Assignment 1: Practicum Journal: Voluntary and Involuntary Commitment

Psychiatric Mental Health Nurse Practitioner (PMHNP) may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

                                       Scenario for Week 7 Case:

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

To Prepare for this Practicum Assignment:

· Review the Learning Resources concerning voluntary and involuntary

commitment.

· Read the Week 7 Scenario in your Learning Resources.

· Research your state’s laws concerning voluntary and involuntary commitment.

                                   The Assignment (3 pages):

· Based on the scenario, would you recommend that the client be voluntarily

committed? Why or why not?

· Based on the laws in your state, would the client be eligible for involuntary

commitment? Explain why or why not.

· Did understanding the state laws confirm or challenge your initial

recommendation regarding involuntarily committing the client? Explain.

· If the client were not eligible for involuntary commitment, explain what actions

you may be able to take to support the parents for or against voluntary

commitment.

· If the client were not eligible for involuntary commitment, explain what initial

actions you may be able to take to begin treating the client.

                                                      Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 4, “Theories of Personality and      Psychopathology” (pp. 151–191)
• Chapter      31, “Child Psychiatry” (pp. 1181–1205)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Neurodevelopmental Disorders”

o “Specific Learning Disorder”

o “Motor Disorders”

Murphy, T. K., Lewin, A. B., Storch, E. A., Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with tic disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 52(12), 1341–1359. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00695-3/pdf 

McGarvey, E. L., Leon-Verdin, M., Wancheck, T. N., & Bonnie, R. J. (2013). Decisions to initiate involuntary commitment: The role of intensive community services and other factors. Psychiatric Services, 64(2), 120–126.

Kaltiala-Heino, R. (2010). Involuntary commitment and detainment in adolescent psychiatric inpatient care. Social Psychiatry and Psychiatric Epidemiology, 45(8),785–793. doi:10.1007/s00127-009-0116-3

Lindsey, M. A., Joe, S., Muroff, J., & Ford, B. E. (2010). Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. General Hospital Psychiatry, 32(3), 300–309. doi: 10.1016/j.genhosppsych.2010.01.007

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 

 

PLEASE REMEMBER TO INCLUDE  INTRODUCTION, CONCLUSION & REFERENCES. (TOTAL PAGES 3, EXCLUDING THE REFERENCES)

Argumentative Strategies

11 unread reply.11 reply.

Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 3; pp. 100-107
• Lesson
• Minimum of 1 scholarly source (one of the listed pro-position articles)

Apply the following writing resources to your posts:

• Link (multimedia presentation): Citing References in Text (Links to an external site.)
• Link (website): APA Citation and Writing (Links to an external site.)

Initial Post Instructions

Part 1: Research & Review
Choose one of the following pro articles to review and discuss with your classmates. If you have a different pro article you would like to use, please discuss it with your professor in advance. All articles can be found in our library databases.

Topics

Pro-Position Articles

Patient Portals

Alpert, J.M., Krist, A.H., Aycock, R.A. & Kreps, G.L. (2017, March). Designing user-centric patient portals: Clinician and patients’ uses and gratifications (Links to an external site.). Telemedicine Journal And E-Health: The Official Journal Of The American Telemedicine Association, 23 (3), 248-253.

Cosmetic Surgery

Jacono, A., Chastant, R.P. & Dibelius, G. (2016). Association of patient self-esteem with perceived outcome after face-lift surgery (Links to an external site.). JAMA Facial Plastic Surgery, 18(1), 42-46.

Cost of Cancer

Newcomer, L. (2014, October). Myths and realities in cancer care: Another point of view. Health Affairs, 33(10), 1805-1807 (Links to an external site.).

Surrogacy

Jadva, V., Imrie, S. & Golombok, S. (2015, February). Surrogate mothers 10 years on: a longitudinal study of psychological well-being and relationships with the parents and child (Links to an external site.). Human Reproduction, 30(2), 373-379.

Organ Donation

Ralph, A., Chapman, J.R., Gillis, J., Craig, J.C., Butow, P., Howard, K….Tong, A. (2014, April). Family perspectives on deceased organ donation: thematic synthesis of qualitative studies (Links to an external site.). American Journal Of Transplantation: Official Journal Of The American Society Of Transplantation And The American Society Of Transplant Surgeons, 14(4), 923-935.

Private Hospitalization

MacAllister, L., Bellanti, D. & Sakallaris, B.R. (2016). Exploring inpatients’ experiences of healing and healing spaces: A mixed methods study (Links to an external site.). Journal Of Patient Experience, 3(4), 119-130. (Click on View Record in DOAJ to access full text.)

