Category: Nursing

Ethical and Legal Implications of Prescribing Drugs

Introduction

Advanced Practice Registered Nurse (APRN) are Registered nurses with obtained further education and specialization. They play a vital role in the healthcare system; with prescription authority, they can assess, diagnose, treat, and manage patients’ conditions. Like many other healthcare professions, this level of responsibility comes with its legal and ethical standards of practice that must be upheld by every licensed APRN. The legal standards and code of ethics for APRNs may vary from state to state. However, they are all in place to ensure the safety of patients and APRNs. Providing care and prescribing medications may sometimes have some conflicting legal and ethical implications. Therefore, APRNs need to know the state and federal regulations governing all aspects of their practice and specialty (American Association of Nurse Practitioners, 2015) Ethical and Legal Implications of Prescribing Drugs. This paper aims to discuss the ethical and legal implications of an APRN prescribing narcotics for a family member who is not a patient; the paper will also discuss the process of writing prescriptions and strategies to minimize medication errors.

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Ethical and Legal Implications of an APRN Prescribing Narcotics for a Family Member

APRNs in the united states have been granted various prescriptive authority levels for medications, procedures, and services. APRNs need to understand the prescriptive authority in their state and federal and state legal and ethical guidelines. Prescribing medication like most healthcare services provided by healthcare professionals first requires an assessment, a review of patients’ history, diagnosis, education, and follow up (American Association of Nurse Practitioners, 2015); this guideline is in line with the nursing ethical responsibility to do no harm (ANA, n.d.). Ethical and Legal Implications of Prescribing Drugs

Many state laws prohibit or restrict the prescription of medication or provision of medical services to family members for safety purposes and to avoid legal and ethical dilemmas, (Conde, 2017). For example, Texas does not prohibit treating family members if a medical record with appropriate assessment and diagnosis is maintained; however, prescription of controlled substances to self, family members, or friends is prohibited unless in the case of emergency (Conde, 2017). The legal implication in this scenario could be the APRN breaking the state law. Ethical implications implied in this scenario could be responsive to the APRN’s duty to do no harm, which may have prompted a narcotic prescription if this was a case of emergency. It could also be a violation of the duty to do no harm if the APRNs are supporting her spouse’s case of substance abuse by prescribing narcotics to them. However, this case scenario will need to be further reviewed to determine whether this was done in good faith.

Strategies to Address Disclosure and Nondisclosure of Medication Error

A medication error can occur from the point of prescription to the point of administration; for APRNs, the risk of medication error is substantial when prescribing. Medication errors are capable of causing serious harm to patients, including death; hence, state and federal laws are put in place to help protect patients against such errors. It is the APRN’s responsibility and any healthcare professional who witnesses a mishap to report when errors or abuse occurs. (Westrick & Jacob, 2016). Making the decision for disclosure or nondisclosure of medication error can be challenging; however, understanding state and federal laws about reporting medication errors and the facility policy can make the process a little less daunting. Therefore, it is important for every APRN to be educated on state, federal, and institutional policies on medication errors and reporting them (Sorrell, 2017)

Medical errors can occur in healthcare at any point during treatment; one of such error includes medication error. When medical errors occur, it is important for patients affected to be informed; this can potentially prevent further errors from occurring and allow the patient to make decisions about their care moving forward. There is the possible legal implication for the spouse as a stakeholder in this scenario if there is a chance that the narcotics prescribed are being abused. According to section 74.106 of the Texas civil law, nondisclosure of medical error or potential harm to a patient is considered a violation of state laws in Texas that could lead to criminal charges for negligence and suspension revocation of license (Texas.gov, n.d.).

Two Strategies an Advanced Practice Nurse Would use to Guide Decision Making in this Scenario

Nurses and all healthcare professionals have a responsibility to do no harm, and patients have a right to full disclosure when receiving medical care; therefore, when a nurse witnesses potential harm to patients occurring, it is their responsibility to address the situation. APRNs must be diligent in making controversial decisions about ethical dilemmas; patient safety must be of the utmost importance when making this decision (Rosenthal & Burchum, 2018). In this scenario, as a nurse witnessing another APRN prescribing medications for a spouse who is not a patient, the first strategy would be to consult with the organizational policy and follow the guidelines for reporting the incident. Another strategy would be to address the said APRN in a professional manner to gather more details and determine if a legal or ethical code is being violated.

Process of Writing Prescriptions

The process of writing a prescription is complex and sensitive due to the potential for life-threatening errors; therefore, every provider, including the APRN, must be familiarized with this process. There are important things that must be included in a prescription, whether electronic or written, although they may differ with state and organizational policies, certain elements are standard and should be included in all prescriptions; these include the provider’s name and information (including signature and DEA/NPI number), the patient’s name and a second identifier (for example, date of birth), drug name, drug strength, route, and frequency (Rosenthal & Burchum, 2018)

Strategies to Minimize Medication Errors

Prescription writing is an important aspect of managing a patient’s care, errors made when writing prescriptions can cause harm, including death to patients (Dyasanoor & Urooge, 2016). Therefore, APRNs and organizations must pay special attention and continually strive to improve the process of writing a prescription. The use of EMAR has been instrumental in improving the process of writing prescriptions and preventing medication errors. The use of EMAR decreases the chances of misinterpreting some elements of a written prescription. For example, an abbreviation or illegible word on a written order has the potential to cause a medication error, whereas, on an EMAR, the probability to misinterpret an abbreviation is greatly decreased.

Another strategy to help prevent medication errors from prescription writing is avoiding the use of verbal orders (American Academy of Ophthalmology, 2015). Verbal orders have the potential to cause medication errors due to being misinterpreted. Another strategy is to utilize a double verification system for prescribed medication before administering it. For example, the pharmacy. Healthcare organizations need to ensure staff are educated and feel comfortable reporting errors to prevent future recurrences; this can be done by providing a safe and non-judgmental environment to promote reporting (Moffatt-Bruce et al., 2016).

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Conclusion

Providing medical services, including medication prescription, has the potential to cause harm. Therefore, APRNs with prescriptive authority need to know state laws, federal laws, and ethical guidelines that govern the prescription of medications. In addition to ethical guidelines and state laws, APRNs need to follow organizational policies and evidence-based guidelines when prescribing medications to avoid medical errors.

 

References

American Academy of Ophthalmology. (2015). Minimizing Medication Errors: Communication about Drug Orders – 2015. 
https://www.aao.org/patient-safety-statement/minimizing-medication-errors-communication-about-d#top

American Association of Nurse Practitioners. (2015). Standards of practice for nurse practitioners. Retrieved from 
https://www.aanp.org/advocacy/advocacy-resource/position-statements/standards-of-practice-for-nurse-practitioners

ANA. (n.d.). Ethics and Human Rights. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics

Conde, C. (2017). Treating your own. Retrieved from 
https://www.texmed.org/template.aspx?id=22563

Dyasanoor & Urooge (2016). Insight into the quality of prescription writing – An Institutional study. Journal of Clinical and Diagnostic Research: 10(3) ZC16-ZC64. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843389/

Moffatt-Bruce, S. D., Ferdinand, F. D., & Fann, J. I. (2016). Patient Safety: Disclosure of Medical Errors and Risk Mitigation. 
https://www.sts.org/sites/default/files/documents/patient_safety/DisclosureofMedicalErrors.pdf

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St Louis, MO: Elsevier.

Sorrell, J.M. (2017). Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare. Retrieved from 
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Ethical-Issues-with-Medical-Errors.html

Texas.gov. (n.d.). Civil practice and remedies code. 
https://statutes.capitol.texas.gov/Docs/CP/htm/CP.74.htm#74.104

Westrick, S. J., & Jacob, N. (2016). Disclosure of Errors and Apology: Law and Ethics. 
The Journal for Nurse Practitioners, 12
(2), 120-126. 
https://doi.org/10.1016/j.nurpra.2015.10.007

Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should 
you
 be prescribing drugs to 
this 
patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

Photo Credit: Getty Images/Caiaimage

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family. Ethical and Legal Implications of Prescribing Drugs

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state. Ethical and Legal Implications of Prescribing Drugs

Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

Explain the process of writing prescriptions, including strategies to minimize medication errors.

Reminder:
 The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at 
https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632
). All papers submitted must use this formatting.

NURS_6521_Week1_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.

23 
(23%)
 – 25 
(25%)

The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

20 
(20%)
 – 22 
(22%)

The response explains the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

Ethical and Legal Implications of Prescribing Drugs

18 
(18%)
 – 19 
(19%)

The response inaccurately or vaguely explains the ethical and legal implications of the scenario selected for all stakeholders involved.

The response includes vague explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

0 
(0%)
 – 17 
(17%)

The response vaguely and inaccurately explains the ethical and legal implications of the scenario selected for all stakeholders involved, or the response is missing.

The response vaguely and inaccurately explains how these implications affect the prescriber, pharmacist, patient, and the patient’s family, or is missing.

Describe strategies to address disclosure and nondisclosure as identified in the scenario selected. Be sure to reference laws specific to your state.

18 
(18%)
 – 20 
(20%)

An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes specific, detailed, and accurate reference to state laws related to the scenario.

16 
(16%)
 – 17 
(17%)

An accurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes accurate reference to state laws related to the scenario.

14 
(14%)
 – 15 
(15%)

A vague or inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes inaccurate or vague reference to state laws related to the scenario.

0 
(0%)
 – 13 
(13%)

A vague and inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided, or is missing.

The response includes vague and inaccurate reference to state laws related to the scenario, or is missing.

Explain two strategies that you, as an advanced practice nurse would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

18 
(18%)
 – 20 
(20%)

The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.

16 
(16%)
 – 17 
(17%)

The response accurately explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately explains whether they would disclose the error, including an accurate justification for the explanation provided.

14 
(14%)
 – 15 
(15%)

The response inaccurately or vaguely explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario, or only explains one strategy.

The response inaccurately or vaguely explains whether they would disclose the error, including a justification that is vague, inaccurate, or misaligned to the explanation provided.

0 
(0%)
 – 13 
(13%)

The response inaccurately and vaguely explains only one strategy that an advanced practice nurse would use to guide decision making in the scenario, or is missing.

The response inaccurately and vaguely explains whether they would disclose the error, with no justification provided, or is missing.

Ethical and Legal Implications of Prescribing Drugs

Explain the process of writing prescriptions including strategies to minimize medication errors.

18 
(18%)
 – 20 
(20%)

The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.

16 
(16%)
 – 17 
(17%)

The response provides an accurate explanation of the process of writing prescriptions, including some strategies to minimize medication errors.

14 
(14%)
 – 15 
(15%)

The response provides an inaccurate or vague explanation of the process of writing prescriptions, including inaccurate or vague strategies to minimize medication errors.

0 
(0%)
 – 13 
(13%)

The response provides an inaccurate and vague explanation of the process of writing prescriptions, including inaccurate and vague strategies to minimize medication errors, or 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.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Ethical and Legal Implications of Prescribing Drugs

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

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 a few (1–2) grammar, spelling, and punctuation errors

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) grammar, spelling, and punctuation errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) 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, running head, parenthetical/in-text citations, and reference list.

5 
(5%)
 – 5 
(5%)

Uses correct APA format with no errors

4 
(4%)
 – 4 
(4%)

Contains a few (1–2) APA format errors

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) APA format errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) APA format errors

Total Points: 100

Name: NURS_6521_Week1_Assignment_Rubric Ethical and Legal Implications of Prescribing Drugs

NURS 6630 week 2 Discussion: Foundational Neuroscience

Agonist-To-Antagonist Spectrum of Action of Psychopharmacologic Agents

In medicine, drugs can act either as agonist or antagonist. As an agonist, drugs bind to target receptor, changing its activity to produce a response. Agonist medications activates the full receptor in the brain while a partial agonist produces a sub-maximal response when in contact with a receptor (Berg & Clarke, 2018). On the other hand, antagonist, binds to target receptors but produces no response, hence preventing agonist from occupying the receptor. Inverse agonists lower the activity of a receptor replicating the opposite effect of an agonist (Berg & Clarke, 2018) NURS 6630 week 2 Discussion: Foundational Neuroscience.

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Actions of g Couple Proteins and Ion Gated Channels.

GPCR, found in eukaryotes, comprise of the largest known class of plasma membrane receptors. They act as principal targets for most of prescribed drugs and binds to many different types of ligands (Weir, 2019. They convert signals from extracellular ligands to signals in intracellular relay proteins, and when bonded with nucleotide guanosine triphosphate (GTP), hydrolyze it to form GDP. Ion gated channels are proteins that regulates the flow of selected ions passively across the plasma membrane. As a gated channel, they only open under specific conditions like for specific ligands (ligand-gated ion channels), or for a specific electrical potential (voltage-gated channels).

