NRNP 6540 Week 1 Discussion Post Essay

NRNP 6540 Week 1 Discussion Post Essay

NRNP 6540 Week 1 Discussion Essay

Hi… Your discussion eloquently articulates the essential aspects of advanced practice registered nurses’ (APRNs) and nurse practitioners’ (NPs) role in ensuring comprehensive patient care. Building upon this foundation, it is evident that a multi-faceted approach is needed to address modern healthcare’s complexities and individual patients’ unique needs. In this discussion, I will delve into various dimensions of the topics discussed, introducing new ideas and insights supported by relevant evidence.

Holistic patient care is a cornerstone of modern medical practice, especially during evaluation. Beyond the immediate medical concerns, the psychosocial aspects of a patient’s well-being play a critical role in their overall health. To this end, fostering effective communication between healthcare providers, patients, and their families takes precedence. Healthcare workers must ensure that the patient’s needs are considered, as they are unique for every patient. Incorporating shared decision-making models, where patients actively participate in their care plans, empowers patients to take charge of their health journey (Egan et al., 2022). Research by Chen et al. (2021) indicates that patient-provider communication correlates positively with patient adherence to treatment regimens, underscoring the importance of a patient-centric approach.

Moreover, discussing assessment tools and guidelines opens the door to exploring innovative diagnostic methods. The emerging field of digital biomarkers, encompassing data collected through wearable devices and mobile applications, offers opportunities for real-time health monitoring. For instance, smartphone-based applications can track subtle changes in speech patterns, gait, and social interactions, potentially aiding in the early detection of conditions such as Parkinson’s disease (Hunt et al., 2021). Integrating these novel approaches into the assessment toolkit could revolutionize the early intervention landscape. The use of guidelines ensures that all healthcare providers give standard care to all individuals, fostering uniformity in care.

The discussion introduces established tools like PHQ-2 and PHQ-9 in mental health assessment. However, it is also worth considering the evolving role of artificial intelligence (AI) in mental health diagnostics. AI algorithms, trained on vast datasets of patient information, can assist clinicians in identifying patterns and risk factors that might not be immediately apparent. Research by Ma et al. (2022) demonstrates the potential of AI-powered analysis in improving diagnostic accuracy and guiding treatment strategies for mental health disorders.

While the discussion briefly touches upon immunizations, the current global health landscape underscores the importance of vaccination campaigns. Vaccine hesitancy, driven by misinformation and distrust, challenges achieving widespread immunization coverage. Addressing this issue requires a multi-pronged approach involving public health campaigns, community engagement, and targeted educational initiatives. The WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) emphasizes the significance of trust-building measures and transparent communication in countering vaccine hesitancy. Due to decreased immunity, older individuals are at the highest risk of contracting infections and thus should be vaccinated to ensure that they enjoy long, healthy lives and stay clear of complications (Cunningham et al., 2021).

The role of APRNs and NPs in modern healthcare transcends conventional medical practices. The interaction of patient-centered care, technological integration, and innovative diagnostic methodologies shapes a dynamic landscape for comprehensive patient evaluation and treatment. By embracing these dimensions and continuously adapting to the evolving healthcare landscape, APRNs and NPs can elevate patient outcomes, enhance preventive strategies, and contribute significantly to advancing healthcare delivery. Thank you for the meticulous discussion, which was very informative on care for elderly patients. The points were well crafted and supported with evidence, making this a credible resource for all the readers.

