
 facts.
 
 

 

4. Identify
 the
 non-­‐medical
 facts
 (patient
 and
 family,
 external
 influences):
 
 
a. Patient
 and
 family
 facts
 such
 as
 culture,
 religion,
 social,
 economic,
 the
 

existence
 of
 an
 Advance
 Healthcare
 Directive,
 verbal
 preferences
 made
 by
 
the
 patient,
 how
 the
 patient
 lived
 his/her
 life.
 
 

b. Those
 that
 you
 discuss
 should
 be
 relevant
 to
 the
 situation.
 
 

 

5. External
 influences
 include:
 organizational
 policies,
 federal
 and
 state
 laws,
 practice
 
acts,
 code
 of
 ethics.
 These
 should
 be
 relevant
 to
 the
 situation.
 
 
 

 

6. For
 both
 step
 2
 or
 3,
 separate
 the
 facts
 from
 the
 assumptions:
 Sometimes
 all
 
healthcare
 professionals
 allow
 assumptions
 to
 guide
 their
 decision-­‐making.
 These
 
must
 be
 identified
 so
 that
 these
 assumptions
 do
 not
 interfere
 with
 the
 process.
 
 

 

 

7. Identify
 items
 that
 need
 clarification.
 Your
 paper
 should
 identify
 facts
 that
 you
 need
 
to
 clarify.
 When
 initially
 discussing
 an
 ethical
 situation,
 it
 is
 not
 unusual
 to
 not
 have
 
all
 of
 the
 answers.
 
 

 

8. Identify
 the
 decision
 makers:
 Is
 the
 patient
 an
 adult
 competent
 to
 make
 their
 own
 
choices?
 Is
 the
 patient
 a
 child
 who
 is
 old
 enough
 to
 have
 a
 say
 in
 the
 decision.
 If
 the
 
patient
 cannot
 make
 their
 own
 decision,
 who
 is
 the
 decision
 maker?
 How
 was
 this
 
person
 selected?
 
 
 

 

 

9. Review
 the
 underlying
 ethical
 principles:
 Review
 which
 ones
 and
 why
 they
 apply
 t
 
this
 particular
 case:
 beneficence,
 nonmaleficience,
 veracity,
 fidelity,
 autonomy
 and
 
justice.
 

 

10. Define
 alternatives:
 One-­‐Way
 to
 proceed
 may
 be
 apparent
 at
 this
 point.
 However,
 
sometimes
 there
 are
 different
 choices.
 
 They
 should
 be
 addressed
 identifying
 the
 
benefits
 and
 burdens
 for
 doing
 one
 thing
 versus
 the
 other.
 

 
11. Follow-­‐up:
 
 Define
 the
 process
 to
 be
 used
 with
 the
 chosen
 alternative.
 
 

 

 

 
Reference
 Source:
 Levine-­‐Ariff,
 J.
 &
 Groh,
 D.H.
 (1990).
 Creating
 an
 Ethical
 Environment.
 
Nurse
 managers'
 bookshelf
 a
 quarterly
 series:
 2:1.
 Baltimore,
 Maryland:
 Williams
 &
 Wilkins.
 
41-­‐61.
 

nursing

Assessment Description

Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the previous course assignments and the guidelines below.


PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).


Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper.

 Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change
.


General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.  

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

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

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

INSTRUCTORS REQUIREMENTS

As you start the final paper for this course, I wanted to point out a couple of items.

1. Review the rubric found in the syllabus and be sure to follow the requirements.

2. Review my comments in previous submission and make the revisions. I attached your paper in the gradebook feedback with extensive feedback. One of the grading criteria for the final paper is evidence of revisions based upon previous feedback.

3. The paper is to be 
1,500-1,750 words. Points will be deducted for exceeding the word count.

4. All references to articles in the be done by using the author's name. The title of the article is not to be in the text of the paper.

