NRNP 6675 Final Exam – Treatment aimed at reducing intimate partner violence and domestic violence includes which of the following?
Question 3 1 pts
Treatment aimed at reducing intimate partner violence and domestic violence includes which of the following?
Group of answer choices
Enhancing self-efficacy of the victim.
Reducing recidivism of the abuser.
Hormonal therapy for the perpetrator of abuse
A and B only
NRNP-6675 Week 9: Discussion – Prescribing for Older Adults and Pregnant Women
Prescribing for Older Adults and Pregnant Women
After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks.
In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the
DSM-5-TR
to use.
Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.
By Day 3 of Week 9
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.
Read
a selection of your colleagues’ responses.
By Day 6 of Week 9
Respond
to
at least two
of your colleagues on
2 different days
who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.
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
Reply
button to complete your initial post. Remember, once you click on
Post Reply
, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on
Post Reply
!
This topic is closed for comments.
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Safurat Olaniba-Adebisi
Jan 29, 2023 10:56pm
Reply from Safurat Olaniba-Adebisi
Discussion week 9
Response 2
Thank you for your post. Your post is very interesting and highly educative.
According to Jahan et al., 2021, class C drugs are safe for use in treating pregnant women safe to use while expecting or nursing a baby. Therefore, Bupropion (Wellbutrin) and Duloxetine (Cymbalta) are an appropriate drug of choice for the pregnant woman. Nonpharmacological treatment is psychotherapy-CBT.
References
Jahan, N., Went, T. R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I. A., & Alfonso, M. (2021). Untreated depression during pregnancy and its effect on pregnancy outcomes: A Systematic Review.
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Safurat Olaniba-Adebisi
Jan 28, 2023 10:32pm
Reply from Safurat Olaniba-Adebisi
Discussion week # 9
Depression in an elderly patient.
The DSM criteria for Depression in the elderly. We must have five or more symptoms present for at least two weeks and at least either one of 1- depressed mood 11 loss of interest/ pleasure need to be present.
The five symptoms are Fatigue or loss of interest, insomnia/ hypersomnia, thought of death, or SI.
FDA-APPROVED ANTIDEPRESSANTS FOR THE ELDERLY
Sertraline is FDA-approved drug, and a safe medication for the elderly due to its tolerability rate, it can be used alone or as an adjunct with another medication possibly SSRI’s .In the journal analysis, it was noted that Sertraline has efficacy and tolerability for different kinds of depression as in other medications, Sertraline has some side effects, such as EPS, dystonia, parkinsonism, and dyskinesia. Therefore, patient education is necessary for better outcomes.
The off-label drug for depression in an elderly is Seroquel, “Quetiapine is an atypical antipsychotic approved for treating schizophrenia, bipolar depression, and mania but is frequently used in an off-label manner to control the behavioral and psychological symptoms of dementia in elderly patients with dementia.”(Ganzetti et al., 2021).
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Safurat
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Kately Anne Sylvia
Jan 28, 2023 4:14pm
Reply from Kately Anne Sylvia
Week 9: Special Considerations Related to a Vulnerable Population
Kately Anne Sylvia
College of Nursing- PMHNP, Walden University
NRNP 6665: PMHNP Across the Lifespan II
Dr. Madeleine Reyes
January 29, 2023
Week 9: Special Considerations Related to a Vulnerable Population
Introduction
This purpose of this discussion is to address special considerations related to a vulnerable population; this population is older adults with major depressive disorder (MDD). The discussion will include the following: one, a recommendation for a Federal Drug Administration (FDA) approved drug, an off-label drug and a non-pharmacological intervention for treating older adults with MDD. Two, a risk assessment will be identified to help to inform the treatment decision making, and the risks and benefits of the FDA-approved medication and the off-label medication will be addressed. Last, the clinical practice guidelines of MDD for the older population will be discussed.
FDA-Approved Drug, Off-Label Drug and a Non-Pharmacological Intervention
Later-life depression occurs in older adults who are 60 years or older (Sozeri-Varma, 2012 as cited in Robertson et al., 2019). Also, depression often goes undetected or is inadequately treated in older adults (Kok & Reynolds, 2017). Antidepressants are usually the first line approach to treatment for MDD. However, an off-label medication and a non-pharmacological intervention may significantly help the patient with their symptoms of depression. A FDA-approved medication therapy for older patients with MDD that will be chosen is one of the selective serotonin reuptake inhibitors (SSRI) called fluoxetine. An off-label drug that will be selected for MDD in older adults is modafinal. Last, a non-pharmacological intervention chosen for this population is interpersonal psychotherapy (IPT). IPT focuses on stressful life events “that are associated with the onset, exacerbation, or perpetuation of current symptoms, while helping patients to connect with social supports and to improve the quality of their relationships (Ravitz & Watson, 2014; Weissman et al., 2007, as cited in Cuijpers et al., 2016).
A Risk-Assessment & the Risks and Benefits of the FDA-Approved and Off-Label Drug
A risk assessment I would use to inform my treatment decision making is the Beers Criteria (BC). BC is a tool that evaluates drugs for “potentially inappropriate medication (PIM) in older adults” (Khamis et al., 2019). PIM is the benefits of the medication must outweigh a drug’s potential for adverse effects; the BC goal is to decrease the PIM to improve the quality and safety of care to older adults (Khamis et al., 2019).
The benefits of SSRIs is they have a better safety profile than other classes of antidepressants “including fewer antimuscarinic and cardiotoxic side effects, rarely fatal in overdose, less dosage titration, once daily administration and greater patient adherence (Mottram et al., 2006; National Institute for Health and Care Excellence [NICE], 2009; Taylor et al., 2018, as cited in Robertson et al., 2019). Some of the more serious risks associated with SSRIs in older adults with co-morbidities are some of the following: first, SSRIs increase the risk of gastrointestinal bleeding, history of bleeding or using such drugs as non-steroidal anti-inflammatory drug (NSAID) or warfarin (Anglin et al., 2014; Jiang et al., 2015; NICE, 2009; Taylor et al., 2018, as cited in Robertson et al., 2019).
According to Kaser (2018), cognitive problems are persistent in depression such as memory, concentration and decision making problems, and cognitive problems do not respond to anti-depressant medications. The off-label drug, modafinal, has been found to have beneficial effects in cognitive functioning (Kaser, 2018). In a study by Kaser (2018), it “showed feasibility of modafinal use to address decision-making problems in depression,” and showed “decision-making cognition can lead to better outcomes in depression.” Side effects that are more common and do not need medical attention are anxiety, nausea, nervousness and headache (Mayo Clinic, 2023). Some side effects that are less common, but most likely will need immediate medical care are the following: black stool, blurred vision, chest pain, clumsiness, confusion, problems with memory, shortness of breath, shaking, troubling voiding, unusual bleeding, and unusual weakness (Mayo Clinic, 2023).
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Clinical Practice Guidelines
The clinical practice guidelines from the American Psychological Association (APA) Guideline Development Panel recommend for the initial treatment of MDD for older adults is the following: “1. Either group life review treatment or Group Cognitive Behavioral Therapy (either alone or added to usual care) over no treatment.” or “2. Combined pharmacotherapy and IPT over IPT alone” (APA, 2019, p 13). For the pharmacotherapy, the panel recommends a second-generation antidepressant because of decreased potential for side effects. The strength of recommendation for use of this initial therapy for MDD in older adults is that APA recommends it for use (2019, p. 14). APA has other therapies, but the strength of the recommendations are “conditional recommendation for use,” and “Insufficient evidence for a recommendation” (APA, 2019, p. 14). Furthermore, for the prevention of recurrence of MDD in older adults APA recommends either the following: “combination interpersonal psychotherapy and pharmacotherapy” or “combination supportive care and pharmacotherapy” (APA, 2019, p. 17). The strength of the recommendation for the prevention of recurrence of MDD in older adults is that APA recommends this for use (2019, p. 17).
Conclusion
Vulnerable populations such as older adults have unique mental health needs compared to younger and middle aged adults. Psychiatric Mental Health Nurse Practitioners (PMHNP) need to be aware of all the drug-to-drug interactions associated with poly-pharmacy because of the co-morbidities the older adult patient’s have that may cause potential harm. Moreover, it is recommended for older adults with MDD to take SSRIs because they have a better safety profile, and to start interpersonal psychotherapy (IPT), which is recommended by APA. An off-label drug such as modafinal can be tried because of its’ positive effects on cognitive functioning in older adults, and a non-pharmacological intervention such as IPT should be started because it helps patients connect with social supports and to improve the quality of their relationships. Furthermore, it is important for PMHNPs to know if the benefits outweigh the risks when taking antidepressants for MDD. Beers Criteria (BC) is a risk assessment that is to decrease the potentially inappropriate medication (PIM) to improve the quality and safety of care to older adults. Last, clinical practice guidelines should be used to verify if the best treatment is initiated and maintained for older adults with MDD to ensure best patient outcomes.
Reference
s
American Psychological Association. (2019).
APA clinical practice guideline for the treatment of depression across three age cohorts
. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.apa.org/depression-guideline/guideline.pdf
Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal psychotherapy for mental health problems: A comprehensive meta-analysis.
The American Journal of Psychiatry, 173
(7). doi.org/10.1176/appi.ajp.2015.15091141
Khamis, S., Abdi, A. M., Uzan, A., & Basgut, B. (2019). Applying Beers criteria for elderly patients to assess rational drug use at a university hospital in Northern Cyprus.
J Pharm Bioallied Sci, 11
(2). doi: 10.4103/jpbs.JPBS_208_18
Kok, R. M., & Reynolds, C. F. (2017). Management of depression in older adults: A review.
JAMA,
317
(20). doi:10.1001/jama.2017.5706
Mayo Clinic. (2023). Modafinal (oral route). https://www.mayoclinic.org/drugs-supplements/modafinil-oral-route/side-effects/drg-20064870?p=1
Robertson, L., Bertolini, F., Meader, N., Davies, S. J. C., Barbui. C., Gilbody, S., & Churchill, R. (2019). Antidepressants for major depression disorder in older people: A network meta‐analysis.
Cochrane Database of Systematic Reviews, 9
. doi:10.1002/14651858.CD013394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727180/
Kaser, M. (2018, November 8).
Computational approach to reinforcement learning in patients with remitted depression: Results from a double-blinded, randomised, placebo-controlled study
[Video]. The Academy of Medical Sciences. Youtube.
https://www.youtube.com/watch?v=eerHwrg_6YM.