References

Chen, J. J., Roldan, C. S., Nichipor, A. N., Balboni, T. A., Krishnan, M. S., Revette, A. C., Hertan, L. M., & Chen, A. B. (2021). Patient-provider communication, decision-making, and psychosocial burdens in palliative radiotherapy: A qualitative study on patients’ perspectives. Journal of Pain and Symptom Management. https://doi.org/10.1016/j.jpainsymman.2021.01.129

Cunningham, A. L., McIntyre, P., Subbarao, K., Booy, R., & Levin, M. J. (2021). Vaccines for older adults. BMJ, n188. https://doi.org/10.1136/bmj.n188

Egan, C., Naughton, C., Caples, M., & Mulcahy, H. (2022). Shared decision‐making with adults transitioning to long‐term care: A scoping review. International Journal of Older People Nursing. https://doi.org/10.1111/opn.12518

Hunt, B., Ruiz, A. J., & Pogue, B. W. (2021). Smartphone-based imaging systems for medical applications: A critical review. Journal of Biomedical Optics, 26(04). https://doi.org/10.1117/1.jbo.26.4.040902

Ma, B., Yang, J., Wong, F. K. Y., Wong, A. K. C., Ma, T., Meng, J., Zhao, Y., Wang, Y., & Lu, Q. (2022). Artificial intelligence in elderly healthcare: A scoping review. Ageing Research Reviews, 101808. https://doi.org/10.1016/j.arr.2022.101808

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Reply to the discussion of Nadine Yohn.

Introduction

As an advanced practice registered nurse (APRN) and nurse practitioner (NP), it is crucial to understand the complexity of patient care for each individualized patient. Wheeler et al. (2022) references the International Council of Nurses and their notable mention regarding the position of the APRN as one who possesses “the expert knowledge base and complex decision-making skills.” (Wheeler et al., 2022, p. 2). Likewise, such knowledge and these decision-making components allow for a proper assessment and evaluation to provide safe and effective patient care with provider, patient, and family involvement. While acknowledging these factors, plus many others related to Mrs. Simmons, a proper evaluation plan will be set in place.

This week’s specific case is as follows:

Mrs. Simmons, an 84-year-old widow, is brought to the office by her daughter. Her daughter claims that her mother seems to be depressed. There is a history of depression approximately 5 years ago, shortly after Mrs. Simmons’s husband died. At that time, she was successfully treated with antidepressants. Currently, the daughter states that her mother’s memory for appointments and events has declined severely, and she can no longer drive because she does not remember the route to the store or other familiar places. The daughter also noted that her mother’s house seemed very disorganized and dirty, there was a limited amount of food in the kitchen, and the checkbook had not been balanced for several months. Mrs. Simmons appears slightly disheveled, she has a flat affect, and she does not maintain eye contact during your interview.

Evaluation Planning

While there are many different evidence-based provisions for care and diagnosis, one of the most important is proper assessment. Additionally, speaking with family and the patient while noting the patient’s appearance, conversation, and current mental status can assist the provider to determine the most critical factors to consider and whether there is a need for emergent attention while assessing. While it is optimal to consider a quiet space for evaluating the patient, the provider should eliminate all possible interruptions and obstacles for a calm environment with an allotted time set out for patient-provider interaction.

According to Clarke et al. (2019), interventions with services held by Accountable Care Organizations (ACOs) can impact and improve health services. While this study focuses more on data collection, the impact of such information assists in connecting such tools intertwined with the overall experience and evaluation throughout the patient-provider encounter and beyond. Formulating evaluation questions around the idea of the potential change or expected outcome may assist the provider in determining objective tools to utilize and the intended effects of treatment (Clarke et al., 2019).

Assessment Tools and Guidelines

According to Siniscalchi et al. (2020), the US Preventive Services Task Force (USPSTF) recommends depression screening in primary care for adults aged 18 and older. Likewise, The American Academy of Family Physicians and Centers for Medicare & Medicaid Services (CMS) also endorse or emphasize improvement models for early depression identification and intervention (Siniscalchi et al., 2020). Some ACO organizations may also meet benchmarks for screening and interventions, earning shared savings (Siniscalchi et al., 2020).