Role of Epigenetics and Pharmacologic Action

Epigenetics describes thestudy of genetic information, changes and modifications coded in gene expression. Its study has led to the understanding of many disease processes and the manufacturing of drugs to counteract such diseases (Stefanska & MacEwan, 2015). Diseases such as cancers and neurodegenerative disorders, are often associated with epigenetic alteration, can be generated by a single base mutation. With genome testing /screening, pharmacological treatments are personalized with precise disease management and prediction (Rasool et al., 2015)

Pharmacogenomics and The Impact on Mental Health Patients

Pharmacogenomics help clinicians personalized treatment to patients based on their individual’s genetic pattern and response to drugs (Butler, 2018). In the psychiatry environment, knowing the genetic make-up of patients and how they respond to specific medications can help providers predict the tolerability and metabolic impact to patients. For instance, individuals with genetic variant with CYP2C9 gene alleles with reduced enzyme activity will require a reduced dose of most medications compared to patients with a normal CYP2C9. Lithium toxicity can easily occur in patients with reduced or no enzyme activity as they metabolize medications slower leading to build of the drug in the system. The reverse can occur with patients with duplications/multiplications of the wild-type allele (Butler, 2018), metabolizes medications faster and may require a higher dose of medications.

References

Berg, K. A., & Clarke, W. P. (2018). Making sense of pharmacology: Inverse Agonism and functional selectivity. 
International Journal of Neuropsychopharmacology
, 
21
(10), 962-977. 
https://doi.org/10.1093/ijnp/pyy071

Butler, M. (2018). Pharmacogenetics and psychiatric care: A review and commentary. 
JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY
, 
2
(2), 17-24. 
https://doi.org/10.29245/2578-2959/2018/2.1120

Rasool, M., Malik, A., Naseer, M. I., Manan, A., Ansari, S. A., Begum, I., Qazi, M. H., Pushparaj, P. N., Abuzenadah, A. M., Al-Qahtani, M. H., Kamal, M. A., & Gan, S. H. (2015). The role of epigenetics in personalized medicine: Challenges and opportunities. 
BMC Medical Genomics
, 
8
(S1). 
https://doi.org/10.1186/1755-8794-8-s1-s5

Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. 
British Journal of Pharmacology
, 
172
(11), 2701-2704. 
https://doi.org/10.1111/bph.13136

Weir, C. J. (2019). Ion channels, receptors, agonists and antagonists. 
Anaesthesia & Intensive Care Medicine
, 
21
(1), 62-68. 
https://doi.org/10.1016/j.mpaic.2019.10.022

 

responses

I appreciate your example of how genetic variations can contribute to impaired metabolism of psychotropic medications in critical ways. Especially with medications such as Lithium that have such a narrow therapeutic window.  Kronfol et al. (2020) describe changes to the p450 system that can occur with aging due to reduced DNA methylation of CYP2E1 genes in mice. As prescribers, it is also important to understand how metabolism of medications changes with aging and why this occurs. Hopefully the ability to genetically test for specific variations will continue to expand.

An interesting study in mice by Kabir et al. (2017) linked alterations in genes, to alterations in specific calcium channel pathways, that than disrupt  signaling of dopamine in ventral tegmental areas (VTA). This connection may shed some light on the pathology around behaviors such as cocaine abuse and depression in humans which are associated with dysfunction in dopamine activity in the VTA (Kabir et al., 2017). The authors found that medications to correct the calcium channel dysfunction resulted in changes in the mice behavior. This study shows both the complexity of the  neuropsychiatric underpinnings of behavior and sheds light into possible ways that medications can be used to alleviate illness.

Thank you for a thought provoking post.

References

Kabir, Z.D., Martínez-Rivera, A. & Rajadhyaksha, A.M. (2017). From Gene to Behavior: L-Type Calcium Channel Mechanisms Underlying Neuropsychiatric Symptoms. 
Neurotherapeutics
 14, 588–613 (2017). https://doi-org.ezp.waldenulibrary.org/10.1007/s13311-017-0532-0

Kronfol, M.M., Jahr, F.M., Dozmorov, M.G. (2020). DNA methylation and histone acetylation changes to cytochrome P450 2E1 regulation in normal aging and impact on rates of drug metabolism in the liver. 
GeroScience 42
, 819–832 (2020). https://doi-org.ezp.waldenulibrary.org/10.1007/s11357-020-00181-5

 

The use of medications and how they exert their pharmacological process can be said to be a biological/scientific process that if not fully understood can cause more harm for the patient that it is intended for. Hence, it is important to always educate one’s self, even acquiring the license to practice.

There are different principles that needs to be put into consideration before a provider prescribes medications for patients. One of these pharmacological actions is the agonist-to-antagonist spectrum of action. The agonist-to-antagonist spectrum of action pharmacological agent describes how some medications are agonists, thereby causing a direct binding effect to the receptor sites to cause the desired action, while there are some that are antagonist, which would just bind to the receptor sites without eliciting any response or produce an undesired/unexpected action (Bolin et al., 2016).

Another action that should be considered is the actions of g couple proteins and ion gated channels. The g couple proteins and ion gated channels are neurotransmitter receptors that binds to postsynaptic sites from the presynaptic sites to get a response (Alexander et al., 2019). In understanding how they differ, Ion gated channels would elicit a rapid response within/across the cell membrane (Alexander et al., 2019), while g-couple protein activate a response at a slower rate outside of the membrane.

Finally, epigenetics would put into consideration a person’s DNA without alteration to develop a pharmacological treatment. Using epigenetics as you have mentioned would be very beneficial in the treatment of inheritable diseases like cancer (Fu & Imani, 2018). Hence, constant education is needed so has to be current on new research about these types of medications that would help people with the same DNA.

All these actions alongside side effects and comorbidities have to be considered in order to develop a pharmacological treatment that would be effective in treating patients. Thanks for an education post.

 

 

 

 

References

Alexander, S. P. H., Mathie, A., Peters, J. A., Veale, E. L., Striessnig, J., Kelly, E., Armstrong, J.

F., Faccenda, E., Harding, S. D., Pawson, A. J., Sharman, J. L., Southan, C., & Davies, J. A. (2019). THE CONCISE GUIDE TO PHARMACOLOGY 2019/20: Ion channels. British Journal of Pharmacology, 176 Suppl 1, S142–S228. 
https://doi-org.ezp.waldenulibrary.org/10.1111/bph.14749

Bolin, B. L., Alcorn III, J. L., Reynolds, A. R., Lile, J. A., & Rush, C. R. (2016). Human drug

discrimination: A primer and methodological review. 
Experimental and clinical             psychopharmacology, 24
(4), 214.

Fu, J., & Imani, S. (2018). Epigenetics in cancer. Science Press. 
https://search-ebscohost-

com.ezp.waldenulibrary.org/login.aspx?direct=true&db=cat06423a&AN=wal.EBC5684596&site=eds-live&scope=site.

 

Discussion: Foundational Neuroscience

As a psychiatric nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat patients, you must not only understand the pathophysiology of psychiatric disorders but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues. NURS 6630 week 2 Discussion: Foundational Neuroscience

Photo Credit: Getty Images/Cultura RF

For this Discussion, review the Learning Resources and reflect on the concepts of foundational neuroscience as they might apply to your role as the psychiatric mental health nurse practitioner in prescribing medications for patients.

By Day 3 of Week 2

Post
 a response to each of the following:

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents, including how partial and inverse agonist functionality may impact the efficacy of psychopharmacologic treatments.

Compare and contrast the actions of g couple proteins and ion gated channels. NURS 6630 week 2 Discussion: Foundational Neuroscience

Explain how the role of epigenetics may contribute to pharmacologic action.

Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action.

Read 
a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond
 to 
at least two
 of your colleagues on 
two different days
 in one of the following ways:

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. NURS 6630 week 2 Discussion: Foundational Neuroscience

If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on 
Submit
, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! NURS 6630 week 2 Discussion: Foundational Neuroscience

 

Discussion Week 2

On the cellar level the ligand gated ion channel an agonist can bind to a receptor and cause the same phycological response as a natural ligand.  An antagonist binds to the receptor and do not cause a phycological response but block that receptor preventing the natural ligand from going into that receptor. For example, most antipsychotic drugs act as dopamine receptor antagonist.  Blocking reuptake of dopamine (Howland, 2016).  Some antipsychotic drugs also act as inverse agonist at the serotonin receptor causing an opposite effect. An inverse agonist produces a opposite effect of the agonist.

In regard to the efficacy of a drug treatments, the NP has to provide a very good patient assessment to provide the patient with an accurate diagnosis.  The NP having knowledge, can correctly prescribe the drug (agonist, antagonist or reverse agonist) that will act on the on the targeted neurotransmitter to produce the desired effect in the patient.

Ion gated channels pull and bond to the agonist changing the protein.  G coupled proteins are proteins used by the cell to convert intracellular signals into responses (Zhao, Deng, Jiang, Oing, 2016).

Epigenetics is modifications in gene expression that is controlled by various fundamental epigenetic mechanisms leading to various physical and psychiatric diseases.  As a result, traditional treatment may often prove ineffective with these patients because these mechanisms regulate cellular and gene expression, just to name a few (Rasool, et al., 2015).

As practitioner, my patient assessment may also include an education and discussion concerning pharmacogenomics.  Particularly, if the patient comes to me after having been on various medication treatments that were unsuccessfully.   Knowledge of a medications action is important for example; treating a patient with Bipolar I that is exhibiting depression symptoms but also reported that he maxed out his credit card last week on video games. With the knowledge that an antidepressant should not be given because the action of the antidepressant would cause the patient to go into mania. NURS 6630 week 2 Discussion: Foundational Neuroscience

 

References

 

Berg, K., A., Clarke, W., P. (2018).  Making Sense of Pharmacology: Inverse Agonism and

Functional Selectivity, 
International Journal of Neuropsychopharmacology
, Volume 21, Issue 10, October 2018, Pages 962–977, 
https://doi.org/10.1093/ijnp/pyy071

 

Howland, R. H. (2016). Pimavanserin: An inverse agonist antipsychotic drug.
 Journal of

Psychosocial Nursing & Mental Health Services, 54
(6), 21-24. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.3928/02793695-20160523-01

 

Rasool, M., Malik, A., Naseer, M. I., Manan, A., Ansari, S., Begum, I., Qazi, M. H., Pushparaj,

P., Abuzenadah, A. M., Al-Qahtani, M. H., Kamal, M. A., & Gan, S. (2015). The role of epigenetics in personalized medicine: challenges and opportunities. 
BMC medical genomics
, 
8 Suppl 1
(Suppl 1), S5. https://doi.org/10.1186/1755-8794-8-S1-S5 NURS 6630 week 2 Discussion: Foundational Neuroscience

 

Zhao, J., Deng, Y., Jiang, Z., Oing, H. (2016). G Protein-Coupled Receptors (GPCRs) in

Alzheimer’s Disease; A Focus om BACE1 Related GPCRs. 
Frontier in Aging Neuroscience
.,  
https://doi.org/10.3389/fnagi.2016.00058

 

Response

Interesting post you have here, i like how you describe all the terms.

Agonist-to-antagonist spectrum of action is crucial in the human body when discussing pharmacology. It expresses the action of the two antagonize each other. An agonist produces action and the antagonist opposes the action which means the two spectrum operates in opposite direction. This describes the mechanism of drug interaction in the human body.

There are agonist, partial agonist, inverse agonist and antagonist. The inverse agonist is the drug that bind to a receptor as an agonist but block or reduces the effect of the agonist. The partial agonist will bind a receptor partially not like the full agonist (Stahl, 2013). An agonist drug is a drug that bind and active a receptor. An antagonist at the other hand is the drug that bind a receptor but will not activate the receptor. The antagonist will decrease the action of the receptor from binding to another agonist. NURS 6630 week 2 Discussion: Foundational Neuroscience

G-protein-coupled receptors (GPCRs) mediate most of our physiological responses to hormones, neurotransmitters and environmental stimulants, and so have great potential as therapeutic targets for a broad spectrum of diseases. They are also fascinating molecules from the perspective of membrane-protein structure and biology G-protein-coupled receptors (GPCRs) mediate most of our physiological responses to hormones, neurotransmitters and environmental stimulants, and so have great potential as therapeutic targets for a broad spectrum of diseases. They are also fascinating molecules from the perspective of membrane-protein structure and biology. The g-couple proteins and ion gated channel are receptor which are useful in their different area and can interact by binding to ligand and cause a chemical response. This action is mostly triggered by the presence of neurotransmitters (Stahl, 2013) NURS 6630 week 2 Discussion: Foundational Neuroscience

G- couple protein also known as G-protein-coupled receptors (GPCRS) are receptors that live on cell membrane and able to bind with ligands to cause a change. These GPCRS receptors are responsible for most physiological processes such as light, odour, hormones, and pain. G-protein can be used to predict poor prognosis in some cancer, and some of these protein function as a potential biomarker for some diagnosis (Zhu, Huang & Jin, 2018).