Links to an external site.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.apa.org/depression-guideline/guideline.pdf
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Tina Baker
Jan 26, 2023 7:15pm
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WK9Assgn+Baker+T6675.docx
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Colette Affiah
Jan 26, 2023 5:35pm
| Last reply Jan 27, 2023 12:36am
Reply from Colette Affiah
Initial Post-Colette Affiah
According to antidepressants, risk can be decreased and the medication more tolerable if the dose is started slowly and titrated slowly up to a tolerable level. Depression in the elderly, according to Robertson et al. (2019), affects the mood and causes anhedonia are lack of pleasure in once-enjoyed activities. Depression also causes low appetite and feeling worthless or hopeless. Pt. also has sleep disturbance, and some patients have an increased rate of suicidality. The elderly, considered adults aged 60 and above, have what is considered later-age depression. As noted by Robertson et al., depression affects 7.5% of women and 5.5% of men aged 55 to 74. The elderly population is prone to taking at least four or more medications for other health issues so drug to drug or drug to disease, as noted by Robertson et al. (2019), so careful dosing becomes a priority in the dosing and treatment plan for the elderly living with Major Depression disorder. According to Robertson et al., antidepressants should be prescribed to the elderly with consideration to their age, physical health, and drug-drug interactions. Depression, as postulated by Robertson et al., is because by the decrease of the monoamines, which include serotonin, norepinephrine, and dopamine, the key brain mood regulators. By taking serotonin, the activities of serotonin become enhanced, allowing for mood regulation for elderly patients.
FDA-APPROVED ANTIDEPRESSANTS FOR THE ELDERLY
Sertraline, an FDA-approved medication, is a Selected Serotonin reuptake Inhibitor and is recognized for treating Major Depression Disorder. According to Lenze & Ajam (2019), in the systematic review and the meta-analysis of comparative studies of antidepressants in older adults, the key finding was that SNRIs but not SSRIs were associated with adverse events versus placebo during acute treatment. Sertraline also has its risk and benefits in the treatment of MDD. Lenze & Ajam (2019) noted that Sertraline is safe for the elderly with a good tolerability rate, adding that it is significantly used in patients aged 65 and over and sometimes in combination with other central nervous system-active agents. The studies by Alexopoulos (2011) noted that the sertraline efficacious rate was higher than that of the placebo effect. Though Alexpoulos (2011) noted that for all types of depression, Sertraline was rated highest for efficacy and tolerability, the new studies have differed in the results, which may be partly due to the low doses of Sertraline prescribed to ensure tolerability and low incidence of side effects. Even with the efficacy of Sertraline also comes with some side effects, including extrapyramidal symptoms like dystonia, parkinsonism, and dyskinesia. As such, there must be followed up scheduled to monitor for the presence of these symptoms. As speculated by Edinoff et al. (2021), the most concerning adverse reaction are the side effect of hyponatremia, which is common in the elderly. According to Edinoff et al. (2021), serotonin may increase the antidiuretic hormone, thereby causing the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).
OFF-LABEL MEDICATION FOR DEPRESSION
Seroquel is an off-label to treat depression, and studies show that using this medicine in low doses has good tolerability and efficacy in patients with depression. Seroquel, an antipsychotic according to Rowe (2007), can improve low mood, which is a significant problem with depression. As noted by Muller et al. (2020), Quetiapine, an antipsychotic drug used for schizophrenia and bipolar disorder, is usually prescribed to the elderly with an indication of depression. The side effect of this medication is that even in very low doses, it can cause serious adverse drug events of hip fractures, orthostatic hypotension, and pneumonia. Muller et al. (2020), in the study of Seroquel in nursing homes of Southern Switzerland, also stated that this medication is used in the presence of dementia, a common problem among the elderly, and is linked with increased risk for mortality. Mueller et al. (2020) also stated that the anonymous data collected during September and November 2016 in 15 nursing homes from either electronic or paper documentation. Out of the total of 1173 patients analyzed, Muller et al. Stressed that 379 patients were prescribed Seroquel. As noted by Muller et al. (2020), the side effects of Seroquel consist of impaired cognitive and functional capabilities. The Clinician is therefore faced with the challenges of ensuring that the elderly safety and tolerance level are maintained while treating the psychological condition of Major Depression Disorder.
According to Park et al.(2014), in the study of the evidenced-based, non-pharmacological treatment guideline for depression in Korea, Cognitive behavioral therapy was stated can be effective for the treatment of depression in mild to moderate depression. Park et al. (2014) state that the non-pharmacological considered by the clinical psychiatrist could provide a good adjunct to the pharmacological approach to producing successful stories of improvement in depressed patients. As clinicians, the success of treating depressed patients is to encourage the patient’s involvement in cognitive behavioral therapy. According to the World Health Organization (WHO), between 2015 and 2050, Gramaglia et al. (2021) noted that the estimated number of older adults that would be diagnosed with MDD is almost estimated to double to 22%. Moreover, Gramaglia et al. (2021) postulated that cognitive behavioral therapy effectively treats MDD in the elderly.
References
Alexopoulos GS. Pharmacotherapy for late-life depression. J Clin Psychiatry. 2011 Jan;72(1):e04. doi: 10.4088/JCP.7085tx2cj. PMID: 21272511; PMCID: PMC3314291.
Edinoff AN, Akuly HA, Hanna TA, Ochoa CO, Patti SJ, Ghaffar YA, Kaye AD, Viswanath O, Urits I, Boyer AG, Cornett EM, Kaye AM. Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurol Int. 2021 Aug 5;13(3):387-401. doi: 10.3390/neurolint13030038. PMID: 34449705; PMCID: PMC8395812.
Lenze EJ, Ajam Oughli H. Antidepressant Treatment for Late-Life Depression: Considering Risks and Benefits. J Am Geriatr Soc. 2019 Aug;67(8):1555-1556. doi: 10.1111/jgs.15964. Epub 2019 May 29. PMID: 31140584; PMCID: PMC6684410.
Müller L, Noseda R, Bertoli R, Bissig M, Ceschi A. Off-label use of quetiapine in nursing homes: Does medical specialty of prescribing physicians play a role? Br J Clin Pharmacol. 2020 Jul;86(7):1444-1445. doi: 10.1111/bcp.14232. Epub 2020 Feb 25. PMID: 32100324; PMCID: PMC7318997.
Robertson L, Bertolini F, Meader N, Davies SJC, Barbui C, Gilbody S, Churchill R. Antidepressants for major depression disorder in older people: a network meta‐analysis. Cochrane Database Syst Rev. 2019 Sep 5;2019(9):CD013394. doi: 10.1002/14651858.CD013394. PMCID: PMC6727180. NRNP-6675 Week 9: Discussion – Prescribing for Older Adults and Pregnant WomenNRNP-6675 Week 9: Discussion – Prescribing for Older Adults and Pregnant Womenand discussion thread from Colette Affiah
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Neethu John
Jan 25, 2023 11:05pm
| Last reply Jan 26, 2023 2:15pm
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Anxiety disorders are prevalent in pregnant women with equal or higher incidence and are often underdiagnosed (Lemon, Vanderkruik, Arch, & Dimidjian, 2020). The first line treatment for generalized anxiety disorder amony pregnant women is cognitive behavioral therapy which has good results, but patients who still need medications should take caution but has to consult the provider for options for medications. Survey shows majority of women that have taken antidepressants stop at the time of pregnancy and the abrupt discontinuation of SSRI’s can harm in many ways and the discontinuation must be discussed with the provider (Lemon, Vanderkruik, Arch, & Dimidjian, 2020). Escitalopram is an SSRI that is approved for use in pregnancy if the benefit outweighs the risks (FDA, 2017). A study conducted with seven full term pregnant women with escitalopram did not show any major fetal harm and had normal Apgar scores upon delivery. Infants who were exposed to escitalopram also did not show any major health problems as well (Bellantuono, Bozzi & Orsolini, 2013). There are drugs that has not been approved by the FDA but is still the first line treatment for some conditions. The drugs that have not been FDA approved does not have enough research and studies behind it. Off the label drugs can be as effective as FDA approved drugs. Since FDA approved drugs are based on vast research, it is considered to be a safer option with the back up of studies. When off the label drugs are used, it is like they are not studied properly and thus considered with more impact (Wittich, Burkle, &Lanier, 2012).
Reference
Bellantuono, C., Bozzi, F., & Orsolini, L. (2013). Safety of escitalopram in pregnancy: A case series. Neuropsychiatric disease and treatment. Retrieved, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772871/
FDA. (2017). Lexapro (escitalopram oxalate).
Lemon, E., Vanderkruik, R., Arch, J. J., & Dimidjian, S. A. (2020). Treating anxiety during pregnancy: Patient concerns about pharmaceutical treatment. Maternal and Child Health Journal, 24(4), 439–446. https://doi.org/10.1007/s10995-019-02873-7
Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2012, October). Ten common questions (and their answers) about off-label drug use. Mayo Clinic proceedings. Retrieved, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538391/
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Solange Ndah Missibi
Jan 25, 2023 11:01pm
| Last reply Jan 27, 2023 4:05pm
Reply from Solange Ndah Missibi
WK 9 Discussion
Selected Disorder: Major Depressive Disorder (MDD) in Pregnant Women
Major Depressive Disorder (MDD) is widespread in pregnant women and lactating mothers due to hormonal changes, physical limitations, social and economic impact, and stress. According to the American Congress of Obstetricians and Gynecologists (ACOG, 2021), about 14-23% of pregnant mothers nationwide are affected by depression annually, and often goes untreated and can result in high suicide tendencies, substance abuse, poor maternal medical health, fetal growth and birth weight, poor interpersonal relations as well as increase risk of premature birth (American Congress of Obstetricians and Gynecologists, 2021). The risk of injury to the fetus also increases during treatment with some antidepressants resulting in congenital disabilities and withdrawal symptoms in the newborn (Mayo Clinic, 2020).
When treating depression in pregnant women, the decision to prescribe or treat is strictly case-by-case basis based on the patient’s symptoms and severity, as there are currently no FDA-approved antidepressant drugs totally safe for use in this population (Gorun, 2018). Antidepressant drugs may have neonatal consequences; however, untreated depression has been shown to have more maternal and fetal consequences (MGH, 2018). Therefore, the patient and clinician must decide whether to initiate or continue therapy for depression during pregnancy.
One selected drug of choice is
Fluoxetine.
Approximately 1.1 million pregnant women with depression in 2016 were treated with an antidepressant, with the most commonly prescribed being SSRIs such as Sertraline, Citalopram, Escitalopram, and Fluoxetine with the exception of Paroxetine (Centers for Disease Control and Prevention (CDC), 2017).
Risks and Benefits of Fluoxetine
Fluoxetine, like most antidepressants, falls into Category C, meaning not enough well-controlled studies in humans due to the risk in this group, but potential benefits may warrant the use of the drug in pregnant women despite potential risks (MGH, 2018). Fluoxetine has been linked with maternal weight changes, neonatal syndrome like jitteriness, irritability, respiratory problems, low Apgar score, hypoglycemia, convulsions, as well as premature birth and neonatal persistent pulmonary hypertension with increased risk seen in late gestational use (Mayo Clinic, 2020).
Risk Assessment
Risk assessments crucial in treatment decision-making and choice of medication in pregnancy should be patient-centered as it greatly depends on the presenting symptoms and severity, poor response to psychotherapy, and patient’s medical history (MGH, 2018). According to the CDC, pregnant women with severe depressive symptoms with suicidal ideations, functional difficulties, and weight loss ought to stay on their drug regime (CDC, 2017). Another risk assessment is the high potential for relapse, worsening symptoms, increased risk of suicidal ideation, and worsening maternal physical health after drug discontinuation. If the decision is made to start treatment, the clinician should titrate the drug beginning with the lowest dose possible with close maternal and fetal monitoring (MGH, 2018). Depression and suicide screening tools such as the PHQ-9 for the severity of depression symptoms and the Columbia Suicide Severity Rating Scale (C-SSRS) for screening for the risk of suicide is essential in treatment planning.