5. All references are to be in APA format. 
Retrieved from is not to be included.

6. Please message me with questions

7.
No late submissions will be accepted after the end of the class which Sunday, October 1, 1159PM.

Dr. Cook

nursing: ethical dilemma

attached

Role and Engagement of Stakeholders

Please see the attachment for the instructions

Consumer Health

Due October 18, 2023 @6PM

part 3a 3b

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3. ( Worksheet attached)

Article #1Zhou, X., Guo, J., Lu, G., Chen, C., Xie, Z., Liu, J., & Zhang, C. (2020). Effects of mindfulness-based stress reduction on anxiety symptoms in young people: A systematic review and meta-analysis. Psychiatry Research, 289, 113002. https://doi.org/10.1016/j.psychres.2020.113002

Article #2 Porter, B., Oyanadel, C., Sáez-Delgado, F., Andaur, A., & Peñate, W. (2022). Systematic review of mindfulness-based interventions in child-adolescent population: A developmental perspective. European Journal of Investigation in Health, Psychology and Education, 12(8), 1220–1243. https://doi.org/10.3390/ejihpe12080085

Article #3 Cohen, Z. P., Cosgrove, K. T., Akeman, E., Coffey, S., Teague, K., Hays-Grudo, J., Paulus, M. P., Aupperle, R. L., & Kirlic, N. (2021). The effect of a mindfulness-based stress intervention on neurobiological and symptom measures in adolescents with early life stress: a randomized feasibility study. BMC Complementary Medicine and Therapies, 21(1). https://doi.org/10.1186/s12906-021-03295-1

Article #4

Peter, A., Srivastava, R., Agarwal, A., & Singh, A. P. (2022). The effect of mindfulness-based cognitive therapy on anxiety and resilience of the school-going early adolescents with anxiety. Journal of Indian Association for Child and Adolescent Mental Health, 18(2), 176–185. https://doi.org/10.1177/09731342221127959

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

D. SAA CULTURE PLAN OF CARE

One is an individual plan of care. This can be a (personal plan of care based on your own culture or a culture of your choice).In place of an APA ASSIGNMENT,  please draft an individual plan of care related to one’s personal culture or a selected population of interest. 

  • The culture that is being recognized.
  • Unique traits of that culture (language, preferences, family dynamics, dietary needs).
  • Health problems associated with that culture.
  • Corrective measures and community resources.
  • Expected outcomes. 
  • Include citations to support your presented data

PLEASE DO IT ON PUERTO RICAN CULTURE

2 Discussions 2 reply

Please see the attachmet for instructions 

Unit 10 Peer response. Medications for Dementia. 800W. APA. 4 references due 10-10-23.

Advanced Psychopharmacology and Health Promotion

Unit 10 Peer response. Medications for Dementia. 800W. APA. 4 references due 10-10-23.

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

· Compare and contrast your initial posting with those of your peers.  

· How are they similar or how are they different?

· What information can you add that would help support the responses of your peers?

· Ask your peers a question for clarification about their post.

· What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

Mojgan

Week 10, Medications for Dementia

Based on the test scores above, do you believe that Mrs. Outcome does have dementia?

        Dementia is characterized by a significant cognitive dysfunction from patients’ usual functioning level, impacting their daily activities and quality of life (Stahl, 2021). The Functional Activity Questionnaire (FAQ) is a validated instrument used to assess functional activity levels in older adults. It evaluates activities that require advanced skills, such as managing finances or preparing meals. The purpose of this questionnaire is to identify individuals with functional impairments, particularly in the elderly population (Vik et al., 2023). Mrs. Outcome's score of 13/30 suggests that she is experiencing disruptions in her daily functioning and may be dealing with cognitive issues.

        The GAD-7 scale (Generalized Anxiety Disorder 7-item scale) is a validated tool that is increasingly utilized for screening and clinical research. It is applicable to both adults and adolescents, in both general population and individuals with anxiety disorders. This scale consists of seven items and is designed to evaluate the level of anxiety in patients (Todorović et al., 2023). Mrs. Outcome's score of 7/21 suggests she is experiencing mild anxiety.

        The Mini-Mental Status Examination (MMSE) has a maximum score of 30 points, with higher scores indicating better cognitive function. It comprises 11 questions that assess aspects such as orientation to time, orientation to place, immediate memory, serial seven
 calculation, delayed memory, naming, repetition, oral instruction, writing instruction, spontaneous writing, and copying a design (Naito et al., 2023). Mrs. Outcome's score of 20/30 suggests mild cognitive impairments. Given Mrs. Outcome medical history, which includes incidents like “losing it,” a fire in her house, and confusion between day and night, there is a clear decline from her previous level of functioning. The test results also indicate cognitive decline. Mrs. Taylor is indeed experiencing some degree of cognitive issues, which could be indicative of dementia

What are the differences between delirium and dementia?