Workplace stress

Davenport, T.O. (2015). The good stress strategy: How managers can transform stress into fulfillment (Links to an external site.). Employment Relations Today (Wiley), 42 (3), 9-20.

Part 2: Application
Evaluate how effective the article’s argument was using Toulmin’s model. Detail as many of the 6 components as possible:

1. Claim: What was the article’s main point? What’s the thesis?
2. Grounds: What kinds of evidence did the author use to support his/her argument? Provide an example.
3. Warrants: Did the author(s) successfully connect the evidence to the main point? How so?
4. Backing: How credible were the sources the author(s) applied? How does credulity affect your overall response?
5. Qualifiers: Did you notice any absolutes (all, every, each) or limiters (some, several, many)? How did they add or subtract from the argument?
6. Rebuttal: Did the author(s) present any points of opposition and counterarguments? How did it influence your reaction?

Note: If a section is missing completely from an article, spend of time discussing how its absence affects the overall success of the argument.

How will you apply a similar approach in your pro-position papers? Based on this assessment, what must you include and what can you avoid in your own argument development?

Follow-Up Post Instructions
Respond to at least two peers or one peer and the instructor. Here, we have an opportunity to compare research notes with our fellow peers.

• Did your peers discover something you missed?
• Do you agree with the stance in this article? If so, what other warrants or grounds might you add to validate the argument? If not, what qualifiers or rebuttals might you present to disprove the argument?

Remember, the goal here is to find multiple perspectives, but those perspectives should be both professional and respectful. Ask questions to keep the conversation going.

DISCUSSIONS

For each of the question in the assignments below, I need about 120 words each with individual references. PLEASE, NO PLAGIARIZED WORK

Unit 1

Q:1

Describe and provide rationale for which methodology you plan to use in your DPI project. Be sure to describe how your methodology is in line with your project questions.

Q:2

Describe and provide rationale for which design you plan to use in your DPI project. Be sure to indicate how your design in aligned with the methodology chosen in Unit 1 Q:1.

Unit 2

Q:1

The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines provide some guidance on the evaluation of quality improvement efforts. They are used as both grant proposal and manuscript preparation guides. Use the “Revised Standards for Quality Improvement Reporting Excellence: SQUIRE 2.0” resource to respond to the following:

Discuss how your project/prospectus fits into the SQUIRE guidelines. Explain why your project is a quality improvement project and not a research project.

Q:2

Discuss why quantitative method is the best method based on your project questions and data. Choose three potential designs that you could use for your project. Based on the three potential designs, determine potential analyses methods and why?

Unit 3

Q:1

Describe a survey, instrument, or tool that you plan to use in your project. Describe the tool in terms of name, number of items, how it is answered (Likert scale, yes/no, open answers, etc.), and the total score. Describe the level of measurement for this instrument. Support with references.

DQ 2

Describe the validity and reliability of the instrument you chose in Unit 3 Q:1. How is this different from external and internal validity?

Unit 4

DQ 1

Describe a vulnerable population in terms of research. Why is the population considered vulnerable? What other groups might also be considered vulnerable populations

DQ 2

Review the “Sample Size” Topic Material. Assume you want to do a project that compares the survey results before an intervention to those after an intervention in the same sample (the same people will take both surveys). You plan to use a paired t-test to analyze your results. Identify and select a tool of your choice to conduct the sample size calculation. You may use your SPSS Statistical Package for the Social Sciences, but it is not required for this assignment. Perform a sample size calculation to determine how large your sample should be. Justify your sample size calculation with citations. Discuss how your sample size may affect the validity of your project.

Unit 5

Q:1

What are the assumptions for a t-test? How should these be run? Do you want to see a p value of <0.05? Why or why not?

Q:2

Review the types of data that are considered protected health information (PHI). Do you plan to collect any of this data during your project? How would the collection of this data affect your project (whether you plan to collect it or not)?

Unit 6

Q:1

Compare your DPI project manuscript thus far to the “Revised Standards for Quality Improvement Reporting Excellence: SQUIRE 2.0” guidelines. Discuss what you can improve in your DPI project manuscript.

Q:2

Describe the process of a retrospective chart review. How are these data collected? How would you access the data? What is the validity and reliability of these data? What steps would you need to take to ensure these data were accurately pulled from the database?

Unit 7

Q:1

Discuss the basic principles of data interpretation used to translate research outcomes into practice. What are common barriers to translating research outcomes into practice? Describe any barriers you may anticipate as you plan to translate the results of your own prospectus into practice

Q:2

Select a journal in which you would be interested in having your research published. Review the author guidelines on the Journal for Nurse Practitioners (JNP) website and answer the following questions. How could author guidelines be beneficial to your practice?