Non-Pharmacologic Treatment
One of the most common and evidence-based non-pharmacologic treatments for depression is light therapy and psychotherapy (Rodriquez, 2019). Cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT) has been recommended as a first-line treatment for depression in pregnant women and most other population groups of patients, with extensive research backing its efficacy or effectiveness and the low associated risk involved. (Rodriquez, 2019). CBT helps change negative thought processes and behavioral patterns, as well as teaches effective stress-coping strategies (Rodriquez, 2019).
OFF-LABEL DRUG
According to the National Center for Complementary and Integrative (NCCIH), one “off-label” drug used in treating depression in pregnant women is S-Adenosyl-methionine (SAMe) dietary supplements naturally found in the body and shown to alleviate depression symptoms (Cuomo et al., 2020). However, most studies were not of the highest scientific because they were short and done over a few weeks (Cuomo et al., 2020).
One risk of taking SAMe is that despite its benefits, studies on the long-term safety of SAMe and its safety for use during pregnancy have not been established according to the NCCIH; hence pregnant patients must talk to their doctor before taking any supplement, including SAMe (Cuomo et al., 2020).
CLINICAL PRACTICE GUIDELINES AND RECOMMENDATIONS
Due to the risk associated with the treatment of depression in pregnant women, the decision to treat and drug choice depends on the patient’s symptoms and severity, relapse potential, drug safety, gestation stage, medical history, and preferences. Psychotherapy might be initiated first due to the low risk to the mother and baby. If drugs must be initiated, the lowest therapeutic dosage possible is advised, and drug dosage may require an increase in the second half of pregnancy (American Congress of Obstetricians and Gynecologists, 2021). Medications are labeled and classified by the FDA into (A, B, C, D, and X) categories based on drug safety in pregnancy, and there is currently no available antidepressant in category A or B (MGH, 2018). Meanwhile, Category D, such as paroxetine, has strong evidence of fetal risk from human studies; potential benefits may permit use despite potential risks (MGH, 2018).
References
American Congress of Obstetricians and Gynecologists. (2021). Depression during pregnancy. Retrieved from https://www.acog.org/search#q=depression%20in%20pregnancy&sort=relevancy
Centers for Disease Control and Prevention. (2017). Antidepressant prescription claims among reproductive-aged women with private employer-sponsored insurance-United States 2008-2013. Retrieved from
https://www.cdc.gov/mmwr/volumes/65/wr/mm6503a1.htm?s_cid=mm6503a1_w
Links to an external site.
Cuomo, A., Beccarini Crescenzi, B., Bolognesi, S., Goracci, A., Koukouna, D., Rossi, R., & Fagiolini, A. (2020).
S
-Adenosylmethionine (SAMe) in major depressive disorder (MDD): a clinician-oriented systematic review.
Annals of general psychiatry
,
19
, 50. https://doi.org/10.1186/s12991-020-00298-z
Gorun, A. (2018). Choosing and discussing SSRIs for depression in pregnancy: A basic guide for residents. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajprj.2018.130602
Mayo Clinic. (2020). Antidepressants: Safe during pregnancy? Retrieved from
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-byweek/indepth/antidepressants/art-20046420
Links to an external site.
MGH Center for Women’s Mental Health. (2018). Psychiatric disorders during pregnancy: Weighing the risks & benefits of pharmacologic treatment during pregnancy. Retrieved from https://womensmentalhealth.org/specialty-clinics/psychiatric-disorders-duringpregnancy/
Rodriguez, T. (2019). 5 non-pharmacological treatments for depression. Retrieved from https://medshadow.org/5-treatments-for-depression-without-meds/
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Safurat Olaniba-Adebisi
Jan 25, 2023 10:58pm
| Last reply Jan 27, 2023 9:28pm
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Discussion week # 9
PRESCRIBING FOR OLDER ADULTS
Hello professor and fellow colleagues, The disorder that usually affects the geriatrics is dementia. Alzheimer’s disease is the most common type of dementia. People with dementia have problems with reasoning, judgement, problem solving, memory, communication and visual perception beyond typical age-related vision changes. (CDC,2022).
Alzheimer’s disease is caused by changes in the brain transmitters and it’s hereditary – runs in the family. The treatment depends on the underlying cause. Neurodegenerative dementia such as Alzheimer’s has no cure but medication to protect the brain or manage the anxiety. Such medication is Namenda.
Namenda reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer’s disease. Namenda is used to treat moderate to severe dementia of the Alzheimer’s type. Side effect of headache, dizziness, and bloating.
References
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of
psychiatry (11th ed.). Wolters Kluwer
CDC.2022
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Ndidi Joan Egemonu
Jan 25, 2023 10:49pm
| Last reply Jan 27, 2023 1:10pm
Reply from Ndidi Joan Egemonu
WEEK 9 Main DQ
Older adults are often affected by a decline in cognition due to Alzheimer’s and dementia. According to DSM-5 331.83 (31.84), a neurocognitive decline in older adults, also known as Alzheimer’s disease, is the cause of about 60 to 80 percent of dementia. Dementia impairs the mental ability to perform activities of daily living. It is not a disease; instead, a cluster of symptoms that impacts and alters the ability and subsequent deterioration of memory, reasoning, functioning, and logical thinking in the affected person. Alzheimer’s disease is one cardinal cause of dementia. As a cluster of symptoms, dementia can be mixed, resulting in the occurrence of multiple brain changes at the same time. Alzheimer’s disease, also called senile dementia, is a progressive disease that damages and impedes memory and other vital functions. As the number one cause of dementia, its pathology affects brain cell connections, and the brain cells degenerate and die, destroying memory and other vital mental functions. Alzheimer’s disease causes memory loss and confusion and has no cure. The goal of medication and management strategies is to improve symptoms and delay their ravaging advancement temporarily.
FDA-approved drug:
The Food and Drug Administration approves the following medications in the USA to help slow the progression of Alzheimer’s disease and improve memory and cognitive functioning, donepezil, galantamine, rivastigmine, memantine, and donepezil/memantine combination). Due to the progressive nature of Alzheimer’s disease, the efficacy of the above five medications will depend on the stage of the disease. According to FDA, in mild to moderate or moderate to severe Alzheimer’s disease, Aricept (donepezil) has been approved to be more effective. The National Institute on Aging, according to research, believes that Aricept (donepezil), galantamine (Razadyne), and rivastigmine (Exelon) may assist in slowing down behavioral symptoms in the interim and delay worsening symptoms.
One non-FDA-approved “off-label” drug:
Medications that fall under antipsychotics, antidepressants, anti-anxiety, and mood stabilizers can be used to alter the brain waves, thereby improving brain function. A drug like Seroquel can change a patient’s mood, perception, and consciousness with Alzheimer’s disease. The pharmacist can dispense such medicines because the FDA did not approve them, provided there is enough evidence documented, other than trial or experimental purposes, to prove that it is acceptable within reasonable health care clinical practice standards.
One nonpharmacological intervention for treating Alzheimer’s Disease.
Alzheimer’s disease progresses for the worse with time; therefore, a multi-dimensional approach to slow its progress is a sound clinical decision. Some nonpharmacological interventions that could be used include cognitive stimulation therapy, validation therapy, and reality reorientation, with reminiscence therapy as a holistic approach.
Explain the risk assessment you would use to inform your treatment decision-making.
Using the Mini-Mental Examination (MMSE), a set of eleven questions to validate a patient’s cognitive impairment will guide my decision-making. Other assessment tools that could be used include the Bristol Activities of Daily Living Scale (BADLS) and Genetic assessment risk factors obtained through comprehensive family history. There are many clinical guidelines that real-life modifications can help prevent the cause of the disease, delay disease progression, or even improve its ravaging side effects. Such lifestyle modifications include regular exercise, both physical and mental, moderate alcohol intake, and avoidance of tobacco and head injuries. A conflicting outcome does exist in the vascular studies that a systolic blood pressure below 140 mmHg is also associated with an increased risk for Alzheimer’s disease. A randomized study of the Guidelines for Neurocognitive disorder treatment conducted by Furey and Wilkins (2019) used three cholinesterase inhibitors, donepezil, rivastigmine, and galantamine, approved by the U.S. Food and Drugs as a baseline for the study of dementias. The treatment efficacy is based on the type of dementia, such as Alzheimer’s disease, vascular dementia, and other dementias, and whether it is mild, moderate, or severe. The participants who received Aricept (donepezil) proved to have more cognitive functioning and slowed the progression of their dementias than those who received placebos.
Most of the information to consider is that interdisciplinary and shared clinical decisions are crucial in the treatment of Alzheimer’s disease. It is what will guide pharmaceutical companies to comply and dispense a medication approved by FDA for one aliment when it is meant to be used as a non-approved for what it is prescribed for. It is also essential to verify the ethical and legal implications of prescribing “off-label medications for the patient’s benefit.
Reference
American Psychiatric Association. (2016).
The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia Links to an external site.
Links to an external site.
. https://doi.org/10.1176/appi.books.9780890426807
American Psychiatric Association (APA) 2013., Diagnostic and statistical manual of mental disorders 5
th
ed. DSM-5. American Psychiatric Publishing Washington, DC / London, England
Furey, K. & Wilkins, K. (2019). Prescribing “Off-Label”: What Should a Physician Disclose?
AMA J Ethics. 2016;18(6):587-593. DOI 10.1001/journalofethics.2016.18.6.ecas3-1606.
Patterson et al. (2008).Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheim er’s disease. CMAJ 2008;178:316-21.
www.cmaj.ca/cgi/content/full/178/5/548/DC1
Links to an external site.
Rabins, P.V. et al., (2014). Guide watch (October 2014): Practice guidelines for treating patients with Alzheimer’s disease and other dementias. APA Guideline
Watch;
https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/alzheimerwatch.pd
Links to an external site.
American Psychiatric Association. (2020).
Geriatric telepsychiatry Links to an external site.
Links to an external site.