Ion gated channel allow the regulation of movement of ions thorough the cell membrane. The ion gated channel are transmembrane protein complexes that conduct the flow of ion channel in response to binding of a neurotransmitter. NURS 6630 week 2 Discussion: Foundational Neuroscience

 

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: 
Neuroscientific basis and practical applications
 (4
th
 ed.). New York. NY: Cambridge University Press

 

Zhu, X., Huang, G., & Jin, P. (2018). Clinicopathological and prognostic significance of aberrant G Protein-Couple Receptor 110 (GPR110) expression in gastric cancer. 
Pathology- Research and Practice
. https://doi-org.ezp.waldenulibrary.org/10.1016/j.prp.2018.12.004 NURS 6630 week 2 Discussion: Foundational Neuroscience

NURS 6630 week 1 Assignment: Short Answer Assessment

Psychopharmacological Approaches to Treatment

Introduction

The brain, which is the most complex part of the human body, is responsible for the regulation and function of the human body. It is made up of billions of nerves that play critical roles in the human body (). The human body can reach its maximum potential through the presence of neurons that control numerous functions such as memory, learning, motivation, homeostasis, and emotion. This implies that nerve cells help people to understand their surroundings by initiating activities like smelling, hearing, touching, and sensing. A neuron is a basic unit of the nervous system which is involved in the transmission of information across nerve cells, glands, and muscles (Beaulieu-Laroche, 2018. This paper aims to discuss the anatomy of neurons, functionalities, its components, and the concept of neuroplasticity. NURS 6630 week 1 Assignment: Short Answer Assessment

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Anatomy of the Neuron

A neuron that is the basic unit of the nervous system is a nerve cell responsible for transmitting information to muscles, glands, and other nerve cells. A neuron has six major parts: synapse, myelin sheath, axon, soma, nucleus, and dendrites. Synapses play the role of sending electrical signals to other neurons while dendrites receive electrical signals from nearby cells (Beaulieu-Laroche, 2018). The soma comprises of cell’s organelle while the nucleus contains the DNA of cells. The axon transmits electrical signals from cells to synapses, while the myelin sheath insulates the axon to control electrical signals. Electrical impulse conduction takes place through the axon, cell body, and dendrite pathway. Impulse termination occurs when it reaches the synapse and communication takes place. Examples of impulses include touch, light, and sound. NURS 6630 week 1 Assignment: Short Answer Assessment

 

Major Components of Subcortical Structures

Subcortical structures are neural formations in the brain which perform complex activities like hormone production, pleasure, emotion, and memory. The structures act as nervous system information hubs by relaying and modulating information in various parts of the brain. The major elements of subcortical structures include;

Diencephalon- It is the posterior of the forebrain and is made up of the epithalamus, thalamus, subthalamus, and hypothalamus that perform primary relay and processing of sensory information (Vertes, 2015).

Pituitary glands- It is an extension of the hypothalamus, which consists of the anterior lobe and posterior lobe and is responsible for secreting, stimulating, and releasing hormones. NURS 6630 week 1 Assignment: Short Answer Assessment

Hippocampus- It is also known as the hippocampal formation and is in charge of spatial navigation and long-term memory.

Basal ganglia- It is made up of nuclei and is responsible for fine-tuning moto neuron functions.

Limbic structures- It is composed of cortical, subcortical, and brain areas, and it controls memory, emotion, olfactory, motivation, learning, and body homeostasis. NURS 6630 week 1 Assignment: Short Answer Assessment

Which Component Plays a Role in Learning, Memory, and Addiction?

The cerebrum or the cortex, which is the largest part of the brain, plays a major role in the control of learning. The limbic system, including the cingulate gyri are responsible for learning. Although different parts of the brain may be responsible for different kinds of memory, the hippocampus and amygdala are generally responsible for memory. While, the nucleus accumbens and is responsible for influencing addiction through feelings of pleasure or reward (Surgeon General, 2016). NURS 6630 week 1 Assignment: Short Answer Assessment.

 

Key Neurotransmitters Located in Nigra Striatal Area of the Brain

Dopamine

Norepinephrine

GABA Gamma-Aminobutyric Acid

The Function of Glia Cells in the Central Nervous System

Glia cells are also known as neuroglia or glial cells, are non-neuronal cells that are found both in the central nervous systems (CNS) and peripheral nervous system (PNS). Glia cells offer a supporting role to neurons and do not take part in the production of electrical impulses. The main functions of glial cells include the formation of myelin, maintaining homeostasis, and offering support and protection to neurons. The functions of glial cells are depicted from its different types, which include astrocytes, microglia, oligodendrocytes, and Schwann cells located in PNS (de Castro et al., 2015). Astrocytes control the floor of the blood in the brain, normalizes communication amongst neurons, and sustain fluid composition around neurons. Astrocytes also offer assistance to neurons during development by locating their destination and creating blood barriers in the brain. This is essential as it helps protect the brain from toxic substances. Microglia act as hunters, which eliminates dead cells and other waste substances. Oligodendrocyte components of glia cells take part in myelin’s production that insulates axons surrounding neurons and increases action potential in the central nervous system.

Part Of Neurons that are Communicating with each Other

Neuronal communication involves the transmission of electrochemical from one component to another. Synapses refer to the intersection between an axon of one neuron and the dendrite of another neuron where communication takes place (Andreae & Burrone, 2018). With this, the parts of neurons that communicate with one another are axons and dendrites. Axons conduct electrical impulses away from nerve cells to other neurons through a process called an action potential. On the other hand, dendrites comprise neurotransmitter receptors, which are released by neurons. If electrical impulses being released are strong, an action potential will travel down the area of the axon in the terminal buttons to release neurotransmitters in the synapse and completes the process of communication (The University of Queensland, 2017). Neuron communication occurs in the downward direction, which is determined by the action potential NURS 6630 week 1 Assignment: Short Answer Assessment.

The Concept of “Neuroplasticity.”

Neuroplasticity/brain plasticity is defined as structural and functional changes that the brain adapts through the formation of new neural connections that result in new experiences in an individual’s environment (Voss et al., 2017). The concept of neuroplasticity describes the human brain’s ability to adapt, learn new skills, store information and memory, and being able to overcome traumatic brain injury. Neuroplasticity occurs through sprouting and rerouting processes naturally or through brain plasticity exercises and cognitive training. Sprouting involves the development of a new connection between neurons, while rerouting is the development of a new neural pathway by eliminating damaged nerve cells where new connections are formed between active neurons. During sprouting, neuron pathways are stimulated by repetitive cognitive functions that reinforce synaptic communication amongst neurons. Examples of neuroplasticity include neurogenesis, synaptogenesis, and long-term potential, and depression. For example, during neurogenesis, new neurons are created in the hippocampus and olfactory bulb. In long-term potential, synapses are strengthened by recurring actions like studying aimed at promoting learning and memory. NURS 6630 week 1 Assignment: Short Answer Assessment

 

Conclusion

Indeed, neurons are significant elements of the brain that are involved in the transmission of information to other neurons. A neuron consists of synapses, axons, dendrites, myelin sheath, soma, and a nucleus, which helps in neurotransmission. Therefore, the components allow a human being to manage learning, emotion, memory, and homeostasis activities with ease. NURS 6630 week 1 Assignment: Short Answer Assessment

References

Andreae, L. C., & Burrone, J. (2018). The role of spontaneous neurotransmission in synapse and circuit development. 
Journal of neuroscience research
, 
96
(3), 354-359.

Beaulieu-Laroche, L., Toloza, E. H., van der Goes, M. S., Lafourcade, M., Barnagian, D., Williams, Z. M., … & Harnett, M. T. (2018). Enhanced dendritic compartmentalization in human cortical neurons. 
Cell
, 
175
(3), 643-651.

De Castro, G. M., Deja, N. A., Ma, D., Zhao, C., & Franklin, R. J. (2015). Astrocyte activation via Stat3 signaling determines the balance of oligodendrocyte versus Schwann cell remyelination. 
The American journal of pathology
, 
185
(9), 2431-2440.

The University of Queensland (2017). 
Action potentials and synapses
. Queensland Brain Institute – University of Queensland. 
https://qbi.uq.edu.au/brain-basics/brain/brain-physiology/action-potentials-and-synapses

Surgeon General (2016). The neurobiology of substance use, misuse, and addiction. Retrieved from 
https://addiction.surgeongeneral.gov/sites/default/files/chapter-2-neurobiology.pdf

Vertes, R. P. (2015). Major diencephalic inputs to the hippocampus: supramammillary nucleus and nucleus reuniens. Circuitry and function. In 
Progress in brain research
 (Vol. 219, pp. 121-144). Elsevier.

Voss, P., Thomas, M. E., Cisneros-Franco, J. M., & de Villers-Sidani, É. (2017). Dynamic brains and the changing rules of neuroplasticity: implications for learning and recovery. 
Frontiers in psychology
, 
8
, 1657. NURS 6630 week 1 Assignment: Short Answer Assessment

 

Assignment: Short Answer Assessment

As a psychiatric nurse practitioner, before you can recommend potential pharmacotherapeutics to address a patient’s condition or disorder, you must understand the basic function and structure of the neuron and central nervous system. For this Assignment, you will review and apply your understanding of neuroanatomy by addressing a set of short answer prompts.

To Prepare:

Review the Learning Resources for this week in preparation to complete this Assignment.

Reflect on the basic function and structure of the neuron in relation to the central nervous system.

Reflect on the inter-connectedness between neurons and the central nervous system, including the pathway and distribution of electrical impulses. NURS 6630 week 1 Assignment: Short Answer Assessment

Reflect on how neurons communicate with each other and review the concept of neuroplasticity.

Photo Credit: Getty Images/Science Photo Libra

To complete:

Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous system, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples. NURS 6630 week 1 Assignment: Short Answer Assessment

Answer the following (listing is acceptable for these questions):

What are the major components that make up the subcortical structures?

Which component plays a role in learning, memory, and addiction?

What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?

In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.

The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.

In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples. NURS 6630 week 1 Assignment: Short Answer Assessment

 

NURS_6630_Week1_Assignment_Rubric

Grid View

List View

Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

In 4 or 5 sentences, describe the anatomy of the basic unit of the nervous sytem, the neuron. Include each part of the neuron and a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse. Be specific and provide examples.

12 
(16%)
 – 13 
(17.33%)

The response accurately and clearly describes in detail the anatomy of the neuron. The response accurately and clearly describes in detail each part of the neuron, and it includes a detailed explanation of the general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse.

Examples fully support the response provided.

NURS 6630 week 1 Assignment: Short Answer Assessment

11 
(14.67%)
 – 11 
(14.67%)

The response accurately describes the anatomy of the neuron. The response accurately describes each part of the neuron, and it includes a general overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse.

Examples support the response provided.

10 
(13.33%)
 – 10 
(13.33%)

The response provides an inaccurate or vague description of the anatomy of the neuron. The response inaccurately or vaguely describes each part of the neuron, and it includes an inaccurate or vague overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse.

Examples vaguely support the response provided.

0 
(0%)
 – 9 
(12%)

The response provides an inaccurate or incomplete description of the anatomy of the neuron, or is missing. The response inaccurately or incompletely describes each part of the neuron, and it includes an inaccurate or vague overview of electrical impulse conduction, the pathway it travels, and the net result at the termination of the impulse, or is missing.

Examples do not support the response provided, or is missing.

Answer the following (listing is acceptable for these questions):

a. What are the major components that make up the subcortical structures?

b. Which component plays a role in learning, memory, and addiction?

c. What are the two key neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control?

12 
(16%)
 – 13 
(17.33%)

The response accurately and clearly details the major components that make up the subcortical structures.

The response accurately and clearly details which component plays a role in learning, memory, and addiction.

The response accurately and clearly identifies the two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.

11 
(14.67%)
 – 11 
(14.67%)

The response accurately identifies the major components that make up the subcortical structures.

The response accurately identifies which component plays a role in learning, memory, and addiction.

The response accurately identifies the two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.

10 
(13.33%)
 – 10 
(13.33%)

The response inaccurately identifies the major components that make up the subcortical structures.