Unit 8

Q:1

Describe how you can be intentional when incorporating feedback from your content expert and faculty chair when revising your prospectus

Q:2

Your prospectus will require many updates and changes as you progress through the program. Your literature review chapter alone will require 50 or more articles and be more than 30 pages long. Describe a plan to continue the search for articles and add them to your prospectus over the coming months.

Overview: Synthesis Paper

You have been reflecting on changes you have undergone since beginning this program in each of your Journal entries in this course. Now you will synthesize those reflections, plus any other insights into a paper articulating your RN to BSN educational journey. You will use your module Journal entries as well as examples from other RN BSN courses to construct the Synthesis paper.

Objectives

Synthesis Paper in a reflective activity comprised of your experience in the RN BSN program.

You will address your experiences before the RN BSN program, you as a lifelong learner, you in the continuum of novice to expert in the professional nursing role, an account of your role transition to a professional nurse, and an evaluation of the program.

The Synthesis Paper will reflect your understanding and use of APA format and scholarly writing.

 

The following rubric will be used to grade the Synthesis Paper. The paper has 6 sections:

Introduction

Before RN-BSN Program

Lifelong Learning

Novice to Expert

Synthesis of Role Transition to Professional Nursing

Evaluation

The paper must have title page, reference page, plus no more than 4 pages that address the 6 sections of the paper outlined in the grading rubric. So with the title page, 4 pages for the body of the paper, and the reference page, the Synthesis Paper must not be more than 6 total pages using 12-point Times Roman font.

The first 2 grading criteria noted in the rubric below apply to all sections of the paper. APA format, scholarly writing, grammar and spelling are graded in each section. Use Spell Check and Grammar Check!

In-text citations are required to support each section when you discuss the RN BSN courses or the program. Points will be deducted if this information is not detailed and referenced in the document and on the reference page. References need to be evidence-based if you choose to reference literature instead of information in RN BSN courses.

 

Instructions

Study the rubric to determine the expectations for each section of the paper. Notice that you are required to cite at least one research article or specific RN-BSN course topic or activity for each section. Locate and record citations for articles you may want to reference, and skim the articles to review the contents. Create an outline that incorporates your main ideas into each section. Follow the outline and the rubric to write a rough draft. You may want to draft your paper by hand, or you might prefer to “type as you go,” editing and making changes both during and after writing the draft.

Your final document should include a title page, all 6 sections of the paper as identified in the grading rubric, and a reference page. Including title and reference pages the paper is not to exceed 6 pages. Part of scholarly writing is to be concise in your writing. The Coach is instructed to grade the title page, the first 4 pages of the body of the paper, and the reference page. If the Synthesis Paper is longer than 6 total pages points may be deducted based on grading rubric sections that were not addressed in the allotted 6 pages.

The title page should be formatted according to UT Arlington College of Nursing format or you may use the title page APA 6th Edition format.

Your writing should be in first person, and is expected to include opinions and personal statements, but have a professional tone. It should flow as a narrative, mostly chronological description your progression through the program including your reflections on specific nursing courses and reflections throughout the program.

Be sure to include a final page titled “References,” and cite your references in correct APA formats. Reference list will include any RN-BSN courses or activities in APA format.

Each section must contain 3-4 well constructed, grammatically correct sentences supported by citations and references (APA 6th Edition Format) as appropriate. Ensure that your writing is informative and interesting, not redundant.

After your write your paper, set it aside and review it again several hours later or the next day. Read it from an objective viewpoint to see if it flows and makes sense. If not, make necessary changes. Have someone else proofread your paper both for content and grammatical accuracy is a vital step. Read your paper out loud before submitting it. Hearing yourself read your own written words can find those last minute mistakes or incomplete thoughts before you submit the paper for grading.

Reflections Paper and Journal attached to provide background information.

Rubric attached to show how points will be awarded for information included in the paper.

Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

· Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

· Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

· Construct a mind map for the disorder described on the Scenario 1: Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

· For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes.  You are required to discuss all three scenarios within the paper component of this assignment.

· Construct one mind map on the disorder described on Scenario 1. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

Instructor Requirements

As advanced practice nurses, we are scholars, nurse researchers and scientists. As such, please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. Students should be using the original citation in Up to Date and go to that literature as a reference. The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference:

1. Up to Date (must use original articles from Up to Date as a resource)
2. Wikipedia
3. Cdc.gov- non healthcare professionals section
4. Webmd.com
5. Mayoclinic.com