[Video].
https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry
Links to an external site.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11
th
ed.). Wolters Kluwer.” Chapter 33, “Geriatric Psychiatry”
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Kimberly Mary Baldor
Jan 25, 2023 8:37pm
| Last reply Jan 26, 2023 12:47pm
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Willie Feagin
Jan 25, 2023 8:31pm
| Last reply Jan 26, 2023 12:46pm
Reply from Willie Feagin
Prescribing for Older Adults and Pregnant Women
The DSM-5 diagnosis that affects older adults is a major depressive disorder. Depression is a huge public health issue due to its severe implications (Gabriel et al., 2020). Older adults are more likely to suffer from subsyndromal depression. This type of depression doesn’t always meet the full criteria for major depression. However, it can lead to major depression if left untreated. Depression in older adults can reduce the quality of life, and increases the risk of suicide and is linked to an increased risk of morbidity, an increased risk of suicide, poorer physical, cognitive, and social functioning, and increased self-neglect, all of which are linked to an increased risk of mortality (Gabriel et al., 2020). `
FDA-approved, Off label, and non-pharmacological intervention
Antidepressants have been shown to reduce the risk of depression recurrence in adults, justifying prolonged antidepressant maintenance therapy for most if not all patients. However, older depressed adults may be at increased risk for antidepressant adverse effects (Diniz & Reynolds, 2014). Historically, TCAs were the first‐line treatment for MDD, but other antidepressants have since been developed that have a better safety profile. SSRIs are generally used as first‐line therapy as they have several advantages over TCAs, including fewer antimuscarinic and cardiotoxic side effects, rarely fatal in overdose, less dosage titration, once-daily administration, and greater patient adherence (Robertson et al., 2019). Sertraline is a medication used to manage and treat major depressive disorder. It is in the SSRI class of medications. Sertraline is an antidepressant medication within the selective serotonin reuptake inhibitors (SSRIs) class. Sertraline is an antidepressant with primarily inhibitory effects on presynaptic serotonin reuptake (“Sertraline,” 2022). The FDA has authorized sertraline as a treatment for elderly patients with severe depression. The results of several carefully planned trials show that sertraline (50-200 mg/day) is effective in treating a major depressive disorder in elderly individuals (> or =60 years of age) (Chen & Shan, 2019). One off-label medicine chosen is fluoxetine, which is useful in treating older people with dementia and depression symptoms. Fluoxetine is the off-label drug chosen because it is effective in treating depression symptoms in older persons (Wang et al., 2021). Psychotherapy may be beneficial for LLD due to specific psychological conditions in old age and a low risk of side effects. Cognitive-behavioral therapy (CBT) is a successful and long-lasting treatment for late-life depression (Gabriel et al., 2020).
Risk and Benefit Assessment
Fortunately, numerous antidepressants have been effective in elderly patients suffering from MDD without psychotic symptoms. While selecting an antidepressant, it is advised that the best side effect profile and the lowest risk of drug-drug interactions be considered. Sertraline, for example, has lesser anticholinergic effects than previous antidepressants and is thus well tolerated by people with cardiovascular disease. Nausea, dry mouth, sleeplessness, somnolence, agitation, diarrhea, excessive perspiration, and, less commonly, sexual dysfunction are common adverse effects of SSRIs (Gabriel et al., 2020). It is critical to monitor sodium levels one month after commencing SSRI treatment, especially if the patient is also taking other drugs that have the potential to cause hyponatremia, like diuretics (Gartlehner et al., 2017). Fluoxetine is not related to the withdrawal syndrome reported with other SSRIs. Fluoxetine should not be shunned in the geriatric population, and in some cases, it may be the medicine of choice. Because of its long half-life and chronic negative effects, fluoxetine is generally not recommended for usage in the elderly. Paroxetine is also not normally suggested for use in the elderly since it has the most anticholinergic impact of any SSRI, comparable to that of the tricyclics desipramine and nortriptyline (Gabriel et al., 2020).
Clinical Guidelines
Clinical practice guidelines do exist for Major Depressive Disorder (MDD). The American Psychiatric Association (APA) and the American Medical Association (AMA) both have guidelines for the treatment of MDD. These guidelines generally recommend a combination of medication and psychotherapy as the first-line treatment for MDD. The APA’s guidelines recommend selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line medication options for MDD. They also suggest that psychotherapy, specifically cognitive-behavioral therapy (CBT), be used in conjunction with medication. The AMA’s guidelines similarly recommend SSRIs or SNRIs as first-line medication options and also suggest the use of psychotherapy, specifically cognitive-behavioral therapy (CBT), as an adjunctive treatment. When making recommendations for the treatment of MDD, it is important to consider the patient’s specific symptoms and medical history, as well as any comorbid conditions or risk factors. It’s also important to monitor the patient’s response to treatment and adjust as necessary. When elaborating on the treatment of MDD, it is important to note that medication and psychotherapy are not the only treatment options available. Electroconvulsive therapy (ECT) is also an effective treatment option for MDD, particularly for patients who have not responded to other treatments or who have severe or life-threatening symptoms. Another important aspect to consider when treating MDD is the patient’s preference and the availability of treatment options. For example, some patients may prefer to avoid medication due to side effects or personal beliefs, in which case psychotherapy alone may be a better option. Additionally, in some rural or low-income areas, access to mental health professionals may be limited, making teletherapy or self-help resources more appropriate options. It’s also important to consider comorbid conditions and risk factors, such as substance abuse, when treating MDD. Patients with comorbid substance abuse may require specialized treatment and support. It’s also important to monitor the patient’s response to treatment and adjust as necessary. This includes regularly checking the patient’s symptoms and side effects, as well as monitoring the patient’s progress in psychotherapy. If a patient is not responding to treatment, it may be necessary to adjust the medication dosage, switch to a different medication, or add or change the type of psychotherapy. It’s also important to provide support and education to the patient and their family, which can help to improve treatment adherence and outcome. In the absence of clinical practice guidelines, the general approach to the treatment of MDD is a combination of medication and psychotherapy. The choice of medication should be based on the patient’s specific symptoms and medical history, and the choice of psychotherapy should be based on the patient’s preference and the availability of the therapist. It’s also important to monitor the patient’s response to treatment and adjust as necessary.
The elderly may be more prone to depression due to psychological or biological reasons. As they get older, older people experience significant losses including losing a companion, their jobs, their social status, and their physical and mental abilities (Robertson et al., 2019). Due to physiological changes due to advanced age, the elderly may be more susceptible to drug therapy. Older individuals could need more cautious dose adjustments and be more vulnerable to the negative effects of drugs (Gartlehner et al., 2017). Elderly people commonly get medication for a variety of reasons, and drug interactions are a worry. Tricyclic antidepressants are no longer recommended as first-line therapy for elderly patients because of the possibility of side effects such as postural hypotension, which can cause falls and fractures, irregular cardiac conduction, and anticholinergic effects. The latter includes symptoms including delirium, urination, dry mouth, retention, and constipation (Van Poelgeest et al., 2021). Alzheimer’s disease, Parkinson’s disease, and cardiovascular issues are just a few of the illnesses that tricyclic antidepressants can make worse (Laird et al., 2019). Because they are less anticholinergic, nortriptyline and desipramine are the best alternatives when tricyclic is used as a second-line treatment. The starting dose of an antidepressant should be half that of a younger adult once it has been decided on for an elderly patient to minimize side effects. Age-related alterations in hepatic metabolism, coexisting medical conditions, and drug-drug interactions are believed to be the root of antidepressant adverse effects in the elderly. It should instead be the goal to progressively increase the dosage at 1- to 2-week intervals until it reaches an average therapeutic level (Gabriel et al., 2020). The average therapeutic dose is frequently lower than that recommended for younger individuals because of how aging affects hepatic metabolism, but there are many individual variations as well, it is now known. Some patients will require a greater therapeutic dosage than usual. Assume that a typical therapeutic dosage is used for 2 to 4 weeks and no appreciable improvement is observed. The dosage should be raised until there is a clinical improvement, serious adverse effects, or until the maximum dosage is achieved (Gabriel et al., 2020). Therefore, scheduling frequent follow-up sessions is essential to monitor therapeutic response, assess side effects, and modify dosage as necessary. Additionally, it’s critical to watch out for any indications of depression getting worse, agitation, or anxiety, as well as the risk of suicide, particularly in the beginning stages of therapy (Buckman et al., 2018). There is no proof that older people who use antidepressants have more suicidal thoughts.
References
Al-Azayzih, A., AlAmoori, R., & Altawalbeh, S. M. (2019). Potentially inappropriate medications prescribing according to beers criteria among elderly outpatients in jordan: A cross sectional study.
Pharmacy Practice
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17
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https://doi.org/10.18549/pharmpract.2019.2.1439
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Diniz, B. S., & Reynolds, C. F. (2014). Major depressive disorder in older adults: Benefits and hazards of prolonged treatment.
Drugs & Aging
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31
(9), 661–669.
https://doi.org/10.1007/s40266-014-0196-y
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Gabriel, F., de Melo, D., Fráguas, R., Leite-Santos, N., Mantovani da Silva, R., & Ribeiro, E. (2020). Pharmacological treatment of depression: A systematic review comparing clinical practice guideline recommendations.
PLOS ONE
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https://doi.org/10.1371/journal.pone.0231700
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Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L., Gaynes, B. N., Viswanathan, M., Patel, S., & Lohr, K. N. (2017). Pharmacological and non-pharmacological treatments for major depressive disorder: Review of systematic reviews.
BMJ Open
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https://doi.org/10.1136/bmjopen-2016-014912
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Robertson, L., Bertolini, F., Meader, N., Davies, S., Barbui, C., Gilbody, S., & Churchill, R. (2019). Antidepressants for major depressive disorder in older people: A network meta-analysis.
Cochrane Database of Systematic Reviews
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https://doi.org/10.1002/14651858.cd013394
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Ruberto, V. L., Jha, M. K., & Murrough, J. W. (2020). Pharmacological treatments for patients with treatment-resistant depression.
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Sertraline. (2022).
van Poelgeest, E. P., Pronk, A. C., Rhebergen, D., & van der Velde, N. (2021). Depression, antidepressants, and fall risk: Therapeutic dilemmas—a clinical review.
European Geriatric Medicine
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Wang, J., Jiang, F., Yang, Y., Zhang, Y., Liu, Z., Qin, X., Tao, X., Liu, T., Liu, Y., Tang, Y., Liu, H., & Cotes, R. O. (2021). Off-label use of antipsychotic medications in psychiatric inpatients in china: A national real-world survey.
BMC Psychiatry
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American Psychiatric Association. (2016).
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.
https://doi.org/10.1176/appi.books.978089
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Francis Archangel
Jan 25, 2023 7:08pm
| Last reply Jan 28, 2023 3:33pm
Reply from Francis Archangel
Main Question Post
Treatments for a Disorder in Older Adults
In this discussion, a neurocognitive disorder is selected as a focus in older adults. Alzheimer’s disease is a neurocognitive disorder that shows cognitive decline or impairment in older adults (American Psychiatric Association [APA], 2022). Dementia of the Alzheimer’s type is a major neurocognitive disorder that is typically diagnosed in individuals older than 65 years (Sadock et al., 2015). Older adults with dementia may experience delusions, depression, and intellectual disorientation (Sadock et al., 2015). Donepezil is a Food and Drug Administration (FDA) approved drug for dementia-related cognitive symptoms (Alzheimer’s Association, 2023). Donepezil is one of the drugs that can help control Alzheimer’s disease progression. Donepezil can be given to all stages of Alzheimer’s disease. Olanzapine is an antipsychotic drug used as an off-label in treating Alzheimer’s disease (Alzheimer’s Association, 2023). Olanzapine may be prescribed to control agitation in an individual with Alzheimer’s disease (Alzheimer’s Society, 2023). Individuals with dementia can be referred to a speech-language pathologist (SLP) for non-pharmacological interventions. SLP sessions for dementia will focus on controlling or improving the individual’s memory, attention, problem-solving, and thinking skills. (American Speech-Language-Hearing Association [ASHA] 023). SLPs will help the individual with dementia to learn important information, and they may also teach the family or caregivers how to best communicate with the patient. (ASHA, 2023).