        Delirium and dementia differ in several ways. Delirium is a sudden-onset neuropsychiatric condition triggered by a medical issue. Delirium is characterized by disturbances in consciousness and cognitive function, with fluctuating symptoms, often affecting vulnerable individuals (Heijden et al., 2023). On the other side, dementia has a gradual onset and progresses over time (Stahl, 2021). While delirium is typically linked to a patient's medical conditions, often occurring in hospitals, and may be reversible if the underlying cause is resolved, dementia is usually progressive and generally not reversible. In delirium, patients experience impaired attention and reduced awareness of their environment, while those with dementia typically have relatively preserved attention and stable awareness. Dementia primarily affects memory and other cognitive areas in the early stages. Delirium can lead to impairments in various cognitive areas, including memory, language, and executive functions. Dementia patients have a higher risk of developing delirium compared to the general population (Fong & Inouye, 2022).

What two categories of medications are often used to treat dementia and how do these medications work?

        As per Stahl (2021), there are two main groups of medications that can help patients with dementia. The first group is Cholinesterase inhibitors, including medications like donepezil, rivastigmine, and galantamine. Cholinesterase inhibitors work by inhibiting the enzyme responsible for breaking down acetylcholine, a key neurotransmitter that is often reduced in dementia patients. This group of medications functions by increasing acetylcholine levels, which can improve cognitive function, particularly in the early stages of Alzheimer's disease. Galantamine, a cholinesterase inhibitor, was initially derived from snowdrops and has a unique mechanism of action, involving both the inhibition of cholinesterase and the regulation of nicotinic cholinergic receptors (Stahl, 2021).

        The second group of medications consists of NMDA receptor antagonists, with memantine being a prominent example. These medications modulate the activity of glutamate, another neurotransmitter with a crucial role in learning and memory processes. By controlling glutamate levels, these medications may slow down the progression of dementia symptoms, particularly in cases of moderate to severe dementia (Stahl, 2021).

References

Fong, T. G., & Inouye, S. K. (2022). The inter-relationship between delirium and dementia: the importance of delirium prevention.
 Nature Reviews. Neurology, 18(10), 579-596. https://doi.org/10.1038/s41582-022-00698-7

Heijden, E. F. v. d., Kooken, R. W. J., Zegers, M., Simons, K. S., & van den Boogaard, M. (2023). Differences in long-term outcomes between ICU patients with persistent delirium, non-persistent delirium and no delirium: A longitudinal cohort study.
 Journal of Critical Care, 76https://doi.org/10.1016/j.jcrc.2023.154277

Naito, T., Suzuki, Y., Yamasue, K., Saito, K., Umemura, M., Kojima, N., Kim, H., Osuka, Y., Ishikawa, Y., & Tochikubo, O. (2023). Relationship between cognitive function and sway of body in standing posture: A cross-sectional study.
 Geriatrics, 8(2), 29. 
https://doi.org/10.3390/geriatrics8020029Links to an external site.

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.)

Todorović, A., Baumann, C., Blanchin, M., & Bourion-Bédès, S. (2023). Validation of Generalized Anxiety Disorder 6 (GAD-6)—A Modified structure of screening for anxiety in the adolescent French population.
 International Journal of Environmental Research and Public Health, 20(8), 5546. https://doi.org/10.3390/ijerph20085546

Vik, A., Kociński, M., Rye, I., Lundervold, A. J., & Lundervold, A. S. (2023). Functional activity level reported by an informant is an early predictor of Alzheimer’s disease.
 BMC Geriatrics, 23, 1-15. https://doi.org/10.1186/s12877-023-03849-7

Mihaela

Unit 10 – Medications for Dementia

1.
Based on the test scores above, do you believe that Mrs. Outcome does have dementia?

Considering the test results given it seems probable that Mrs. Outcome is experiencing dementia. The score of 20/30, on the NMSE indicates cognitive impairment (Korsnes, 2020). The clock drawing test score of 2/5 indicates challenges with visuospatial abilities, which are often affected in individuals with dementia (Palsetia et al., 2018). Furthermore, her FAQ score of 13/30 suggests that she is experiencing functional impairment in daily activities (Gonzalez et al., 2022). The GAD-7 and PHQ-9 scores indicate mild levels of anxiety and depression which are often seen in individuals with dementia (Stocker et al., 2021). Taking into account these scores, along with other observations like confusion regarding day and night, calling out for assistance, and daytime sleepiness it seems likely that she may be dealing with dementia.