According to Levis et al. (2020), tools and guidelines to diagnose depression may include patient health questionaries such as the PHQ-2 and PHQ-9. Additionally, these tools are helpful in primary care. The PHQ-2 is the first tool used with the same first two questions of the PHQ-9. These questionnaires assess the frequency of depressed mood, anhedonia, and severity of depression (Levis et al., 2020, p. 2290). The Mini-Mental State Exam (MMSE) also seems appropriate due to the patient’s current presentation to evaluate her cognitive function. This tool assesses orientation to time, place, registration, attention, calculation, recall, and language. (Yongkang et al., pp. 1-2) Some other strategies that may appear appropriate in addition to assessment, medication regimen, and plan are referrals to psychiatry, a nutritional assessment, and home safety evaluation., laboratory values such as a CBC CMP, TSH, folate, vitamin B-12, toxicology, lead level, and uranalysis (Leik, 2021, p. 379).

Relevant Information

Stren et al. (2020) note some risk factors for major depression may include but are not limited to a prior episode of depression, older age, comorbid medical illness, chronic pain, female sex (being two to three times more common), stressful life event/s, and substance abuse or dependence. (p. 566) Some relevant information about this case that may indicate a diagnosis of depression would be using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the American Psychiatric Association, the DSM-5 (2023) was set to assist clinicians in providing a mental health diagnosis accurately and reliably. Some criteria utilized for diagnosis require five of the nine components for major depressive disorder (MDD) to follow with patient symptoms within 2 weeks. These include fatigue, suicidal ideation, depressed mood, anhedonia, weight change, agitation, impaired concentration, feelings of worthlessness, and sleep disturbance, where one symptom must be depressed mood or anhedonia) (Stern et al., 2020, p. 566).

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Additional Factors

Follow-up questions would be to note the patient’s medication regimen and her compliance, the depression medication she used in the past and why it was stopped, as well as any other mental or physical limitations. Considering Mrs. Smith’s age, prior history of falls or trauma, neurological conditions, and living alone are also some critical considerations. Additionally, knowing what family and friends support the patient has to include how far family lives to the patient as the current information shows an unsafe circumstance for her to be alone.

Immunizations

According to the Centers for Disease Control and Prevention (CDC) (2023), some immunizations necessary for patients aged 65 and older include:

PPSV23 (for those who have not previously received a dose of PCV13, PCV15, or PCV20)

COVID-19 (2 or 3 doses)

Tdap every ten years

Annual influenza vaccine

While immunizations are a necessary concern for this patient, at this specific encounter, I would make a follow-up appointment to review prior immunizations and complete necessary immunizations once the patient can communicate better and has a plan of care.

Conclusion

As a future APRN, knowing how to evaluate each patient’s case is vital to their overall health outcome. While there are many different tools, guidelines, and protocols to follow, it is just as essential to incorporate the patient, family, friends, history, physical, and living situation into the care plan. Continued follow-up appointments and referrals are also necessary in this case. While this encounter proves difficult for the patient and family, incorporating all areas of the patient evaluation plan will assist in the long-term care goal.

References

Centers for Disease Control and Prevention (CDC) (2023). CDC Vaccine Schedules. https://www.cdc.govLinks to an external site.

Clarke, G. M., Conti, S., Wolters, A. T., Steventon, A. (2019). Evaluating the impact of healthcare interventions using routine data. BMJ, 365: l2239. http://doi:10.1136/bmj.l2239.

Leik, M. T. C. (2021). Adult-Gerontology Nurse Practitioner Certification-Intense Review. 4th Ed. Springer Publishing.

Levis B, Sun Y, He C, et al. Accuracy of the PHQ-2 Alone and in Combination With the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. JAMA.323(22):2290–2300. http://doi:10.1001/jama.2020.6504

Siniscalchi, K. A., Broome, M. E., Fish. J., Ventimiglia, J., Thompson, J., Roy, P., Pipes, R., & Trivedi, M. (2020). Depression Screening and Measurement-Based Care in Primary Care. J Prim Care Community Health.11:2150132720931261. http://doi:10.1177/2150132720931261.

Stern, S. D. C., Cifu, A. S., & Altkorn, D. (2020). Symptoms to Diagnosis: An evidence-based guide. (4th ed.). McGraw-Hill.

Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E. & Rayens, M. K. (2022). Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study. Annals of Global Health, 88(1). https://doi.org/10.5334/aogh.3698Links to an external site.