Risk Assessments
Before prescribing medications, it is critical to consider the patient’s health in all aspects. The provider must understand how a particular drug could affect every organ system. The provider must be knowledgeable about drug interactions, potential side effects, adverse reactions, management of drug side effects or adverse reactions, and critical laboratory tests. The provider must conduct regular follow-up appointments to evaluate pharmacological and non-pharmacological interventions and possible modification of the management plan. The provider must assess the competency of the patient, family, and caregivers to participate in the treatment and their access to health. People with low health literacy typically need help understanding the processes involved in healthcare, have problems providing accurate health histories, and have challenges in health management engagement (Stewart & DeNisco, 2019).
Risks and Benefits of FDA-Approved and Off-Label Drugs
The benefits of drugs, in general, are the relief from symptoms such as blood pressure abnormalities, infections, and pain (FDA, 2018). The risks of medicines, in general, are unexpected or unwanted effects or reactions, including abdominal pain or liver damage. The FDA approves a drug when it has been determined to be safe enough for a particular health condition that outweighs its risks (FDA, 2018). All medicines have side effects; however, if the drug is FDA-approved, the side effects are generally not critical and are safe for use as intended (FDA, 2019). FDA approval means the drug underwent and passed a clinical trial effective for its intended use. The labels for FDA-approved medicines also include information about their risks and benefits (FDA, 2018). Moreover, the labels of FDA-approved drugs also show indications for use (Congressional Research Service, 2021)
On the other hand, off-label drug use is also legal in the United States (American Cancer Society [ACS], 2015). When the FDA approves a drug, physicians can use it in any way when they consider it medically appropriate. Medications without FDA approval are not regulated (ACS, 2015). Providers may consider off-label prescriptions to incorporate the latest ideas or treatment approaches available (Congressional Research Service, 2021). Many insurance companies do not reimburse off-label drugs and mark them as experimental or investigational. Off-label use of drugs is a legal risk because it did not pass appropriate clinical trials and is not a standard of care that could result in poor patient outcomes (ACS, 2015).
Clinical Practice Guidelines for Alzheimer’s Disease
Clinical practice guidelines exist for Alzheimer’s disease. Donepezil is an FDA-approved drug for treating Alzheimer’s disease (Alzheimer’s Association, 2023). Donepezil can treat mild, moderate, and severe Alzheimer’s, which inhibits the breakdown of acetylcholine in the brain (National Institute on Aging [NIA], 2021). Individuals with Alzheimer’s disease have low levels of acetylcholine in the brain, which is important in sending messages between nerve cells. (Alzheimer’s Society, 2023). A higher level of acetylcholine in the brain may ease the symptoms of Alzheimer’s (Alzheimer’s Society, 2023). Donepezil is typically started in low dosages and is increased as determined necessary. However, higher doses of donepezil have a higher risk of side effects (NIA, 2021). Patients on donepezil must be monitored regularly due to potential side effects, including allergic reactions and abdominal upset. Behavioral symptoms of Alzheimer’s disease, such as agitation, restlessness, depression, wandering, and aggression, can be treated to provide patient comfort. Different anti-anxiety drugs, sleeping aids, antipsychotics, and anticonvulsants can be used to treat or control the behavioral symptoms of Alzheimer’s. In addition, managing the behavioral symptoms of Alzheimer’s will make it less complicated for the patient’s family to take care of them (NIA, 2018).
References
Alzheimer’s Association. (2023).
Medications for memory, cognition, and dementia-related
behaviors.
https://www.alz.org/alzheimers-dementia/treatments/medications-for-
Links to an external site.
memory#:~:text=Donepezil%20(Aricept%C2%AE)%3A%20approved,moderate%20stag
es%20of%20Alzheimer’s%20disease.
Alzheimer’s Association. (2023).
Treatments for behavior.
https://www.alz.org/alzheimers-
Links to an external site.
dementia/treatments/treatments-for-behavior
Alzheimer’s Society. (2023).
Antipsychotics and other drug approaches in dementia care.
https://www.alzheimers.org.uk/about-dementia/treatments/drugs/antipsychotic-
Links to an external site.
drugs#:~:text=The%20off%2Dlabel%20antipsychotics%20most,other%20symptoms%20
of%20these%20conditions.
Alzheimer’s Society. (2023).
How do drugs for Alzheimer’s disease work?
https://www.alzheimers.org.uk/about-dementia/treatments/dementia-drugs/how-do-
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drugs-alzheimers-disease-
work#:~:text=In%20the%20brain%20of%20a,use%20acetylcholine%20are%20also%20lost.
American Cancer Society. (2015, March 17).
Off-label drug use.
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label-
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druguse.html#:~:text=Many%20insurance%20companies%20will%20not,experimental%
E2%80%9D%20or%20%E2%80%9Cinvestigational.%E2%80%9D
American Psychiatric Association. (2022).
Diagnostic and statistical manual of mental
disorders, fifth edition, text revision (DSM-5-TR).
American Speech-Language-Hearing Association. (2023).
Dementia.
https://www.asha.org/public/speech/disorders/dementia/
Links to an external site.
Congressional Research Service. (2021).
Off-label use of prescription drugs
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National Institute on Aging. (2021, July 8).
How is Alzheimer’s disease treated?
https://www.nia.nih.gov/health/how-alzheimers-disease-treated
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
Kaplan & Sadock’s synopsis of psychiatry
(11th
ed.). Wolters Kluwer
Stewart, J. G., & DeNisco, S. M. (2019).
Role development for the nurse practitioner
(2nd
ed.)
.
Jones & Bartlett Learning.
United States Food and Drug Administration. (2018, June 18).
Think it through; managing the
benefits and risks of medicines.
https://www.fda.gov/drugs/information-consumers-and-
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patients-drugs/think-it-through-managing-benefits-and-risks-medicines
United States Food and Drug Administration. (2019, October 28
). Frequently asked questions
about CDER.
https://www.fda.gov/about-fda/center-drug-evaluation-and-research-
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cder/frequently-asked-questions-about-cder#:~:text=6.-
,Once%20FDA%20approves%20a%20drug%2C%20does%20this%20mean%20that%2
0the,effects%20are%20generally%20not%20serious.
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Pamela Mccleary
Jan 25, 2023 4:27pm
| Last reply Jan 28, 2023 5:41pm
Reply from Pamela Mccleary
Women with bipolar disorder have a 50% increased risk for exacerbations during the perinatal period, so discontinuing treatment increases the risk of symptom worsening and changing their ability to function and engage in risky behaviors, including substance abuse and poor prenatal compliance (Clark, 2020). Another concern is that exposing a fetus to untreated bipolar disorder can lead to low birth weight, preterm birth, small gestational age, and microcephaly (Clark, 2020). During pregnancy, pharmacokinetics are altered, causing metabolism and elimination of medications to change substantially, requiring close monitoring of any treatment. Clinicians will need to adjust treatment throughout the pregnancy (Montiel et al., 2022
Lithium is still one of the best treatments for bipolar disorder, and if the client is stable on Lithium, consider continuing Lithium during the pregnancy. The risk for cardiac malformations, including Epstein’s anomaly, was less than previously reported; there is also a risk of increased birth weight, hypoglycemia tremor, and heart rate (Clarke, 2020). Mothers with hyperemesis, pre-eclampsia and renal insufficiency are at risk for Lithium toxicity and must be closely monitored. Completing an ultrasound at 16–20 weeks to rule out congenital malformations is also recommended (Clarke, 2020).
Invega (paliperidone) can be used off-label to treat bipolar disorder. There is a limited study available about the effects of its use during pregnancy. However, studies have shown no evidence of teratogenic or harmful impact on the mother or fetus (Onken et al., 2018). Since Invega is cleared renally, plasma levels depend on renal clearance, which increases during pregnancy. If Invega is tolerated well before pregnancy, current literature supports continuing the medication with frequent monitoring after reviewing the benefits versus risks of continued treatment.
There are clinical practice guidelines in place, but they are inconsistent internationally. Pregnancy has had limited studies and updates to guidelines due to the FDA having limited research information about pregnant women who use antipsychotic drugs. The guidelines recommend closely monitoring lithium levels, review of benefits versus risks, increasing monitoring in the third trimester, and not recommending breastfeeding (Malhi et al., 2017). If possible, stopping Lithium in the first trimester is also recommended. The recommendations are clear and concise and include the best practice so that I would incorporate them into my practice. However, there will always be a chance of a client that doesn’t fit into the guidelines, and as a practitioner, a review of the latest evidence-based research will be necessary to meet that client’s needs.
Risks versus benefits for both FDA-approved and off-label use would include considering the client’s symptoms and disease history. Untreated bipolar disease can lead to risky behaviors and general health neglect, and studies show increased fetal/infant health risks. Also, with untreated bipolar disorder, postpartum depression and difficulty stabilizing the mother’s mood becomes a concern. So maintaining some form of treatment during pregnancy may be the preferable course of care. If a client is pregnant or telling you they are considering pregnancy, reviewing each of their medications using evidence-based research is indicated to discuss the medication’s risks and benefits so that decisions can be made using current research findings. Increased assessment and monitoring of the mood and medication levels will also be part of the treatment plan. The decision to prescribe any medication during pregnancy should be thoroughly assessed, and medications should only be prescribed when the risk of untreated maternal disorder outweighs the potential risk to the fetus from exposure to the medication. Clinicians should prescribe the minimum effective dose. The close collaboration of care with the OB/GYN is essential.
Bright Light Therapy (BLT) is a non-pharmacological treatment for mood disorders, including bipolar disorder. BLT can be used alone or as adjunctive therapy, and results have been seen in as little as one week. If effective medication doses could be decreased, further reducing the risk of fetal injury. The therapy works by regulating the biological mechanisms and mediating dysregulation of the circadian rhythm by affecting the pineal gland light, which induces melatonin production and balances cortisol. This is a natural, noninvasive, and safe treatment option that can quickly and safely be incorporated into a treatment plan (Cuomo et al., 2023)
References
Clark, C. T. (2020). Psychotropic drug use in perinatal women with bipolar disorder.
Seminars in Perinatology
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44
(3), 151230.
https://doi.org/10.1016/j.semperi.2020.151230
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Cuomo, A., Carmellini, P., Garo, M. L., Barillà, G., Libri, C., Spiti, A., Goracci, A., Bolognesi, S., & Fagiolini, A. (2023). Effectiveness of light therapy as adjunctive treatment in bipolar depression: A pilot study.
Journal of Affective Disorders
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Links to an external site.
Grover, S., & Avasthi, A. (2015). Mood stabilizers in pregnancy and lactation.
Indian Journal of Psychiatry
,
57
(Suppl 2), S308.
https://doi.org/10.4103/0019-5545.161498
Links to an external site.
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of Lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines.
Journal of Affective Disorders
,
217
, 266–2https://doi.org/10.1016/j.jad.2017.03.052
Montiel, C., Newmark, R. L., & Clark, C. T. (2022). Perinatal use of lurasidone for the treatment of bipolar disorder.
Experimental and Clinical Psychopharmacology
,
30
(2), 249–252.
https://doi.org/10.1037/pha0000509
Links to an external site.
Onken, M., Mick, I., & Schaefer, C. (2018). Paliperidone and pregnancy—an evaluation of the German Embryotox database.