The response inaccurately identifies which component plays a role in learning, memory, and addiction.

The response inaccurately identifies two neurotransmitters located in the nigra striatal region of the brain that play a major role in motor control.

0 
(0%)
 – 9 
(12%)

The response inaccurately and incompletely identifies the major components that make up the subcortical structures, or is missing.

The response inaccurately and incompletely identifies which component plays a role in learning, memory, and addiction, or is missing.

The response inaccurately and incompletely identifies two neurotransmitters in the nigra striatal region of the brain that play a major role in motor control, or is missing.

In 3 or 4 sentences, explain how glia cells function in the central nervous system. Be specific and provide examples.

12 
(16%)
 – 13 
(17.33%)

The response accurately and clearly explains in detail how glia cells function in the central nervous system.

Examples fully support the response provided.

11 
(14.67%)
 – 11 
(14.67%)

The response accurately explains how glia cells function in the central nervous system.

Examples support the response provided.

10 
(13.33%)
 – 10 
(13.33%)

The response inaccurately or vaguely explains how glia cells function in the central nervous system.

Examples inaccurately or vaguely support the response provided.

0 
(0%)
 – 9 
(12%)

The response inaccurately and vaguely explains how glia cells function in the central nervous system, or is missing.

Examples do not support the response provided, or is missing.

The synapse is an area between two neurons that allows for chemical communication. In 3 or 4 sentences, explain what part of the neurons are communicating with each other and in which direction does this communication occur? Be specific.

12 
(16%)
 – 13 
(17.33%)

The response accurately and clearly explains in detail the part of the neurons that communicate with each other and the direction in which this communication occurs.

11 
(14.67%)
 – 11 
(14.67%)

The response accurately explains the part of the neurons that communicate with each other and the direction in which this communication occurs.

10 
(13.33%)
 – 10 
(13.33%)

The response inaccurately or vaguely explains the part of the neurons that communicate with each other and the direction in which this communication occurs.

0 
(0%)
 – 9 
(12%)

The response inaccurately and vaguely explains the part of the neurons that communicate with each other and the direction in which this communication occurs, or is missing.

In 3–5 sentences, explain the concept of “neuroplasticity.” Be specific and provide examples.

12 
(16%)
 – 13 
(17.33%)

The response accurately and clearly explains in detail the concept of neuroplasticity.

Examples provided fully support the response provided.

11 
(14.67%)
 – 11 
(14.67%)

The response accurately explains the concept of neuroplasticity.

Examples provided support the response provided.

10 
(13.33%)
 – 10 
(13.33%)

The response inaccurately or vaguely explains the concept of neuroplasticity.

Examples inaccurately or vaguely support the response provided.

0 
(0%)
 – 9 
(12%)

The response inaccurately and vaguely explains the concept of neuroplasticity, or is missing.

Examples do not support the response provided, or is missing.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 
(6.67%)
 – 5 
(6.67%)

Uses correct grammar, spelling, and punctuation with no errors.

4 
(5.33%)
 – 4 
(5.33%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 
(4.67%)
 – 3.5 
(4.67%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 
(0%)
 – 2 
(2.67%)

Contains many (≥ 5) 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/in-text citations, and reference list.

5 
(6.67%)
 – 5 
(6.67%)

Uses correct APA format with no errors.

4 
(5.33%)
 – 4 
(5.33%)

Contains a few (1 or 2) APA format errors.

3.5 
(4.67%)
 – 3.5 
(4.67%)

Contains several (3 or 4) APA format errors.

0 
(0%)
 – 2 
(2.67%)

Contains many (≥ 5) APA format errors.

Total Points: 75

Name: NURS_6630_Week1_Assignment_Rubric

NURS 6630 week 1 Assignment: Short Answer Assessment

NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

Mini-Mental State Exam (MMSE)

Health care providers alway use the Mini-Mental State Exam (MMSE)While gathering subjective and objective data to evaluate the mental health status of the elderly. MMSE is a standardized tool used to assess cognitive function changes over time. The 11 items measuring orientation, registration, attention and calculation, recall, ability to follow commands, and language it takes approximately 5 to 10 minutes to administer NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The maximum score is 30. A score 20 or less may be associated with dementia, and a score of 26 or higher is not associated with dementia.Higher education is associated with higher MMSE scores, even when dementia is present. MMSE has been translated into multiple languages and adapted for many cultures, and in some cases external validity, sensitivity, and specificity have been evaluated (Ball et al., 2019).

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 This test is often used to help diagnose Alzheimer’s disease and dementia. This quantitative-styled survey scores one’s as either zero (incorrect), one (correct), six (item administered, participant does not answer), or nine (test item not administered/unknown). Out of thirty points, a score that ranges between twenty to twenty-four marks mild dementia; thirteen to twenty defines moderate dementia; and anything less than twelve is classified as severe dementia (Alzheimer’s Association, 2019) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. This tool is often used to get a baseline on the degree of dementia and used to evaluate the effectiveness of medications that function to delay the progression of the disease. While the MMSE provides useful information that adds to a mental health diagnosis, this test should not be the only information used. The National Institute on Aging (2017) asserts that in addition to neuropsychological tests such as the MMSE, providers also use laboratory tests and brain scans to validate a diagnosis of dementia. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

The MMSE method has many advantages. The method is popular and it has a large quantity of data that is readily available to find standards that can be used for comparison in various circumstances and settings. It has been made popular because of its standardized structure that can be applied universally that has enabled it to be accepted by many as a measurement unit and a basis for assessing the severity of CI and DEM (Palsetia et al., 2018). Again its structure enables assessment of various cognitive aspects and its rating scale has been accepted globally for measuring mental functioning  It is very quick and easy to practice where it involves less instructions which can be administered in ten minutes and therefore it can be administered with less training and is widely taught in most institutions.. Their scoring system is standardized which makes it easy to calculate the results. The method can be applied using different languages since instructions are simple and can be applied NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

       The test method also has several disadvantages. The main disadvantage is the fact that the method is not very useful in identifying mild impairment (Palsetia et al., 2018). It also offers problems in detecting changes that occur in severe dementia. The method does not give accurate information for people who are educated because of the ceiling effect (Palsetia et al., 2018). Furthermore, the method does not offer fine details for impairments such as neglect, aphasia and apraxia that occur for people in post-stroke NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The method does not put more emphasis for memory loss since it is given only three points while orientation and language are given more most points (Palsetia et al., 2018). This shows that the method is not dedicated to assess the core domain for cognitive ability (Palsetia et al., 2018). Furthermore, the lack of full standardization for the method offers another problem. Three words for the registration stage are critical in the memory stage but there are no criteria for choosing these words. Freedom is given to the examiner to choose these three words of which the choice can be affected by several factors such as frequency of use, familiarity, imaginability others. Other items that are not standardized are drawings and calculations. Besides, some of the instructions require reading and writing skills which limits its use on illiterate people.

In conclusion, MMSE has become a very popular tool for assessing cognitive impairment for older people. Some of the reasons for its popularity is because of shorter instructions, ease of administering and ease of translating the instructions into different languages all over the world. The method fits well for the older generation because it takes a few minutes to complete it. The method reliability was proved to be adequate and its validity was also adequate with a high sensitivity and specificity.

  References

 Alzheimer’s Association. (2019). Medical tests. Retrieved from

https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to

physical examination: An interprofessional approach (9th ed.) St Louis, MO: Elsevier

Mosby.

 National Institute on Aging. (2017, December 31). Basics of Alzheimer’s disease and dementia.

Retrieved from

https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis

 Palsetia, D., Rao, G. P., 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.

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

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.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

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. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

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.

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by comparing your assessment tool to theirs.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

 

Week 2 initial post Positive and Negative Syndrome Scale

          This week’s resources give us as students a plethora of information that can help us to diagnose many different psychiatric disorders that we will experience as advance nurse practitioners. The key is to use the tools that will be the most effective and give us the best outcomes for our clients and their families. The decisions we make will help us to diagnose and treat clients effectively and to determine the best tools to use we will be examining those tools individually and together through this discussion forum. The Positive and Negative Symptom Scale may be a tool that can help with the diagnosis of Schizophrenia, Schizoaffective disorder and Schizophreniform however It seems that the reliability of this tool has not been proven to be consistent with different diagnosticians (Kølbæk et al, 2018). Not because it is ineffective, but due to the time constraints which are not always amenable to the client’s condition in a crisis (Kølbæk et al, 2018).

According to Sadock, Benjamin et al., the psychiatric interview is the most valuable element of the evaluation and care of clients with mental illness (2017). However, without the medical and mental history as well as the examination of the client and questioning of family or people close to the client the diagnosis may be skewed. Many clients with schizophrenia or any diagnosis that has delusional aspects or hallucinations may have knowledge that is corrupt in nature due to the nature of their illness (Andresen et al., 2006). Additionally, a patient may have a medical condition that is causing their psychosis. For this reason, the medical including drug or alcohol use need to be considered and ruled out prior to diagnosing a client with a psychotic disorder (Psychiatry Lecture, 2020).

The Medical history is the first component I feel is important to the interview of a patient that is having psychosis simply to rule out any organic causes for the psychosis such as infection, trauma or tumor. These things can be ruled out by taking completing blood tests, diagnostic imaging, and a system review. Taking care of the client’s physical needs may be the answer to help resolve his psychosis (Sadock et al, 2017).

The psychiatric history of the client and the family is a second component that is especially important with psychotic patients. Knowing the history and how long the client has been suffering with the symptoms will help to determine the diagnosis of the client. If the client has been dealing with his or her current symptoms for more than 6 months, and they have a family history of schizophrenia, then the risk for the patient regarding schizophrenia is much higher (American Psychiatric Association, 2013).

The third component which is particularly important is the history and current use of substances including alcohol, medication, and illegal substances. I believe it is important to talk about all substances including medications the patient is currently taking as well as the amounts they are taking. The client could be taking their prescribed medications incorrectly, causing an exaggerated reaction or side effect which can be remedied easily by educating the client on proper use and dosing (American Psychiatric Association, 2016) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

The assessment tool assigned to me is the Positive and Negative Symptom Scale (PANSS). This tool is one of many primarily used for diagnosis by giving a reliable method of determining the severity of the symptomology presented by clients in psychosis (Fleishhacker, 2016). The second purpose of the tools for diagnosis of schizophrenia and other psychotic diagnosis’ is to determine the effectiveness of treatment (Fleishhacker, 2016). The PANSS tool which was published in 1987 (Ostergaard, Opler & Correll, 2017) is considered the gold standard for diagnosis of psychotic mental health issues once medical reasons for the psychosis is ruled out (Takeuchi et al, 2016). The psychometric properties of the PANSS have proven this to be an exceptionally reliable and valid instrument for determining the factors in schizophrenia and other psychotic disorders especially for research (Østergaard, Opler, & Correll, 2017). However, the practicality of using this tool with clients who are presenting in crisis is questionable. It requires 45 to 60 minutes of uninterrupted time with a client to administer this test which makes it impractical in many psychiatric intake settings (Kølbæk et al., 2018.)

This instrument is valuable for research and to help evaluate clients who are stable and able to verbalize their feelings and symptoms. In clinical practice it may be more effective for us as advance practice nurses to use an abbreviated version of this tool such as the 6-item positive and negative syndrome scale (PANSS-6) or the Simplified negative and positive symptom interview (SNAPSI) (Ostergaard, Opler & Correll, 2017).

The PANSS is a 30 item Positive and Negative as well Global symptoms. Positive symptoms are those that are added to a clients’ “normal” These consist of things like hallucinations, delusions, disorganized concepts, hostility, grandiosity, suspicion, and excitement Negative symptoms are when the client is lacking where his or her personality is concerned. For instance, if a client is not socializing with others. Negative symptoms included on the PANSS are blunted affect, emotional withdrawal, poor rapport, apathy or social withdrawal, problems with abstract thinking, no spontaneity and stereotypical thinking. The third factor of the PANSS is the general psychopathology scale. This consist of 16 items which include anxiety, somatic concerns, depression, poor attention, poor impulse control and preoccupation. The lowest that can be scored on any one of the items is 1. So, the lowest score possible is 30 (Kay, Fiszbein, & Opler, 1987).

To have a high degree of reliability with this instrument, there must be training for those rating the clients using said instrument (Opler, Yavorsky, & Daniel, 2017). In the case of the PANSS raters there are 4 principles that are required.

Each item definition and points must be interpreted as literally as possible.

The highest rating possible must be given if it applies.

The reference period and time frame must be considered for each item.

All information given in the interview must be considered for each item, therefore the instrument must be completed after the interview is completed.

The training for rating this instrument should be included in clinical training (Opler, Yavorsky, & Daniel, 2017).