1.
What are the differences between delirium and dementia?

Delirium and dementia are two conditions that can lead to cognitive impairment and have notable distinctions. Delirium typically manifests suddenly and exhibits fluctuating symptoms often triggered by a medical condition or medication side effect. It can usually be reversed by addressing the underlying cause (Grover & Avasthi, 2018). In contrast, dementia refers to a progressive deterioration in cognitive abilities over time and is irreversible (Duong et al., 2018).

1.
What two categories of medications are often used to treat dementia and how do these medications work?

There are two types of medications that are commonly used for treating dementia: cholinesterase inhibitors and N methyl D aspartate (NMDA) receptor antagonists. Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine work by increasing the levels of acetylcholine in the brain, which helps improve cognitive function to some extent (Battle et al., 2021). On the other hand, NMDA receptor antagonists like memantine help regulate glutamate activity in the brain and may slow down the progression of symptoms associated with moderate-to-severe Alzheimer's disease (Wang et al., 2018). According to the World Health Organization, Alzheimer’s disease is the major cause of dementia, for approximately 60–70% of cases. This chronic neurodegenerative condition exhibits a progression of symptoms over time starting with forgetfulness and gradually affecting language skills, orientation, and behavior, and leads to severe loss of memory and impairment of certain bodily functions until the ultimate death (Wang et al., 2018).

References

Battle, C. E., Abdul-Rahim, A. H., Shenkin, S. D., Hewitt, J., & Quinn, T. J. (2021). Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: A network meta-analysis. 
Cochrane Database of Systematic Reviews
2021(2). 
https://doi.org/10.1002/14651858.cd013306.pub2Links to an external site.

Duong, S., Patel, T., & Chang, F. (2018). Dementia. 
Canadian Pharmacists Journal / Revue des Pharmaciens du Canada
150(2), 118–129. 
https://doi.org/10.1177/1715163517690745Links to an external site.

González, D., Gonzales, M. M., Resch, Z. J., Sullivan, A., & Soble, J. R. (2021). Comprehensive evaluation of the functional activities questionnaire (faq) and its reliability and validity. 
Assessment
29(4), 748–763. 
https://doi.org/10.1177/1073191121991215Links to an external site.

Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for management of delirium in elderly. 
Indian Journal of Psychiatry
60(7), 329. 
https://doi.org/10.4103/0019-5545.224473Links to an external site.

Korsnes, M. (2020). Performance on the mini-mental state exam and the montreal cognitive assessment in a sample of old age psychiatric patients. 
SAGE Open Medicine
8, 205031212095789. 
https://doi.org/10.1177/2050312120957895Links to an external site.

Palsetia, D., Rao, G., Tiwari, S. C., Lodha, P., & De Sousa, A. (2018). The clock drawing test versus mini-mental status examination as a screening tool for dementia: A clinical comparison. 
Indian Journal of Psychological Medicine
40(1), 1–10. 
https://doi.org/10.4103/ijpsym.ijpsym_244_17Links to an external site.

Stocker, R., Tran, T., Hammarberg, K., Nguyen, H., Rowe, H., & Fisher, J. (2021). Patient health questionnaire 9 (phq-9) and general anxiety disorder 7 (gad-7) data contributed by 13,829 respondents to a national survey about covid-19 restrictions in australia. 
Psychiatry Research
298, 113792. 
https://doi.org/10.1016/j.psychres.2021.113792Links to an external site.

Wang, R., & Reddy, P. (2018). Role of glutamate and nmda receptors in alzheimer’s disease. 
Journal of Alzheimer's Disease
57(4), 1041–1048. 
https://doi.org/10.3233/jad-160763Links to an external site.

CLINICAL SKILLS SELF-ASSESSMENT

 

Use the PMHNP Clinical Skills Self-Assessment Form to complete the following:   

  • Rate yourself according to your confidence level performing the skills identified on the Clinical Skills Self-Assessment Form.  
  • Based on your ratings, summarize your strengths and opportunities for improvement.   
  • Based on your self-assessment and theory of nursing practice, develop 3–4 measurable goals and objectives for this practicum experience. Include them on the designated area of the form.