Archives of Women’s Mental Health
,
21
(6), 657–662.
https://doi.org/10.1007/s00737-018-0828-z
Links to an external site.
Uguz, F. (2020). Pharmacological prevention of mood episodes in women with bipolar disorder during the perinatal period: A systematic review of current literature.
Asian Journal of Psychiatry
,
52
.
https://doi.org/10.1016/j.ajp.2020.102145
Links to an external site.
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Ogechukwu Christiana Obiajulu
Jan 25, 2023 3:34pm
| Last reply Jan 28, 2023 9:56pm
Reply from Ogechukwu Christiana Obiajulu
Week 9 Discussion
Prescribing for pregnant women
Schizophrenia is a developmental disease that is caused by an interaction of genetic susceptibilities combined with environmental insults .The genetic contribution is well-established, with up to a 10-
fold increase in the risk of developing
schizophrenia
(Bates et al., 2018)
.
Schizophrenia is one particular DSM-5-TR disease that may have an impact on expectant mothers. Hallucinations, delusions, and disorganized thinking are all symptoms of the mental illness schizophrenia. Psychotherapy and antipsychotic medications are frequently used in the treatment of schizophrenia. The possible dangers and advantages of the medicine for both the mother and the growing fetus must be taken into account while treating pregnant women with schizophrenia (Bates et al., 2018).
FDA-approved drug
There are numerous therapies for schizophrenia in expectant mothers that are supported by evidence. Clozapine is one drug used to treat schizophrenia that has FDA approval. An antipsychotic drug called clozapine helps lessen hallucinations, delusions, and disordered thinking. Clozapine use during pregnancy, however, should be thoroughly monitored by a healthcare professional due to the drug’s increased risk of agranulocytosis (Uguz, 2020).
One off-label drug
Quetiapine, an antipsychotic drug that has not received FDA approval for use during pregnancy, provides an additional option for treating schizophrenia in expectant patients (Zheng et al., 2020). But compared to clozapine, quetiapine has been demonstrated to be beneficial in lowering schizophrenia symptoms and is linked to a lower incidence of agranulocytosis (Zheng et al., 2020). Last but not least, nonpharmacological treatments like psychotherapy can be effective in treating schizophrenia in expectant women (Gentile & Fusco, 2019)
T
he risk assessment
used
to inform my
treatment
decision making
.
Clinical practice guidelines provide direction for the management of schizophrenia in both pregnant women and older persons. According to these recommendations, antipsychotic drugs should be used as the first line of treatment for schizophrenia. Clozapine is advised as a first-line option for pregnant women, and quetiapine is advised as a second-line alternative. The recommendations make psychotherapy a second-line or adjunctive treatment for schizophrenia. Assessing risks to humans and the environment for remediation programs is technically feasible. The risk assessment will be based on the benefits and drawbacks that the drug has for the patient. Going through the drug leaflet, understanding the contraindications of the drug, knowing the drug interaction, and completing a wholesome psychiatric evaluation, as well as monitoring the drug effects, are all part of risk assessment.
Risks and benefits of the FDA-approved medicine
U.S Food and Drug Administration (FDA) -approved medicine has some risks and benefits towards an individual’s healthy life. Gourgari et al. (2017) analyzed that some FDA-approved drugs like sedatives and anti-anxiety medications can cause low blood pressure, slowed breathing, and memory problems which can be a considerable threat to a patient’s health. On the other hand, FDA-approved medicines can be of much benefit in that a patient is fully aware of their effectiveness and safe to consume. The U.S federal law requires drugs to be examined and proved to be safe for patients.
Risks and benefits of the off-label drug
Off-label drugs are drugs that have unapproved use. Off-label drugs are beneficial because they can be prescribed for a disease that is not approved to treat (Good & Gellad, 2016). For instance, antipsychotics approved to treat a particular type of mental condition can also treat a different kind of psychosis because it is not approved for a specific type. The risk associated with off-label drugs includes such a drug can cause a client to experience adverse body events like allergic response, drug interaction, and drug reaction (Good & Gellad, 2016).
Clinical practice guidelines for schizophrenic pregnant women
Clinician-developed clinical practice guidelines are statements that make recommendations for enhancing patient care. They are educated through a thorough study of the facts as well as an assessment of the benefits and risks of different care alternatives
.
Clinical practice guidelines do exist for the treatment of schizophrenia in pregnant women adults. Patients and Healthcare providers must look for side effects. Clinicians’ practice guidelines allow noncompliance and therapy-associated adverse effects when creating a thorough treatment plan to manage schizophrenia. The American Psychiatric Association’s (APA’s) clinical practice standards are critical in helping healthcare practitioners to select healthcare options for schizophrenic patients. The therapeutic procedures for schizophrenia are founded on proven medication and non-pharmacological therapies. To the guidelines, mentally ill persons like people with schizophrenia should be treated with an antipsychotic drug and their efficacy and adverse reactions should be monitored carefully (Avasthi et al., 2017)
References.
Avasthi, A., Grover, S., Chakrabarti, S., & Kulhara, P. (2017). Clinical Practice Guidelines for Management of Schizophrenia.
Indian Journal of Psychiatry
,
59
(5), 19.
https://doi.org/10.4103/0019-5545.196972
Links to an external site.
Bates, V., Maharjan, A., Millar, J., Bilkey, D. K., & Ward, R. D. (2018). Spared motivational modulation of cognitive effort in a maternal immune activation model of schizophrenia risk.
Behavioral Neuroscience
,
132
(1), 66–74.
https://doi.org/10.1037/bne000023
Links to an external site.
Gentile, S., & Fusco, M. L. (2019). Schizophrenia and motherhood.
Psychiatry and Clinical Neurosciences
,
73
(7), 376–385.
https://doi.org/10.1111/pcn.12856
Links to an external site.
Good, C. B., & Gellad, W. F. (2016). Off-label Drug Use and Adverse Drug Events.
JAMA Internal Medicine
,
176
(1), 63.
https://doi.org/10.1001/jamainternmed.2015.6068
Links to an external site.
Gourgari, E., Wilhelm, E. E., Hassanzadeh, H., Aroda, V. R., & Shoulson, I. (2017). A comprehensive review of the FDA-approved labels of diabetes drugs: Indications, safety, and emerging cardiovascular safety data.
Journal of Diabetes and Its Complications
,
31
(12), 1719–1727.
https://doi.org/10.1016/j.jdiacomp.2017.08.005
Links to an external site.
Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi,A., … & WHO World Mental Health Survey Collaborators. (2020). Findings from worldmental health surveys of the perceived helpfulness of treatment for patients with major depressive disorder JAMA psychiatry,77(8), 830-841
Uguz, F. (2020). The Use of Clozapine During Pregnancy And Lactation: A Case Report.
Psychiatry and Clinical Psychopharmacology
,
30
(2), 193.
https://doi.org/10.5455/pcp.20200502080433
Links to an external site.
Zheng, L., Tang, S., Tang, R., Xu, M., Jiang, X., & Wang, L. (2020). Dose Adjustment of Quetiapine and Aripiprazole for Pregnant Women Using Physiologically Based Pharmacokinetic Modeling and Simulation.
Clinical Pharmacokinetics
,
60
(5), 623–635. https://doi.org/10.1007/s40262-020-00962-3
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Preston Eyerman
Jan 25, 2023 12:42pm
| Last reply Jan 26, 2023 12:45pm
Reply from Preston Eyerman
When treating schizophrenia in older adults, the safest approach is to always start at a low dosage and titrate slowly. One FDA-approved drug that is available for the treatment of schizophrenia is Abilify. When treating patients with antipsychotics, especially older adults, it is imperative to educate the patient and closely monitor them for side effects. Some of the more concerning side effects for this population include anticholinergic effects (such as urinary retention, constipation, and cognitive impairments) and orthostatic hypotension (which increases the risk for falls) and sedation (Marder, 2022). The benefits of using Abilify in patients with schizophrenia would be an improvement in psychotic symptoms. Though it takes about 2 weeks to achieve a steady-state, it may take up to 4-6 weeks to observe a desired response after an effective dose is reached (Marder, 2022).
In treatment resistant schizophrenia, Clozapine is typically the next suggested treatment modality. A patient is categorized as treatment-resistant if they are experiencing moderate symptoms, functional impairment, and have had at least two unsuccessful trials of antipsychotic treatment (Kane, Rubio, Kishimoto, & Correll, 2021). Antipsychotic treatment trials must have been at least six weeks at the highest tolerated dose. If clozapine is not an option, then the use of ECT to augment the current antipsychotic is recommended. This is based off of a meta-analysis of 11 random clinical trials that compared ECT augmentation of a non-clozapine antipsychotic versus treatment of a non-clozapine antipsychotic alone. The study found that the patients who augmented treatment with ECT had enhanced symptom improvement compared to those treated with antipsychotic monotherapy. The most common risks associated with ECT includes memory impairment and headache.
If the patient does not have a significant clinical response to ECT (after an 8-week trial of ECT 2-3 times per week), and clozapine therapy is not a possibility, then Lamotrigine is the next recommended choice of treatment (Kane, Rubio, Kishimoto, & Correll, 2021). This recommendation is based upon consistent, though limited, evidence supporting its use in this population. Three randomized studies have revealed a decrease in psychotic symptoms with the use of adjunctive lamotrigine (in combination with an antipsychotic) compared to placebo. Lamotrigine, a mood stabilizer, carries a boxed warning for potentially causing serious rashes. If a patient develops a rash, then the medication should be discontinued in hopes to avoid progression to a more serious form of the rash such as Stevens-Johnson syndrome or toxic epidermic necrolysis (Lamotrigine: Drug information, n.d.). Other risks include blood dyscrasias, suicidal ideation, and nausea.
Clinical guidelines do exist for the treatment of Schizophrenia. First-line treatment of a second-generation antipsychotic is typically recommended for acute psychosis and ongoing maintenance therapy. Second-generations are preferred over first generation due to their decreased risk for EPS production. Though these are the general guidelines, a first-line antipsychotic, such as Haldol, may be more appropriate in some cases such as during extreme agitation. This methodology excludes the use of clozapine as a first-line option. Though it has been proven to be more effective than other antipsychotics, Clozapine is reserved for treatment-resistant patients due to its associated side effects and necessity for frequent monitoring (Marder, 2022).
References
Kane, J., Rubio, J., Kishimoto, T., & Correll, C. (2021). Evaluation and management of treatment-resistant schizophrenia.
Up to date
. Retrieved from
https://www.uptodate.com/contents/evaluation-and-management-of-treatment-resistant-schizophrenia?search=schizophrenia%20&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5#H1536388995
Links to an external site.
Lamotrigine: Drug information. (n.d.).
Up to date
. Retrieved from
https://www.uptodate.com/contents/lamotrigine-drug-information?search=schizophrenia%20&topicRef=14808&source=see_link#F186309
Links to an external site.
Marder, S. (2022). Psychosis in adults: Initial management. Up to date. Retrieved from
https://www.uptodate.com/contents/psychosis-in-adults-initial-management?sectionName=INITIAL%20MANAGEMENT&search=schizophrenia%20treatment&topicRef=14805&anchor=H4035521878&source=see_link#H498310159
Links to an external site.