This instrument and the other many instruments that are available in psychiatric practice helps me to understand there is still so much to learn. I know that this is only the tip of the iceberg and I am looking forward to using the different tools available to us. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

 

References

American Psychiatric Association. (2013). Section I DSM-5 basics. In Diagnostic and statistical manual

of mental disorders (5
th
 ed., pp. 5-29). Author.

https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

The American Psychiatric Association. (2016). Practice Guidelines for the Psychiatric Evaluation of

Adults (3
rd
 ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Andresen, B., Moritz, S., Moritz, S., & Woodward, T. S. (2006). Positive and Negative and Disorganized

Symptoms Scale. 
Journal of Abnormal Psychology
, 
115
(1), 15–25. N

Fleischhacker, W. W. (2016). The usefulness of rating scales in patients with schizophrenia. 
Acta

          Psychiatrica Scandinavica
, 
133
(6), 435. 
https://doi-

org.ezp.waldenulibrary.org/10.1111/acps. 12588

Kay, S.R., Fiszbein, A, Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for

schizophrenia. Schizophr Bull. 1987;13:261-276.

. Kølbæk, P., Blicher, A. B., Buus, C. W., Feller, S. G., Holm, T., Dines, D., O’Leary, K. M., Sørensen,

R.S., Opler, M., Correll, C. U., Mors, O., Bech, P., & Østergaard, S. D. (2018). Inter-rater

reliability of ratings on the six-item Positive and Negative Syndrome Scale (PANSS-6) obtained

using the Simplified Negative and Positive Symptoms Interview (SNAPSI). 
Nordic Journal of

          Psychiatry
, 
72
(6), 431–436. 
https://doi-
  de

org.ezp.waldenulibrary.org/10.1080/08039488.2018.1492014

Opler, M.G.A., Yavorsky, C., & Daniel, D.G. (2017). Positive and Negative Syndrome Scale (PANSS)

Training: Challenges, Solutions, and Future Directions. 
Innovations in Clinical

          Neuroscience
, 
14
(11/12), 77–81.erg/watch/schizophrenia-and-other-psychotic-

Østergaard, S. D., Opler, M. G. A., & Correll, C. U. (2017). Bridging the Measurement Gap

Between Research and Clinical Care in Schizophrenia: Positive and Negative Syndrome Scale-6

(PANSS-6) and Other Assessments Based on the Simplified Negative and Positive Symptoms

Interview (SNAPSI). 
Innovations in Clinical Neuroscience
, 
14
(11/12), 68–72.

Psychiatry Lecture: How to do a Psychiatric Assessment Retrieved December 7, 2020 from

 

https://www.youtube.com/watch?v=IRiCntvec5Urh/schizophrenia-and-r-psychotic-disorderstch/schizophrenia-and-other-psychotic-disorders NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

Sadock, Benjamin, et al. 
Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry
, Wolters

Kluwer, 2017.
 ProQuest Ebook Central
,

https://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=5340671
.

Takeuchi, H., Fervaha, G., Lee, J., Agid, O., & Remington, G. (2016). A preliminary examination of the

validity and reliability of a new brief rating scale for symptom domains of psychosis: Brief Evaluation

of Psychosis Symptom Domains (BE-PSD). 
Journal of Psychiatric Research
, 
80
, 87–92. 
https://doi-

org.ezp.waldenulibrary.org/10.1016/j.jpsychires.2016.06.005

Classroom Productions (Producer2015). Schizophrenia and other psychotic disor NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

The Psychiatric Evaluation and Evidence-Based Rating Scale

According to Saddock, Saddock, and Ruiz (2015), the psychiatric interview is the most important element in the evaluation and care of persons with mental illness.  It is how we obtain information that will drive the criteria-based diagnosis and ultimately, the plan of care.  From the beginning, the interview will establish the client-provider relationship which, can have a profound influence on the outcome of treatment.  Three important elements of the psychiatric interview include past psychiatric illness, mental status exam, and formulation NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

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Past Psychiatric Illness

The past psychiatric history should include all psychiatric illnesses, symptoms, and treatment over the patient’s lifespan.  The symptoms should include, when they occurred, how long they lasted, and the frequency and severity of episodes (Saddock, Saddock, & Ruiz, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.  Special considerations, such as, suicidal or homicidal ideations, and episodes of self-injury should be assessed.  Treatment episodes should include outpatient, inpatient, day, and voluntary/involuntary treatment.  The practitioner should collect and review information about medication use and other modalities such as electroconvulsive therapy (ECT) that have been used and the response experienced by the patient.  Did the patient experience side effects or any other negative effects from the treatment?  Finally, was a diagnosis made in previous episodes that should be considered now.

Mental Status Exam

The mental status exam (MSE) is intended to explore all areas of mental functioning and denotes evidence of signs and symptoms of mental illness (Saddock et al, 2015).  The practitioner will begin the MSE upon initiation of the interview through observation, direct questioning, and the cognitive screening.  According to Sadock et al (2015), components of the screening include appearance, behavior, motor, speech, mood, affect, cognition, abstract reasoning, and thought process.  If suicidal ideations are present, intention, methods, motivation, reason for living, and the patient’s therapeutic alliance should also be assessed (American Psychiatric Association, 2016) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

Formulation

Formulation consists of the culmination of all the data collected, the diagnosis, recommendations, and treatment planning.  The formulation should include a brief summary of the patient’s history, presentation, and current status (Saddock et al, 2015) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.  Combined, these elements should lead to the differential diagnosis of the patient’s illness as well as the provisional diagnosis.  The formulation should include a summary of the safety assessment, an estimate of the patient’s suicide risk, rationale for treatment selection, and treatment related preferences (American Psychiatric Association, 2016).  All should be explained and collaborated with the patient; differential diagnosis, risks of untreated illness, treatment options, and benefits and risks of treatment (American Psychiatric Association, 2016). NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

Psychometric Properties of the Geriatric Depression Scale

The Geriatric Depression Scale has been tested and used extensively with the older population. The GDS is a self-report measure of depression in older adults.  The response is a yes/no format and was formulated because of their high correlation with depressive symptoms in previous validation studies (American Psychiatric Association, 2020).  Of the 15 items on the assessment, 10 indicate the presence of depression when answered positively while the other 5 are indicative of depression when answered negatively (short form) NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.

American Psychiatric Association (2020).  
Geriatric Depression Scale (GDS)
.  Retrieved from https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/geriatric-depression

American Psychiatric Association. (2016). 
Practice guidelines for the psychiatric evaluation of adults (3
rd
 ed.
). https//psychiatriconline.org/doi/pdf/10.1176/appi.books..9780890426760

Greenberg, Sherry A. (2020).  
The Geriatric Depression Scale (GDS)
. Hartford Institute for Geriatric Nursing. Retrieved from https://hign.org/consultgeri/try-this-series/geriatric-depression-scale-gds

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

 

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

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 NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

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. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by comparing your assessment tool to theirs.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Main Discussion Post

 
Examining, assessing, and diagnosing the client are all important aspects of being a psychiatric mental health nurse practitioner. Becoming skilled and confident in these areas helps providers to develop appropriate and effective treatment plans. One thing that has been emphasized in our reading this week and last week is the client-provider relationship. The initial assessment is where the provider lays the groundwork for a positive rapport to be developed. Sadock et al. (2015) stated one of the crucial aspects of the examination is showing empathy while retaining objectivity. Providing privacy, confidentiality, respect, and comfort are all significant factors of the assessment process as well. American Academy of Child and Adolescent Psychiatry (1995) recommended providers approach the interview with three things in mind: to obtain a diagnosis, determine if treatment will be indicated, and develop a treatment plan that will keep the client engaged. One of the objectives for this class is to feel confident with assessment tools and deciding which ones are appropriate for which clients. This post will discuss three important components of the psychiatric interview. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion I will also be discussing the Positive and Negative Symptom Scale (PANSS) and how the provider uses it to determine appropriate diagnoses and treatment.

 
The psychiatric interview, also referred to as an examination or assessment, is complex and time-consuming. With a cooperative client, the process can still take around an hour to complete. Three crucial components of the interview include the social history, family history, and past medical history NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. The social history gives the provider vital information about how the client functions and what kinds of coping skills they currently employ. This part of the interview also allows the provider to assess the client’s use and history with illicit drugs and alcohol. Sadock et al. (2017) recommended approaching this section of the interview carefully, as the provider will need honest information to get a clear picture of the client’s situation. Asking questions about substance use and abuse should be done without judgment. This tactic includes tone of voice, inflection, and body language. This information is critical in determining which symptoms could be related to substance abuse and what treatment would be most appropriate for each individual client. An example would be a client who presents with attention deficit disorder and reveals that they have a history of meth use. In this case, the provider would probably want to steer away from effective medications such as Adderall due to the possibility of abuse NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion.
 

 
Many psychiatric disorders have a genetic component that can be assessed during the interview’s familial history portion. The provider can use this information to determine an accurate diagnosis and treatment. For example, if a client came in complaining of symptoms that seemed to align with anxiety and then stated her mom, sister, aunt, and grandmother all had been diagnosed with anxiety, it is very likely the client has a genetic predisposition for that particular disorder. Because genetics can also affect how successful treatment is, it could be useful to know how the client’s family responded to treatment. Another significant part of the family history is the history of suicide attempts and aggressive behaviors. American Psychiatric Association (2016) found that a family history of suicidal ideation and aggression puts the client at higher risk for the same behaviors. As a provider, I would use this information to focus a few more questions in these areas for a clearer picture of my client’s situation.
 

 
A client’s past medical history is important for a variety of reasons. A medical history can give the provider insight into possible risk factors for mental disorders. It also will affect how the provider develops a treatment plan. American Psychiatric Association (2016) stated that the provider would also need to determine how any current medical conditions could be affecting the presentation of symptoms and how that will influence the diagnosis. An example of this could be head injuries. The medical history is also important because it will cover any allergies or drug sensitivities the client may have had in the past. Providers use this information when developing their treatment plan if it includes medications. Another crucial component of the medical history is the current medications and supplements the client is taking. The provider will need to ensure that anything they propose to add to the client’s regimen will not cause adverse effects. Lastly, a past medical history gives the provider insight into other professionals they can collaborate with regarding the client. The physical health of the client is important and should be monitored while receiving psychiatric treatment.
NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

 
One tool that can be used during a psychiatric interview is the PANSS. This tool is used to determine the severity of the disorder and the client’s quality of life. Once the diagnosis of schizophrenia is decided on, this tool can be used to determine the direction of effective treatment. Therefore, this tool is only used at the end of an interview and only when the client has been appropriately diagnosed with schizophrenia. The symptoms of schizophrenia are classified as positive and negative. Positive symptoms include things like hallucinations, delusions, paranoia, and grandiosity. Negative symptoms include social withdrawal, blunted affect, difficulty communicating with a natural flow, and apathy. This assessment can take up to 45 minutes, so it may be beneficial to schedule a time to perform just this assessment after the first consultation and diagnosis are complete. Depending on the client’s condition, the provider should also plan to include caregivers during the evaluation and information gathered from previous providers. The client is rated in 30 different areas from one to seven. The areas are broken down into positive symptoms, negative symptoms, and general psychopathology NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion. There is a PANSS-6 that only assesses six of the core symptoms of schizophrenia and a Simplified Negative and Positive Symptoms Interview (Kølbæk et al., 2018). These could be used in place of the more detailed assessment if time were a factor. One study I researched found that vitamin D levels directly correlated to the PANSS score. Prasanty et al. (2018) stated that the lower the level of vitamin D, the higher the PANSS score was. Ordering a vitamin D level would be worthwhile when treating a client with schizophrenia.
 

 
Psychiatric interviews should be client-centered, and the treatment should reflect the client’s goals, not those of the provider (Sadock et al., 2015). Client-centered interviews and treatment focus on the client’s strengths and culture, as well as areas identified by the client that need work. Providers should take the interview as an opportunity to begin a solid foundation of collaborative decision making between them and the client. Open-ended questions are helpful at the beginning of the interview, with more focused questions used to clarify the information required to determine differential diagnoses and treatment. Prioritizing the client’s symptoms and diagnoses will also be an important aspect of the assessment because many clients have comorbid conditions. The client’s social history, family history, and past medical history are all crucial aspects of the psychiatric interview.
NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

 

References

American Academy of Child and Adolescent Psychiatry. (1995).
 
Practice parameters for the assessment and treatment of children and adolescents.
 
https://www.aacap.or/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessments_practice_parameter.pdf

American Psychiatric Association. (2016).
 
Practice guidelines for the psychiatric evaluation of adults.
 
