EXPLORING MIDDLE RANGE THEORIES AND FRAMING PRACTICE ISSUES

Every paper written should involve mental health and addiction or psyc as that’s my present practice area and main educational focus. 

Topic: find something related to stigma in mental health

You will begin this Discussion by identifying a practice issue that will be your frame of reference as you analyze the theoretical basis of nursing practice. Be aware that your choice can potentially carry through the course, as you will continue to address this issue in the context of other types of theories in Week 3. This practice issue can also be one focus of your Module 3 exploration of evidence-based practice and quality improvement, and your Module 4 investigation of a critical practice question. Consequently, as you prepare for this Discussion, think carefully about your example for connecting middle range nursing theories to patient care.

RESOURCES

Be sure to review the Learning Resources before completing this activity.Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

 

TO PREPARE:

• Analyze your nursing practice for issues of particular interest or concern to you or your organization. Identify one issue as the focus of your application of theory to practice.
• Review the Week 2 Learning Resources to identify specific middle range theories that may apply to your practice issue.
• Choose at least two middle range theories that might be most relevant and valuable in addressing your practice issue.
• Search the Walden Library for scholarly articles that address application of middle range theories to practice issues.
• Consider how to frame your focus practice issue in terms of the middle range theories that you have selected.

With these thoughts in mind …

BY DAY 3 OF WEEK 2

Post an explanation of your practice issue. Then, describe two middle range theories that are most valuable in addressing this issue and explain why. Be specific and provide examples.

Read a selection of your colleagues’ posts.

 

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Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Explain the pathophysiology of heart failure by analyzing a patient’s symptoms. (CO1)
2. Differentiate between systolic and diastolic heart failure. (CO1)
3. Explain the significance of physical exam and diagnostic findings in the diagnosis of heart failure. (CO4)

Due Date

Initial post is due on Wednesday by 11:59 p.m. MT. All posts are due by Sunday, 11:59 p.m. MT

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.

Total Points Possible: 100

Preparing the Assignment

Requirements

1. Read the case study below.
2. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
3. Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario

A 72-year-old male presents to the primary care office with shortness of breath, leg swelling, and fatigue. He reports that he stopped engaging in his daily walk with friends three weeks ago because of shortness of breath that became worse with activity. He decided to come to the office today because he is now propping up on at least 3 pillows at night to sleep. He tells the NP that he sometimes sleeps better in his recliner chair. PMH includes hypertension, hyperlipidemia and Type 2 diabetes.

Physical Exam:

BP 106/74 mmHg, Heart rate 110 beats per minute (bpm)

HEENT: Unremarkable

Lungs: Fine inspiratory crackles bilateral bases

Cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd heart sound; jugular venous distention. Bilateral pretibial and ankle 2+pitting edema noted

ECG: Sinus rhythm at 110 bpm

Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection fraction of 25%

Diagnosis: Heart failure, secondary to silent MI

Discussion Questions

• Differentiate between systolic and diastolic heart failure.
• State whether the patient is in systolic or diastolic heart failure.
• Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea.
• Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%.

DISCUSSION CONTENTCategoryPoints%Description

Application of Course Knowledge

30

30%

The student:

• Differentiates between systolic and diastolic heart failure.
• States whether the patient is in systolic or diastolic heart failure.
• Explains the pathophysiology associated for each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea.
• Explains the significance of the presence of a 3rd heart sound and an ejection fraction of 25%.

Support from Evidence-Based Practice

30

30%

• Initial discussion post is supported with appropriate, scholarly sources; AND
• Sources are published within the last 5 years (unless it is the most current CPG); AND
• Reference list is provided and in-text citations match; AND
• All answers are fully supported with an appropriate EBM argument

Interactive Dialogue

30

30%

In addition to providing a response to the initial post due by Wednesday, 11:59 p.m. MT, student provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question. A response to faculty could include a question posed to a student or the entire class or a faculty question directed towards another student. AND 

• Evidence from appropriate scholarly sources are included; AND
• Reference list is provided and in-text citations match

90

90%

Total CONTENT Points = 90 pts

DISCUSSION FORMAT

CategoryPoints%DescriptionOrganization

5

5%

• Case study responses are presented in a logical format; AND
• Responses are in sequence with the numbered questions; AND
• The case study response is understandable and easy to follow; AND
• All responses are relevant to the case topic

Format

5

5%

• Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*

(*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.

1010%Total FORMAT Points = 10pts100100%DISCUSSION TOTAL= ___ out of 100 points

 

 

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Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

TO PREPARE:

Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

Consider the elements of the psychiatric interview, history, and examination.

Consider the assessment tool assigned to you by the Course Instructor.

BY DAY 3 OF WEEK 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Last names: 

Cognitive Disorders Scales:

Delirium Rating Scale Revised—98 (DRS—R98)

Mini-Mental State Examination (MMSE)

St Louis University Mental Status Exam (SLUMS)

Montreal Cognitive Assessment (MOCA)

Confusion Assessment Method (CAM)

 

RESOURCES

If you were to give a box of 100 different photographs to 10 people and ask them to sort them into groups, it is very unlikely that all 10 people would sort them into the exact same groups. However, if you were to give them a series of questions or a classification system to use, the chances that all 10 people sort them exactly the same increases depending on the specificity of the system and the knowledge of those sorting the photographs.

This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms, many of which can change over time, is a daunting task when used by a variety of specialists, doctors, and other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.

In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5-TR, to render a diagnosis. In this second week of the course, you will examine how DSM-5-TR is organized and how clinicians use it to render diagnoses. 

Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5-TR classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role. 

 

• Classroom Productions. (Producer). (2015). Diagnostic criteriaLinks to an external site.[Video]. Walden University.
• MedEasy. (2017). Psychiatric history taking and the mental status examination | USMLE & COMLEXLinks to an external site.[Video]. YouTube. https://www.youtube.com/watch?v=U5KwDgWX8L8
• Psychiatry Lectures. (2015). Psychiatry lecture: How to do a psychiatric assessmentLinks to an external site.[Video]. YouTube. https://www.youtube.com/watch?v=IRiCntvec5U

 

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