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Chasity Cooper
Jan 25, 2023 11:16am
| Last reply Jan 26, 2023 12:45pm
Reply from Chasity Cooper
Treating Depression in Pregnant Women
Chasity Cooper RN,BSN
PMHNP Care Across the Lifespan II
Dr.Reyes
1/25/22
Treating Depression in Pregnant Women
Many pregnant women experience increased sadness and cognitive changes during pregnancy. Especially, if they are unaccepting of the bodily changes or unable to complete their normal daily routines. Depression during pregnancy is called prenatal depression. According to Jahan and others (2021), prenatal depression in studies has proven to lead to pre-term delivery, poor birth weight, slow fetal development, anemia, and uterine problems. The Edinburgh Postnatal Depression Scale and Patient Health Questionaire are effective screening tools for depression (Niel & Payne, 2020).
The FDA’s approval for medication use to treat depression in pregnancy is often unclear. In many drug books it sees controlled studies have not be done on pregnant women.The FDA has created categories to label medications for their warnings during pregnancy. SSRI’s are usually the first line treatment option for depression during pregnancy. The FDA categorizes most SSRI’s in the C category. The C category informs clinicians that complications are possible, but the benefits may outweigh the risks. Sertraline and citalopram are believed to have the smallest risk. The dose of Zoloft should be on the lower scale and avoid use in the first trimester if possible. Effective non-pharmacologic treatment options for depression are yoga, psychotherapy, and cognitive behavioral therapy.
When it is time to discuss the risks associated with treatment of the perinatal depression, I would used information from the CDC. The CDC runs a Pregnancy Risk Assessment Monitoring System. It is a questionnaire that assesses depression in women during pregnancy and postpartum (Ellington, 2021). The CDC records stats of the incidences of depression among pregnant women and complications. As mentioned above the EDPS is effective for making a decision to treat the depression. Molenaar and others (2018), have created clinical practice guideline and the researchers promote psychotherapy for mild to moderate cases. The authors state that if antidepressants are used, cardiovascular monitoring should take place. Treatment with antidepressants can cause pre-term delivery, low birth weight, congenital heart defects, new-born, pulmonary hypertension, and gestational diabetes (Hlongwane & Phoswa, 2021). However, as mentioned above studies have shown the benefits of medications may outweigh the risks.
References
Hlongwane, R., & Phoswa, W. N. (2021). Effect of antidepressants in pregnancy outcomes: A protocol for systematic review and meta-analysis.
Medicine
,
100
(50), e27885. https://doi.org/10.1097/MD.0000000000027885
Jahan, N., Went, T. R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I. A., & Alfonso, M. (2021). Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review.
Cureus
,
13
(8), e17251.
https://doi.org/10.7759/cureus.17251
Links to an external site.
Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review.
The Australian and New Zealand journal of psychiatry
,
52
(4), 320–327. https://doi.org/10.1177/0004867418762057
Niel, M. S. V., & Payne, J. L. (2020, May 1).
Perinatal depression: A Review
. Cleveland Clinic Journal of Medicine. Retrieved January 24, 2023, from https://www.ccjm.org/content/87/5/273
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Jennifer Lisa
Jan 25, 2023 7:06am
| Last reply Jan 25, 2023 8:43am
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Jennifer Lisa — Week 9 Discussion Post (Initial Post)
NRNP 6675 Week 9 Discussion — MDD in pregnancy.docx
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Cindy Mecham
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Jan 25, 2023 2:17am
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NRNP6675Wk9MechamC.pdf
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Cindy Mecham
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Jan 25, 2023 2:15am
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Mbalu Madlene Kebbie
Jan 25, 2023 1:55am
| Last reply Jan 27, 2023 11:26am
Reply from Mbalu Madlene Kebbie
Evidence shows that depression, which is a serious mood disorder characterized by persistent feelings of sadness which affects the way a person feels, behaves and thinks is commonly seen among older adults, whereas clinical depression is not a normal part of aging, and when left untreated, can profoundly affect a person’s functioning and overall quality of life (National Institute on Aging, 2021). Older adults could experience different types of depression including Major Depressive Disorder, evidenced by symptoms that last a minimum of two weeks interfering with one’s ability to perform daily tasks, Persistent Depressive Disorder, known as Dysthymia which is a depressed mood lasting more than two years, wherein the person may be still able to perform daily tasks, Substance/Medication-Induced Depressive Disorder which pertains to the use of substances such as alcohol and pain medications, and Depressive Disorder, due to a medical condition which concerns with separate illnesses such as diabetes or heart disease (National Institute on Aging, 2021). Clinical application to treat depression in older adults recommends three psychotherapeutic interventions as well as a second-generation antidepressant- selective-serotonin reuptake inhibitors-SSRIs, selective-norepinephrine reuptake inhibitors-SNRIs, or norepinephrine-dopamine reuptake inhibitors- NDRIs (apa.org, 2019).
FDA Approved Drug for Treating Depression in Older Adults.
An FDA-approved drug for clinical use in the treatment of depression in older adults is Citalopram hydrobromide, which is a SSRI that acts as an antidepressant by potentiating serotonergic activity in the central nervous system, and selectively inhibiting serotonin reuptake in presynaptic neurons (National Library of Medicine, 2021).
Off-Label Drug for Treating Depression in Older Adults.
An off-label drug is one that has been approved by the FDA, with an unapproved use to treat a disease or medical condition, wherein a health care provider makes an appropriate and sound clinical judgement to determine that the off-label drug is medically appropriate for prescription for their patients, given that there may not be an approved drug to treat that specific illness or medical condition, or in other instances wherein the patient may have tried all other approved treatments without seeing benefits or results, or the drug prescribed for the particular illness is either too expensive or inaccessible (U.S. Food & Drug Administration). Trazodone, used for insomnia is an off-label medication used for depression in older adults, which works by aiding to restore the balance of serotonin in the brain, improving mood and energy, and decreasing anxiety and insomnia which are thought to be related to depression (drugs.com, 2022).
Non-pharmacological Intervention for Treating Depression in Older Adults
Among others, a non-pharmacological intervention used to treat older adults with depression is Life-Review Therapy, which involves an adult person referencing their past to attain a sense of peace and empowerment about their lives, allowing a person to put his or her life into perspective, while revealing significant memories about friends and loved ones, thereby aiding the person to deal with challenging or unresolved conflicts that are preventing them from feeling at peace (healthline.com).
Risk Assessment Used to Inform Treatment Decision-Making.
To simplify, risk assessment primarily involves a series of processes and measures put in place to assess, monitor, and mitigate risks, while improving desired outcomes (HealthCare Compliance Pros). In prescribing pharmacological and therapeutic treatments for older adults with depression, it’s prudent that the provider takes into consideration the patient’s medical and psychiatric condition with adequate clinical evidence to make appropriate diagnosis and treatment plan that is patient-centered, aimed at treating/managing the symptoms in ways that the benefits far outweigh potential risks, to improve patient outcomes. In managing risk assessment pertained to prescribing medications and treatments, it’s important that the provider assess a drug or treatment’s benefit-risk balance, implement tools that minimizes risks while preserving benefits, evaluate effectiveness of tools used and re-assessing their benefits-risk balance and making appropriate adjustments to risk minimization tools to further improve the benefit-risk balance, while ultimately providing patient information about their prescribed drug or treatment, with inclusion of package inserts that provide the prescribing information which highlights essential information about the safe and effective use of the drug or treatment (U.S Food & Drug Administration). Other areas of relevance include assessing the patient’s allergy history to prevent adverse and negative treatment outcomes, and fostering interprofessional collaboration that involves providers, pharmacists, nurse practitioners and other clinicians to engage in the implementation and execution of policies and care to improve the patient’s health outcomes (National Library of Medicine, 2022).
Benefits of FDA Approved Medicines
FDA approved medications bear many benefits which includes regulating the safety and effectiveness of drugs sold in the U.S, with ongoing monitoring of the drug for its safety and effectiveness for as long as it’s on the market (Congressional Research Services). In addition, FDA approved medications undergo rigorous clinical trials and scrutiny to validate their efficacy and ensures that the manufacturer meets required specifications including the safety and effectiveness in the drug’s proposed use, appropriateness of the proposed labeling, adequacy of manufacturing methods to assure the drug’s identity, strength, quality, and purity, to optimize treatment outcomes and preserve public/consumer safety (Congressional Research Services).
Risks Of FDA Approved Medicines.
Risks of FDA approved drugs include the likelihood that the drug may not work for its intended use, the possibility of a harmful interaction of the drug with other drugs, food or supplements, and the potential for abuse by consumers, which could cause more harm than good, offsetting its intended purpose and possibly causing patient harm, and the chances that the drug may cause additional problems including addiction which contributes to medical and psychiatric problems (U.S Food & Drug Administration).
Benefits of Off-Label Drugs.
The benefits of off-label drugs include accessibility and cost-effectiveness for consumers, there may be evidence to demonstrate that the drug works for its off-label use, prevents prolonged waiting for treatment interventions in instances when FDA approved drugs are in shortages, or in cases wherein other approved FDA drugs have failed to treat the patient’s condition (Medical News Today).
Risks Associated in Use of Off-Label Drugs.
Potential risks associated in use of off-label drugs include a lack of strong scientific evidence to back up its efficacy in treating a specific illness or condition which potentiates increased risks of adverse effects, in addition to lack of coverage by insurance for off-label drugs, which may pose financial burden to the patient who may already have financial hardship (drugs.com, 2022). In addition, off-label drugs have legal action potential, given that its use often does not reflect “standard of care” treatment, posing legal risks to the provider in the event of unwanted drug/treatment outcomes, lacks sufficient scientific information on the best way to use the drug other than for its intended approval, as well as ethical issues related to its use in patients and for unintended purposes (American Cancer Society).
Clinical Practice Guidelines for Depression In Adults
Clinical practice guidelines are primarily intended to be a central determinant of treatment choice, and mainly pertains to systematic review of evidence about efficacy of treatment in illnesses including depression, data regarding risk of harm gotten from treatments, data regarding patient preferences, values regarding treatments, and data regarding applicability of treatments across populations and settings, serving as essential tool for providers, and guides clinical decision-making for patients to receive the care they need (American Psychological Association). Clinical practice guidelines for older adults with depression specifies a step-by-step action involved in treatment proceedings while monitoring progress to determine effectiveness or modification of plan of care, which is ultimately aimed at improving practice and patient outcomes, hence my recommendation for its utilization in clinical practice, given its evidence-based credibility.
References
American Cancer Society. Off-Label Drug Use: What Is Off-Label Drug Use?
https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/off-label-drug-use.html#:~:text=What%20problems%20can%20be%20caused%20by%20off-label%20drug,does%20not%20regulate%20the%20practice%20of%20medicine.%20
Links to an external site.
American Psychological Association, (2022). Using the APA Clinical Practice Guidelines for The Treatment of Depression in Adults.
https://www.apa.org/depression-guideline/decision-aid-adults.pdf
Links to an external site.
American Psychological Association, (2017). Placing Clinical Practice Guidelines in Context.
https://www.apa.org/about/offices/directorates/guidelines/context
Links to an external site.
apa.org, (2019). Depression Treatments for Older Adults.
https://www.apa.org/depression-guideline/older-adults
Links to an external site.