(3
rd
ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.boooks.9780890426760

Kølbæk, P., Blicher, A. B., Buus, C. W., Feller, S. G., Holm, T., Dines, D., O’Leary, K. M., Sørensen, R. S., Opler, M., Correll, C. U., Mors, O., Bech, P., & Østergaard, S. D. (2018). Inter-rater reliability of ratings on the six-item Positive and Negative Syndrome Scale (PANSS-6) obtained using the Simplified Negative and Positive Symptoms Interview (SNAPSI).
 
Nordic Journal of Psychiatry
,
 
72
(6), 431–436. https://doi-org.ezp.waldenulibrary.org/10.1080/08039488.2018.1492014

Prasanty, N., Amin, M. M., Effendy, E., & Simbolon, J. (2018). Low vitamin D serum level increases severity symptoms in schizophrenic patients measured by Positive and Negative Symptoms Scale (PANSS) in Batak Tribe Sumatera Utara, Medan-Indonesia.
 
Bali Medical Journal, 7
(1), 249-254. https://doi-org.ezp.waldenulibrary.org/10.15562/bmj.v7i1.921

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
 
Kaplan & Sadock’s synopsis of psychiatry
(11
th
ed.). Philadelphia, PA: Wolters Kluwer.

Sadock, B. J., Sadock V. A., & Ruiz, P. (2017).
 
Kaplan and Sadock’s concise textbook of clinical psychiatry
 
(4
th
ed.). Philadelphia, PA: Wolters Kluwer. NRNP 6635 The Psychiatric Evaluation and Evidence-Based Rating Scales Discussion

Hamilton Anxiety Rating Scale (HAM-A)

Week 2 Initial Post

           The psychiatric interview is the basis upon which all the other work of the PMHNP is based. It is during this assessment that the key data points are collected that are needed for diagnosis and treatment planning. The purpose of this discussion to briefly explain three components of the psychiatric interview and to look at the psychometric properties of the Hamilton Anxiety Rating Scale.

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            The first component, and arguably the most important, is the history of present illness (HPI). This section discusses, chronologically, the events and the symptoms that lead the client to seek treatment. It also covers other changes that may impact these symptoms, such as interpersonal relationships, personal habits, physical health, and behaviors (Sadock, Sadock, and Ruiz, 2017). Because this part of the interview sets the tone for the remainder of the visit, and also allows for the collection of data relating to the client’s primary concerns, it is critical for a proper diagnosis and treatment plan Hamilton Anxiety Rating Scale (HAM-A).

The second component this post will discuss is the past psychiatric history (PH). This piece allows the provider to obtain relevant data related to the client’s psychiatric illnesses, including symptoms and treatment over the course of their lifetime (Sadock, Sadock, and Ruiz, 2017). These elements are important, as they help to create a complete picture of the mental illness that the client is seeking help for.

The third component is the family history. Hamilton Anxiety Rating Scale (HAM-A) This part of the interview covers mental health diagnoses, substance use issues, and suicidal or violent behaviors in biological relatives (American Psychiatric Association, 2016). This information is important, as genetic links have been found to influence the development of psychiatric illness in individuals.

In addition to the psychiatric interview, clinicians often use rating scales to get a clearer picture of the symptoms that clients report, such as severity, triggers, and other variables. For anxiety, the Hamilton Anxiety Rating Scale (HAM-A) is often utilized by practitioners. This scale discusses fourteen symptoms of anxiety, ranging from anxious mood to autonomic symptoms, and asks the client to rate them from 0, or not present, to 4, or very severe (Hamilton, 1959). It would be appropriate to use this scale during the history of present illness portion of the psychiatric interview (American Psychiatric Association, 2016). Utilizing the HAM-A at this point of the interview allows the PMHNP to determine if the described symptoms do support the diagnosis of anxiety and to what severity.

In conclusion, the psychiatric interview is crucial to the assessment, diagnosis, treatment planning, and evaluation of clients with mental health issues. Each section allows the collection of critical data for the PMHNP to utilize. In addition, clinical rating scales add to this information and allow for an objective piece of data to support the subjective data collected during the interview. When taken together, the big picture of a client’s concerns can be formulated and needs addressed. Hamilton Anxiety Rating Scale (HAM-A)

References

American Psychiatric Association. (2016
). Practice guidelines for the psychiatric evaluation of adults (3rd ed.)
. https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Hamilton, M. (1959). Hamilton anxiety rating scale (HAM-A). 
Br J Med Psychol 1959
; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. 
Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed.)
. pp. 9–15. Wolters Kluwer.

responses

Thank you for an informative and interesting post on the Hamilton Anxiety Scale (HAM-A). This tool is a widely used interview scale that measures the severity of a patient’s anxiety. The scale predates the current definition of generalized anxiety disorder (GAD). However, it covers many of the features of GAD and can be helpful also in assessing its severity (Porter et al., 2017). The major value of the HAM-A is to document results of the psychotherapy, rather than as a diagnostic or screening tool. It takes roughly 15 minutes to complete the interview and scoring. Each item is given a 5 point score, 0 (not present) to 4 (severe). The questionnaire consist of a total of 14 questions (Porter et al., 2017). The scale has demonstrated high levels of accuracy and validity, and the results give important clues to possible mental disorders that warrant follow-up by a health care provider (Porter et al., 2017).

The assessment tool I chose was the CAGE Questionnaire. This test is widely used and measures the possibility of alcohol dependency. The test is composed of a total of 4 yes or no questions. Each question answered yes increases the chances of alcohol dependency. Answering with 2-3 yes responses often indicates alcohol abuse or dependency (Bush et al., 2016). The CAGE questionnaire aims to evaluate the current state of an individual rather than long-term (Bush et al., 2016). The questionnaire is reported to accurately identify people with alcohol dependency 93 percent of the time (Bush et al., 2016). This makes the questionnaire relatively accurate, and a quick way to screen people for alcohol dependency.

References

Bush, B., Shaw, S., Cleary, P., Delbanco, T. L., & Aronson, M. D. (2016). Screening for alcohol abuse using the cage questionnaire. 
The

               American Journal of Medicine
, 
82
(2), 231–235. 
https://doi.org/10.1016/0002-9343(87)90061-1

Porter, E., Chambless, D. L., McCarthy, K. S., DeRubeis, R. J., Sharpless, B. A., Barrett, M. S., Milrod, B., Hollon, S. D., &

Barber, J. P. (2017). Psychometric properties of the reconstructed hamilton depression and anxiety scales. 
The

            Journal of 
Nervous and Mental Disease
, 
205
(8), 656–664. 
https://doi.org/10.1097/nmd.0000000000000666

 

 

Thank you for your insight on the Hamilton Anxiety Rating Scale (HAM-A) and your overall view of the psychiatric evaluation. The

American Psychiatric Association also states that in the initial exam the interviewer may have to return to elaborate on certain aspects of the exam depending on the presentation of the client (2016).  I think it is important for us to remember as you indicated that we need to focus on the presenting problem and not get to tied up with making sure that every single line item on the intake exam be covered on the first visit.

I am dealing with a patient who has a huge amount of anxiety. His issues are overwhelming to him. He has Congestive Heart Failure, debilitating arthritis and now he is positive with Covid-19.  He is so afraid that it will get in his lungs and kill him. His pain with the arthritis sends him in a tailspin and he feels like his worst problem is Covid-19.  His oxygen saturation is 99% when he says he cannot catch his breath. He has perseverated about having this dreaded virus since he tested positive 3 weeks ago. He is still saying he does not want it to get into his lungs and kill him. However, he is refusing to do anything such as taking medication or supplements or even a breathing treatment when he is feeling short of breath. His breath sounds are clear. He is not suffering from Covid related shortness of breath, but his anxiety is making him feel like he is at deaths door.

I think the clients’ medical history is extremely important to how they are presenting. A head-to-toe exam may help the patient who is suffering from anxiety, feeling like they are surely dying to have some comfort. A physical exam with laboratory testing may help this patient to relax so that he can recover more effectively from the Covid. In case studies done with current heart patients, anxiety can cause clients to manifest the symptoms they fear the most (Giannitsi et al.,2020) (Tully, Cosh, & Baumeister, 2014) Hamilton Anxiety Rating Scale (HAM-A).

References

The American Psychiatric Association. (2016). Practice Guidelines for the Psychiatric Evaluation of

Adults (3
rd
 ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

org.ezp.waldenulibrary.org/10.1080/08039488.2018.1492014

Giannitsi, S., Tsinivizov, P., Poulimenos, L. E., Kallistratos, M. S., Varvarousis, D., Manolis, A. J.,

Tsamakis, K., Rizos, E., Spandidos, D. A., Tsiptsios, D., & Triantafyllis, A. S. (2020). [Case Report]

Stress induced (Takotsubo) cardiomyopathy triggered by the COVID-19 pandemic. 
Experimental &

          Therapeutic Medicine
, 
20
(3), 2812./watch/schizophrenia-and-other-psychotic-

Tully, P. J., Cosh, S. M., & Baumeister, H. (2014). The anxious heart in whose mind? A systematic review

and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity

risk in coronary heart disease. 
Journal of Psychosomatic Research
, 
77
(6), 439–448 
https://doi-

org.ezp.waldenulibrary.org/10.1016/j.jpsychores.2014.10.001 Hamilton Anxiety Rating Scale (HAM-A)

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

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.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

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.

Hamilton Anxiety Rating Scale (HAM-A)

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.

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by comparing your assessment tool to theirs.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! Hamilton Anxiety Rating Scale (HAM-A)

Discussion: Networking Opportunities Introduction

My name is xxxx. I am a native of xxx. I have been living in America with my family for the past eleven years. This year in May mark my five years of becoming a nurse. I love my being a nurse, and I find so much happiness and passion in it. I have worked in various settings in the last five years, and I have enjoyed taking care of every kind of population. I want to learn more in-depth about the disease process and medications with advanced degrees and training. Hence the Family Nurse Practitioner is something that incorporates all my clinical experiences at an advanced level.

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My Goals and University Vision and Mission 

 
As a nurse, I think it is important to have a career goal to progress and succeed. According to the American Nurses Association’s (ANA) 2015 Code of Ethics for Nurses with Interpretive Statements, it is the nurse’s responsibility to maintain competence and incorporate fundamental values and duties beyond individual patient interactions to practice within an ever-changing healthcare environment. Nursing requires ongoing training and education, and there are many specialties in healthcare to learn and grow. Discussion: Networking Opportunities

My ultimate goal is to become a Family Nurse Practitioner (FNP). I looked into several universities to obtain my degree in Family Nurse Practitioner. Among all the universities, I found Walden University to be one that meets my career goal. According to Walden University (WU) of Nursing’s vision statement, the degrees offer diverse specialization and an opportunity for growth (University, Vision, Mission, and Goals, 2020). From WU’s vision statement, the degree from them will be useful and relevant to help the graduate try to solve society’s problems around the world. Discussion: Networking Opportunities

 
Our country is very diverse, and we are increasingly getting patients from all different religious backgrounds. Walden University’s (2020) mission is to “provide a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they can effect positive social change.” I want to be able to provide essential care with mutual respect and evidence-based knowledge to all those from different backgrounds.

WU’s goals and outcomes match my academic and professional goals. Upon completing the program, I hope to have a deeper understanding of nursing theories and emphasize ethical and critical decision-making skills.

I hope to learn to apply my leadership skills in the provision of high-quality nursing care.

Incorporation of Social Change 

WU wants its graduates to obtain knowledge and skills that will help them make the world a better place. Professional nursing is defined as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (Epstein, B., Turner, M. 2015). For me, nursing is the holistic care of all kinds of patients, regardless of their age, gender, race, and religion, in a comfortable environment with full confidentiality, right, and respect of a patient. I plan to bring positive change into practice settings, meet the patient’s unique, holistic needs, and make an incredible difference in the patient’s healthcare experience. Discussion: Networking Opportunities

Academic and professional collaboration

English is my third language. Due to the language barrier, I often struggle with academic and professional development. I will be taking advantage of Walden’s writing center and academic skills center to help to grow academically. My professional goal is to continue to work full time as a float pool nurse. Discussion: Networking Opportunities

 

References

 

Epstein, B., Turner, M., (May 31, 2015) “The Nursing Code of Ethics: Its Value, Its

History” 
OJIN: The Online Journal of Issues in Nursing
. Retrieved from 
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/The-Nursing-Code-of-Ethics-Its-Value-Its-History.html

 

Fowler, M. D. M. (2015). 
Guide to the code of ethics for nurses with interpretive
 

statements: development, interpretation, and application
. American Nurses Association. Retrieved from 
http://search.ebscohost.com.ezproxy.coloradomesa.edu/login.aspx?direct=true&db=cat01465a&AN=cmu.b54440063&site=eds-live&scope=site

 

Walden University
. (2020). Vision, Mission, and Goals. Retrieved June 1, 2020,
 

from 
https://catalog.waldenu.edu/content.php?catoid=172&navoid=59420

 

 

 

response

Hi xxx, in response to your comment about the need of culturally competent professionals to address our ever-changing society, I believe it’s an important component in today’s healthcare system so each patient gets the best care they deserve. There is an overwhelming evidence which suggests that providing sensitive care using patient-centered culturally sensitive care yields better outcomes for patients and the healthcare system overall, as it was published in the journal of Health Psychology. This article titled, “Patient-Centered Culturally Sensitive Health Care: Model Testing and Refinement”, presents a model to improve care for ethnically diverse patients seen in community-based primary care clinics (Tucker, Marsiske, & Rice, 2011).

Choosing Walden’s university was the right step toward your goal, becoming FNP. As you’ve mentioned, graduating to a diverse society requires professionals equipped with a new set of skills. Discussion: Networking Opportunities. As we all know, America’s diversity will continue growing each year and the health disparities will grow along with it, as predicted. However, if nurses and other healthcare providers take action in culturally and socially competent ways, then health disparities may be “altered, and the mandate to reduce and ultimately eliminate disparities may be realized sooner” (Giger et al, 2007). I look forward collaborating with you!

References

Giger, Joyce & Davidhizar, Ruth & Purnell, Larry & Harden, J & Phillips, Janice & Strickland, Ora. (2007). American Academy of Nursing Expert Panel Report. Journal of transcultural nursing : official journal of the Transcultural Nursing Society / Transcultural Nursing Society. 18. 95-102. 10.1177/1043659606298618.

Tucker, C. M., Marsiske, M., Rice, K. G., Nielson, J. J., & Herman, K. (2011). Patient-centered culturally sensitive health care: model testing and refinement. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 30(3), 342–350. 
https://doi.org/10.1037/a0022967

 

Discussion: Networking Opportunities

In this module, you begin laying the foundation for your academic and professional success. Your efforts begin with a vision that includes your own definition of success. Your vision may vary from those of your colleagues, but this does not mean you have to take these first steps alone.

Walden University and the College of Nursing also have a vision and mission, which include helping you to make your own vision a reality. Members of your new academic community, such as faculty, support teams, and fellow students, can also be helpful. Current practitioners and other member of the professional community can also help you to clarify your vision.

This Module’s Discussion asks you to consider how the Walden mission and vision as well as the College of Nursing’s mission and vision apply to your professional and academic goals. You will also begin to identify individuals and teams who can help you along the way as you begin designing the “blueprint”—your Academic Success and Professional Development Plan—that will guide you toward your own vision for academic and professional success.

To Prepare:

Review the Walden and College of Nursing mission and vision statements, Walden’s goals and University Outcomes, and the MSN Program Learning Outcomes presented in this Module’s Learning Resources.

Reflect on your professional and academic goals as they relate to your program/specialization.

Consider how the information in these resources fit with your own goals and to your becoming a scholar-practitioner.

Also consider academic and professional individuals and teams with whom you may collaborate in support of your efforts as a student at the university and as a professional within your organization and career. Discussion: Networking Opportunities

By Day 3 of Week 1

Post
 a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiatives relate to your professional and academic goals and to your becoming a scholar-practitioner. Also include an explanation for how the Walden MSN Program Outcomes and perspectives relate to your professional and academic goals and to your becoming a scholar-practitioner.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues’ posts by suggesting additional individuals and/or teams with whom you wish to collaborate or by offering additional networking strategies.

ORDER A PLAGIARISM-FREE PAPER HERE

Hello my name is xxx and I am enrolled in the Post Masters Psychiatric NP program.  I reside in Virginia Beach Virginia and I am a traveling nurse.  I enrolled in the Post Master Psychiatric program in hopes to  address and identify problems and challenges within communities.

Walden University was founded on the platform and need for social change in the community by expanding access to higher education. The mission of the University is to provide a diverse community of career professionals with the opportunity to transform themselves as scholar- practitioners to effect positive social change (Walden University, 2020). Discussion: Networking Opportunities This is especially significant to me as I am on the path to becoming a psychiatric nurse practitioner, and I understand the need for knowledgeable and skilled practitioners to practice in the community and effect change. Through the program at Walden, I expect that I will be equipped with the skills that will enable me translate research and knowledge into practice, to address the issues affecting the psychiatric patients in the community. This is also in line with the vision of the University where the aim is to ensure that the knowledge gained can be applied by the graduates to address key issues in the society (Walden University, 2020) Discussion: Networking Opportunities. As a graduate psychiatric nurse practitioner, I expect that with the combination of the knowledge and skills gained, I will be able to identify challenges in the community and apply the same to develop solutions (Kverno, 2016). I also expect that I will be able to improve practice by applying knowledge based on the context and needs of the patients to advance social change and improve patient outcomes.

The Walden MSN program outcomes have a focus on meeting the demand for mental health providers who are equipped with advanced skills and practicum training for the provision of care. Through these, I will be able to meet my professional and academic goals by becoming knowledgeable and equipped in the use of evidence based practice in the provision of care. This will require me to be able to engage in and utilize research in my practice to identify new output and interventions that have been identified through research, and apply them to my clinical context while considering the needs of the patient (Kverno, 2016). Through this, I will be on the way to becoming a scholar practitioner by translating evidence into practice to ensure improved patient outcomes. Discussion: Networking Opportunities

References

Kverno, K. (2016). Promoting access through integrated mental health care education. 
The Open Nursing Journal
, 
10
, 73.

Walden University. (2020). About Walden. Retrieved from: 
https://www.waldenu.edu/about
 Discussion: Networking Opportunities

Yale-Brown Obsessive-Compulsive Scale

Psychiatric Interview Components

One important component of the psychiatric interview is gathering the history of present illness (HPI) (Carlat, 2017). One piece of the HPI is gathering information on the current and premorbid level of functioning (Carlat, 2017). I find this component important because it establishes which symptoms of the illness may be interfering with the patient’s daily activities. For example, a patient may state that their anxiety has gotten to the point where they are no longer able to participate in family gatherings, which is something they once enjoyed. In addition, this establishes a baseline for the patient (Carlat, 2017). This information may establish treatment goals for the patient. Yale-Brown Obsessive-Compulsive Scale

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A second component of the psychiatric interview is obtaining a family psychiatric history (Carlat, 2017). I find this component of the interview important because oftentimes psychiatric illnesses, or risk of substance use disorders, have a familial tie. For example, for a patient presenting to the clinic with depressive symptoms that have a significant family history of bipolar, it may be pertinent to inquire about symptoms of mania that the patient may not recognize as symptoms of a psychiatric disorder.

A third component of the psychiatric interview is obtaining a psychiatric history (Carlat, 2017). I find this piece of the psychiatric interview important because it gathers information about past treatments and the age of onset of symptoms (Carlat, 2017) Yale-Brown Obsessive-Compulsive Scale. It is important for a clinician to know which treatments were already tried and whether or not they were successful.

Psychometric Properties

The rating scale that I was assigned to explore and discuss is the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Originally developed for adults, this is a ten-item scale that establishes the severity of Obsessive-Compulsive Disorder (OCD) after a formal diagnosis is made (Stanford Medicine, 2020). The scale was developed in 1989, it showed psychometric properties in measuring the effects of medication and psychotherapy for the treatment of OCD (Castro-Rodrigues et al., 2018). However, the original scale showed a weakness in measuring severe cases and inconsistently measuring resistance to obsessions (Castro-Rodrigues et al., 2018).

The scale was revised in 2000, now known as the Y-BOCS-II (Castro-Rodrigues et al., 2018). Items in the scale were rephrased and the order of assessments were changed; this is now used as the gold standard to measure the severity of OCD symptom (Castro-Rodrigues et al., 2018) Yale-Brown Obsessive-Compulsive Scale.

Rating Scale Used in Practice

As stated above, the Y-BOCS is not used to make a case for the diagnosis of OCD, but rather establish the severity of symptoms. A clinician may implement this assessment and then share it with their patient in an attempt to assist the patient in recognizing the severity of their symptoms, and which symptoms may be part of their illness (Standford Medicine, 2020). In addition, a response to treatment may be measured through a decrease in scoring on the sale (Stanford Medicine, 2020).The revised scale, Y-BOCS II, has been found to have excellent psychometric properties in the measurement of the severity of OCD symptoms (Castro-Rodrigues et al., 2018) Yale-Brown Obsessive-Compulsive Scale.

Since its creation in 1989 for use in adult patients, the scale has been modified to assess children and adolescents (Lopez-Pina et al., 2015). In addition to assessing the severity of symptoms in OCD, the scale is useful in measuring the severity of symptoms where compulsions are a symptom of the disorder; for example, such as eating disorders, gambling, etc. (Lopez-Pina et al., 2015).

References

Carlot, D. (2017).
The psychiatric interview
(4
th
ed.). Wolters Kluwer.

Castro-Rodrigues, P., Camacho, M., Almeida, S., Marinho, M., Soares, S., Barahona-

Correa, J., & Oliveira-Maia, A. (2018). Criterion validity of the Yale-Brown Obsessive-Compulsive Scale second edition for the diagnosis of obsessive-compulsive disorder in adults.
Frontiers in Psychiatry, 9,
431. https://www.frontiers.org/articles/10.3389/fpsyt.2018.00431/full Yale-Brown Obsessive-Compulsive Scale

Lopez-Pina, J., Sanchez-Meca, J., Lopez-Lopez, J., Marin-Martinez, F., Nunez-Nunez,

R., Rosa-Alcazar, A., … & Ferrer-Requena, J. (2015). The Yale-Brown Obsessive-Compulsive Scale: a reliability generalization meta-analysis.
Assessment, 22
(5), 619.628. https://www.researchgate.net/profile/Ja-Lopez-Pina/publication/266380252_The_Yale-Brown_Obessive_Compulsive_Scale/links/550090d70cf2de950a6ea031/The-Yale-Brown-Obsessive-Compulsive-Scale.pdf

Stanford Medicine. (2020). Obsessive-compulsive and related disorders.

https://med.stanford.edu/ocd/about/diagnosis.html Yale-Brown Obsessive-Compulsive Scale

 

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

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. Yale-Brown Obsessive-Compulsive Scale

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

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.

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond
 to at least 
two
 of your colleagues on 
2 different days
 by comparing your assessment tool to theirs.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! Yale-Brown Obsessive-Compulsive Scale

 

Responses

Thank you for your very educational post.  I enjoyed reading yours and our colleagues’ posts this week because I am learning a lot in terms of various evidence-based rating scales.  I admit I am only familiar with a very few and those that we use in the hospital for our interviews and assessments with patients. Yale-Brown Obsessive-Compulsive Scale

Your post caught my attention because I have never heard of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).  This is one scale that we do not normally use in our hospital setting as clinicians.  Upon further research, I found out that The YBOCS was developed in the late 1980s by Drs Wayne Goodman and Dennis Charney to measure the severity of symptoms in OCD (Yale School of Medicine, n.d.).  As you mentioned, it has ten items rated based on a semistructured interview. The first five items concern obsessions: the amount of time that they consume, the degree to which they interfere with normal functioning, the distress that they cause, the patient’s attempts to resist them, and the patient’s ability to control them. The remaining five items ask parallel questions about compulsions (Sadock et al., 2015).  This scale is considered the gold standard to evaluate OCD.  According to Rector and Arnold (2016), the Y-BOCS was designed to measure and compare the efficacy of treatments, initial medical treatment, and then CBT in the field of OCD.  Sadock et al., (2015), added that the YBOCS has become the standard instrument for assessing OCD severity and is used in virtually every drug trial. It may also be used clinically to monitor treatment response.  This scale has been used in the first clinical trials demonstrating the efficacy of the medications that are now standard treatments for the disorder – the SSRIs and the neuroleptics. Yale-Brown Obsessive-Compulsive Scale

References

Rector, N., & Arnold, P. (2016, March). Yale-Brown Obsessive Compulsive Scale. Retrieved December 10, 2020, from https://www.sciencedirect.com/topics/medicine-and-dentistry/yale-brown-obsessive-compulsive-scale

Sadock, B. J., Ruiz, P., & Sadock, V. A. (2015). 
Kaplan et Sadocks synopsis of psychiatry: Behavioral sciences, clinical psychiatry
 (11th ed.). Philadelphia: Wolters Kluwer.

Yale School of Medicine. (n.d.). History of the Clinic. Retrieved December 10, 2020, from https://medicine.yale.edu/psychiatry/ocd/aboutus/history/ Yale-Brown Obsessive-Compulsive Scale

 

 

 

Thanks for your post!

When comparing the Hamilton Anxiety Rating Scale to the Yale-Brown Obsessive-Compulsive Scale, similarities become quickly apparent. Because Obsessive-Compulsive disorder is a specific type of anxiety disorder, it makes sense the two scales would address some of the same symptoms (Storch, et al., 2010). Like the HAM-A, the Y-BOCS is used to establish the severity of symptoms, but not as a tool for diagnosis. Both scales are subjective and require the provider to observe clinical presentation in addition to the scale results themselves, and then to interpret accordingly. Though the Y-BOCS is directed at a more specific subset of symptoms, they are very comparable in their purpose. Yale-Brown Obsessive-Compulsive Scale

References

Hamilton, M. (n.d.). Hamilton anxiety rating scale (HAM-A). 
Br J Med Psychol 1959
; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

Storch, E. A., Rasmussen, S. A., Price, L. H., Larson, M. J., Murphy, T. K., & Goodman, W. K. (2010). Yale-Brown Obsessive-Compulsive Scale–Second Edition. 
Psychological Assessment,
22(2), 223–232. Yale-Brown Obsessive-Compulsive Scale

NURS – 6003 Week 1 Networking Opportunities

My Goals and University Vision and Mission

After being a nurse for 11 years, I feel the healthcare field is changing its dynamics and feel naturopathic medicine has become more excepted over recent years. Around five years ago, I developed an interest in naturopathic medicine and would like to pursue that after completion of my Nurse Practitioner degree.
 
My current professional goal is to eventually open a naturopathic office treating patients and also have a separate component for energy healing, massage, acupuncture, and other treatment modalities in the alternative medical field. “
Principles of Naturopathic Medicine
—that include such things as stimulating the healing power of the body and addressing the underlying causes of disease, rather than focusing on alleviating symptoms. NURS – 6003 Week 1 Networking Opportunities The practice of naturopathic medicine requires understanding illness within the context of a person’s whole life
 
(Education, 2020).
 
When searching a University to advance my degree, I did not yet know naturopathic and alternative medicine would be my focus. Therefore, my goal was to pursue a degree for Family Nurse Practitioner. Since I began at Walden University, I was able to slowly gain more detail and focus on what I believe to be my true interest. NURS – 6003 Week 1 Networking Opportunities

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I came to Walden University after finishing my BSN at Grand Canyon University. Once finished with my BSN, I found Grand Canyon’s NP program was not credentialed in Michigan and therefore had to find a college to transfer too. Several factors played a role in my choice at Walden University. Two of my biggest concerns were cost and flexibility. Like many, I compared the cost with other schools but that would not be the make it or break it in my decision. One very big concern was flexibility since I work two jobs. I found while completing my degree at Grand Canyon, that homework and assignments were consistently due throughout the entire program, on the same days. This type of consistency throughout the program, made it possible for me to work two jobs and create a work schedule that was consistent and able to be planned out ahead of time. I found that to be more beneficial than anything and was looking for an NP program with the same type of format. Walden had that same exact format, which was a huge two thumbs up for me. NURS – 6003 Week 1 Networking Opportunities After learning cost and its scheduling consistency, I began to research Walden’s mission, vision, and goals, for its University. I liked that Walden’s vision of knowledge being, “judged worthy to the degree that it can be applied by its graduates to the immediate solutions of critical societal challenges, thereby advancing the greater global good” (University, Vision, Mission, and Goals, 2019). I personally think of myself as a humanitarian and also make decisions based on the greater good of the people. By increasing my knowledge in this program, I feel I can be part of creating solutions for the greater good of society.
 
 Walden’s mission to create a diverse community within the professional healthcare system to allow healthcare professionals to advance their skills and knowledge in order to create a positive social change, allows everyone at all levels of healthcare to have an opportunity to make a difference in the community
 
(University, 2019). Attending a college that promotes diversity among its students, for me, is beneficial in promoting different perspectives within healthcare and among students. One of 
 
Walden’s goals are to “provide innovative, learner-centered educational programs that recognize and incorporate the knowledge, skills, and abilities”
 
(University, Vision, Mission, and Goals, 2019). My goal is to also do my best to develop these skills to better treat patients within my chosen field. NURS – 6003 Week 1 Networking Opportunities

 

 

University Outcomes

Walden University outcomes are in alignment with my outcomes to have the ability to “facilitate positive social change where they work, in their communities, and society”
 
(University, Vision, Mission, and Goals, 2019). My goal is to have the ability to create positive changes within my work environment and within my community and neighborhood. I relate these outcomes to having the ability to be an advocate of creating better outcomes within the healthcare system and having the knowledge to promote those outcomes to the community where I live and work. This also includes having the knowledge and expertise to know how to improve the healthcare field.
 

MSN Learning Outcomes

As most of us know, not only is high-quality healthcare an objective among our communities, but so is cost-effective healthcare. Everyone deserves both, and as stated in Walden’s learning outcomes, I considered this to be a primary goal in learning my role as an NP student. Good healthcare is well rounded and includes both of these criteria in order to benefit the patient. Learning how to “critique evidence-based literature”
 
(University, Master of Science in Nursing (MSN), 2019)
 
is also important for me to continue to educate myself in the future as the healthcare field changes with new technology and medical discoveries. NURS – 6003 Week 1 Networking Opportunities Walden also has a learning outcome to teach its students to develop the ability to correctly communicate not only to their patients, but to the community, other professionals within the healthcare field, and diverse populations
 
(University, Master of Science in Nursing (MSN), 2019). Communicating appropriately within this profession is beneficial in the advancement of my career.

Academic and professional individuals are vital to the success of completion of this program, but also important to helping you throughout your career. I am currently a member of the American Association of Nurse Practitioners which gives me access to professional individuals and vital information within my chosen field. I have also developed a relationship with two prior Walden students who have recently graduated the Nurse Practitioner program and have helped me connect with my current preceptor and two other preceptors in the future rotations. These prior students have been extremely valuable to me as resources for the program and as a support team for questions and answers regarding any first-hand information I may need regarding the program. By collaborating with these individuals, doors have opened for me to complete my degree and most likely obtain an NP position in the future.

 

References

Education, C. o. (2020).
 
Naturopathic Medicine
. Retrieved from Council on Naturopathic Medical Education: https://cnme.org/naturopathic-medicine-an-overview/

University, W. (2019).

University, W. (2019, October 4).
 
Master of Science in Nursing (MSN)
. Retrieved from Walden University Catalog: https://catalog.waldenu.edu

University, W. (2019, October 4).
 
Vision, Mission, and Goals
. Retrieved from Walden University Catalog: https://catalog.waldenu.edu

 

response

I was very impressed with your explanation of Naturopathic Medicine.  I am not to familiar with it, but I believe finding the etiology of the problem will be more beneficial for the patient instead of treating the symptoms.   It is also mentioned in your citations from Education, 2020 that it includes stimulating the healing power of the body and that is why I have chosen to obtain my degree as a Psychiatric Mental Health Nurse Practitioner (PHMNP). It was interesting when I did a search on the Web, I was able to find an article of similarity.  According to the Journal of alternative and complementary medicine (2016), the Mind-Body Complementary Health (CHAs) “are a diverse group of health care practices focused on the relationships among the mind, body, brain, and behavior that are not currently considered a part of the conventional medicine” (Burnett-Zeigler et al., 2016, para. 2). NURS – 6003 Week 1 Networking Opportunities

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     I was initially going to return to Chamberlain College of Nursing where I obtained my BSN, but knowing Walden utilized the same platform and provided a had specialization for Mental Health Nursing the decision became easier.  It was not until I spoke with the enrollment specialist and now reviewed in detail the Vision, Mission, and Goals set for by Walden that I have made the correct choice.  Walden’s mission to take an eager fresh new student again like myself and bring me into a community of professionals, so that I can promote a positive social change is what I will need and forever be grateful for (
Walden University
, 2020, para. 2).

References

Burnett-Zeigler, I., Schuette, S., Victorson, D., & Wisner, K. (2016). Mind–Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. 
Journal of Alternative and Complementary Medicine
. Retrieved June 2, 2020, from 
https://doi.org/10.1089/acm.2015.0038

Vision, Mission, and Goals
. (2020). Walden University. Retrieved June 1, 2020, from 
https://catalog.waldenu.edu/content.php?catoid=172&navoid=59420

 

Discussion: Networking Opportunities

In this module, you begin laying the foundation for your academic and professional success. Your efforts begin with a vision that includes your own definition of success. Your vision may vary from those of your colleagues, but this does not mean you have to take these first steps alone. NURS – 6003 Week 1 Networking Opportunities

Walden University and the College of Nursing also have a vision and mission, which include helping you to make your own vision a reality. Members of your new academic community, such as faculty, support teams, and fellow students, can also be helpful. Current practitioners and other member of the professional community can also help you to clarify your vision.

This Module’s Discussion asks you to consider how the Walden mission and vision as well as the College of Nursing’s mission and vision apply to your professional and academic goals. You will also begin to identify individuals and teams who can help you along the way as you begin designing the “blueprint”—your Academic Success and Professional Development Plan—that will guide you toward your own vision for academic and professional success.

To Prepare:

Review the Walden and College of Nursing mission and vision statements, Walden’s goals and University Outcomes, and the MSN Program Learning Outcomes presented in this Module’s Learning Resources.

Reflect on your professional and academic goals as they relate to your program/specialization.

Consider how the information in these resources fit with your own goals and to your becoming a scholar-practitioner.

Also consider academic and professional individuals and teams with whom you may collaborate in support of your efforts as a student at the university and as a professional within your organization and career. NURS – 6003 Week 1 Networking Opportunities

By Day 3 of Week 1

Post
 a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiatives relate to your professional and academic goals and to your becoming a scholar-practitioner. Also include an explanation for how the Walden MSN Program Outcomes and perspectives relate to your professional and academic goals and to your becoming a scholar-practitioner.

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues’ posts by suggesting additional individuals and/or teams with whom you wish to collaborate or by offering additional networking strategies.

 

I am currently attending Walden to receive my MSN and, ultimately, become a nurse practitioner (NP). I have been a nurse for a little over six years, primarily in the Oncology field. I hope to remain in the oncology field when I finish my degree.

Walden’s (n.d.) states their vision is to advance the greater good. The mission indicates there should be a transformation in students to scholar-practitioners (Walden, n.d.). A scholar-practitioner would use knowledge to drive commitment and ethical conduct (Miller, 2013). To become an NP, I feel I would be advancing the greater good as an NP can increase efficiency and effectiveness of care (Fowler, Landry, & Nunn, 2019). NPs also make care more accessible and improve patient satisfaction (Fowler, Landry, & Nunn, 2019) NURS – 6003 Week 1 Networking Opportunities. By transforming myself into an NP, I can utilize my knowledge to drive change in the world and ethically advance the greater good.

Nurses are taught from early on to follow one of the university outcomes, which is to practice ethical integrity (Walden, n.d.). By attending Walden and becoming an NP, I demonstrate my commitment to another university outcome: being a lifelong learner (Walden, n.d.). NURS – 6003 Week 1 Networking Opportunities

Another university outcome, specifically having a positive impact on my profession (Walden, n.d.), can be accomplished in part by professional networking. Professional networking can be achieved by being an active member of a professional nursing organization, such as the ANA (Schmidt, n.d.). Being a member of the Oncology Nursing Society fills not only this goal, but also the lifelong learning goal, as there are frequent networking and learning events sponsored by this organization. These events further our knowledge and understanding of providing the most up-to-date, evidence-based care to our patients. NURS – 6003 Week 1 Networking Opportunities

References

Fowler, L.H., Landry, J., and Nunn, M.F. (2019). Nurse Practitioners Improving Emergency Department Quality and Patient Outcomes. 
Critical Care Nursing Clinics, 31(2): 237-247. 
DOI: 10.1016/j.cnc.2019.02.010.

Miller, J. (2013). Theory to Practice or “Becoming a Scholar-Practitioner”. Retrieved from 
https://sites.psu.edu/joancsa/2013/02/10/theory-to-practice-or-becoming-a-scholar-practitioner/

Schmidt, K. (n.d.). 5 reasons nurses should engage in professional networking [Blog post]. Retrieved from 

5 Reasons Nurses Should Engage in Professional Networking

Walden University (n.d.). Walden University catalog. Retrieved from 
https://catalog.waldenu.edu
. NURS – 6003 Week 1 Networking Opportunities