Congressional Research Services. How FDA Approves Drugs and Regulates Their Safety and Effectiveness.
https://sgp.fas.org/crs/misc/R41983.pdf
Links to an external site.
drugs.com, (2022). Trazodone: What is Trazodone?
https://www.drugs.com/trazodone.html
Links to an external site.
drugs.com, (2022). Off-Label Drug Use: What Is It?
https://www.drugs.com/slideshow/off-label-or-off-limits-
Links to an external site.
1237#:~:text=What%20Are%20the%20Drawbacks%20to%20Off-Label%20Prescribing%3F%201,cancer%20regimens%20when%20used%20in%20an%20off-label%20manner.
HealthCare Compliance Pros. Risk Assessment HealthCare: Why Does It Matter?
https://www.healthcarecompliancepros.com/risk-assessment-healthcare#:~:text=Risk%20assessment%20in%20healthcare%20is%20a%20complex%20procedure.,safeguarding%20your%20patient%20information%20and%20other%20organizational%20assets
Links to an external site.
.
healthline.com. Life-Review Therapy: What Is Life-Review Therapy?
https://www.healthline.com/health/life-review-therapy
Links to an external site.
National Institute on Aging, (2021). Depression and Older Adults.
https://www.nia.nih.gov/health/depression-and-older-adults
Links to an external site.
National Library of Medicine, (2022). Risk Management Event Evaluation and Responsibilities.
https://www.ncbi.nlm.nih.gov/books/NBK559326/
Links to an external site.
National Library of Medicine, (2021). Citalopram.
https://www.ncbi.nlm.nih.gov/books/NBK482222/#:~:text=Mechanism%20of%20Action%20Citalopram%20hydrobromide%20acts%20as%20an,norepinephrine%20%28NE%29%20and%20dopamine%20%28DA%29%20neuronal%20reuptake.%20
Links to an external site.
Medical News Today. What To Know About Off-Label Drug Use.
https://www.medicalnewstoday.com/articles/off-label-drug-use
Links to an external site.
U.S Food & Drug Administration. Understanding Unapproved Use of Approved Drugs “Off-Label”
https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label
Links to an external site.
U.S Food & Drug Administration. FDA’s Role in Managing Medication Risks.
https://www.fda.gov/drugs/risk-evaluation-and-mitigation-strategies-rems/fdas-role-managing-medication-risks
Links to an external site.
U.S. Food & Drug Administration. Think It Through: Managing The Benefits and Risks Of Medications.
https://www.fda.gov/drugs/information-consumers-and-patients-drugs/think-it-through-managing-benefits-and-risks-medicines
Prescribing For Older Adults and Pregnant Women
Insomnia is a common condition among pregnant women, affecting up to 80% of women in the third trimester. Insomnia is experienced as difficulty falling asleep, staying asleep, and waking too early in the morning. This can be especially troublesome for pregnant women, as it can interfere with the rest needed for a healthy pregnancy. Insomnia can negatively affect a woman’s emotional, physical, and mental health, as well as the fetus. As such, it is important to understand the causes and possible treatments of insomnia in pregnant women. The post will recommend one FDA-approved drug, one off-label, and one nonpharmacological intervention for treating insomnia disorder in pregnant women. It will explain the risk assessment I would use to inform my treatment decision-making, the risk and benefits of the FDA medicine, and the risk and benefits of the off-label drug. It will then explain whether clinical practice guidelines exist for insomnia disorder.
FDA-Approved Drug, Off-Label Drug and Nonpharmacological Intervention for Treating Insomnia
An FDA-approved medicine for treating insomnia disorder in pregnant women is doxepin. Doxepin is a tricyclic antidepressant that is effective in treating insomnia. It is thought to work by increasing the amount of serotonin in the brain, which helps regulate mood and sleep cycles. It is generally considered safe for pregnant women, though there is some evidence that it may increase the risk of preterm delivery. Therefore, it is essential to discuss the risks and benefits of doxepin with the pregnant woman and her care provider before starting the medication (Stahl, 2020). Melatonin is an off-label drug that could be used to treat insomnia disorder in pregnant women. Melatonin is a hormone naturally produced in the body that helps regulate sleep cycles. It is available in supplement form and is considered safe for pregnant women. However, there is not enough evidence to suggest that melatonin effectively treats insomnia in pregnant women. Therefore, it is important to discuss the risks and benefits of melatonin with the pregnant woman and her care provider before starting the medication (Hollifield & Manber, 2018).
A nonpharmacological intervention for treating insomnia disorder in pregnant women is cognitive-behavioral therapy (CBT). CBT is a type of psychotherapy that helps people identify and change their thinking and behavior patterns that are causing distress. It is considered a safe and effective treatment for insomnia in pregnant women and can help them learn how to manage their sleep cycles better (Sivertsen et al., 2020).
Risk Assessments used to Inform my Treatment Decision Making
When making treatment decisions for pregnant women with insomnia disorder, it is important to consider each treatment option’s potential risks and benefits. For the FDA-approved medicine, doxepin, the potential risks include preterm delivery and other adverse effects, while the potential benefits include improved sleep and possibly improved mood. For the off-label medicine, melatonin, the potential risks include unknown effectiveness and possible side effects, while the potential benefits include improved sleep and possibly improved mood (Stahl, 2020). For the nonpharmacological intervention, CBT, the potential risks include the time and effort required to complete the therapy, while the potential benefits include improved sleep, improved mood, and improved coping skills (Sivertsen et al., 2020).
Clinical practice Guidelines
Clinical practice guidelines exist for treating insomnia disorder in pregnant women. The American College of Obstetricians and Gynecologists (ACOG) guidelines recommend that pregnant women with insomnia consider behavioral interventions, such as CBT, as first-line treatments. If these interventions are ineffective, ACOG then recommends using pharmacologic treatments, such as doxepin, as second-line treatments. If these treatments are also ineffective, ACOG recommends the off-label use of melatonin (Sivertsen et al., 2020). Therefore, the recommendations for treating insomnia disorder in pregnant women align with the ACOG guidelines.
A multifaceted approach is recommended to treat insomnia disorder in pregnant women. An FDA-approved drug, such as Doxepin and Zolpidem, should be used with caution due to their potential side effects, including dizziness, confusion, and daytime drowsiness. An off-label drug, such as melatonin, should also be considered an alternative, as it has few known side effects. A nonpharmacological approach, such as mindfulness meditation, may help reduce stress and improve sleep quality. Clinical practice guidelines should also be consulted to determine the safest and most effective treatment for this disorder.
References
Hollifield, M., & Manber, R. (2018). Benzodiazepines for Insomnia: A Review of Effectiveness and Safety. Current Psychiatry Reports, 20(7), 44.
Sivertsen, B., Mork, E., Pallesen, S., Nordhus, I. H., & Bjorvatn, B. (2020). Non-pharmacological Treatment of Insomnia: A Review. Sleep Medicine Reviews, 49, 101098.
Stahl, S. M. (2020). Insomnia: Pharmacological Treatment Options. CNS Spectrums, 25(4), 347–355.
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Saffie Conteh
Jan 24, 2023 3:58pm
Reply from Saffie Conteh
Applied Informatics
Saffie Conteh
NRNP-6675
Dr. Madeleine Reyes
Date 1/24/20203
Applied Informatics
Ideas in Medical Informatics applied in administration and operations to improve data.
The field of healthcare administration informatics is one of the models of applied informatics used in healthcare administration. The relevance of applied informatics in healthcare administration is based on the primary concern of implementing evaluation, acquisition, and implementation of proper day-to-day operations of the healthcare organization (Motiwala et al., 2022). The relevant aspect of implementing applied informatics in healthcare administration is that information technology has made it easier for healthcare managers to use technology systems to support all administrative and clinical functions.
The use of informatics in the management of data for healthcare administration has improved healthcare delivery since all the provider-related issues are essentially addressed. For instance, healthcare providers have difficulty managing provider data regarding which medical experts should operate during which shifts (Pramanik et al., 2020). However, with provider portals, it remains possible to manage to assign changes. The healthcare organization’s daily operations are improved and effectively approved. These administrative decisions are only made better by healthcare-applied informatics in administration. Healthcare administrators can tailor incentive plans to patients through healthcare administrators. Below are how to apply these aspects to healthcare organizations.
Applications of these ideas
In the assisted living organization, applied informatics can be used to achieve proper day-to-day operations of various systems. One area that healthcare administration informatics could apply is to have patient-generated data. Patient-generated data would help manage the patients so the organizations do not have to deal with aspects relating to leaked patient information that can attract legal suits. In conclusion, applied informatics for healthcare administration is a perfect way to deal with challenges regarding day to day operations of the organization.
References
Motiwala, T., Zhang, P., Gregory, M., Fareed, N., Ning, X., Coombes, K., … & Hebert, C. (2022). Review of applied health informatics courses in a multidisciplinary biomedical informatics department.
Learning Health Systems
,
6
(4).
https://www.proquest.com/openview/3306585991d2e670bdb8f7945d951206/1?pq-origsite=gscholar&cbl=4370300
Links to an external site.
.
Pramanik, M. I., Lau, R. Y., Azad, M. A. K., Hossain, M. S., Chowdhury, M. K. H., & Karmaker, B. K. (2020). Healthcare informatics and analytics in big data.
Expert Systems with Applications
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152
, 113388.
https://www.sciencedirect.com/science/article/pii/S0957417420302128
Links to an external site.
.
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Oluwaseun Obajolu
Jan 24, 2023 8:17am
| Last reply Jan 28, 2023 4:33pm
Reply from Oluwaseun Obajolu
Discussion: Prescribing for Pregnant Women
Postnatal depression and prenatal depression share many characteristics, with depression experienced at other times. Depression is characterized by anxious and pessimistic thoughts directed at the unborn child (Khanghah et al., 2020). Women frequently doubt their abilities to be excellent parents and worry about how others see them. Unfortunately, women often delay receiving therapy for prenatal or postnatal depression much longer than is necessary because they, their families, and occasionally even medical professionals may not recognize the condition (Jahan et al., 2021). This is due to a variety of factors. There is some overlap between typical pregnancy symptoms and depression. Still, women assume incorrectly that their symptoms are a natural aspect of pregnancy or transitioning to having a new baby (Frieder et al., 2018). Unnecessarily, some people worry that others could judge them as unfit parents. Another frequent emotion is shame over not being joyful and ecstatic. Anyone can have perinatal mental health concerns, so if you feel you might be having a problem, don’t hesitate to ask for assistance.
FDA-Approved Drug: Bupropion (Wellbutrin)
The FDA has approved this drug to treat depression, seasonal affective disorder, and substance use disorders linked to smoking. These cover solely adult therapy options. Norepinephrine-dopamine reuptake inhibitors include bupropion. By boosting the levels of dopamine and norepinephrine in the brain by inhibiting their reabsorption following synaptic transmission, the medication improves the patient’s mood, as implied by the name. Bupropion is a class C drug (Jahan et al., 2021). Since there are little to no dangers associated with the medicine on either the patient or the unborn, it is safe for use in treating pregnant women. It is safe to use while expecting or nursing a baby.
Off-Label Drug: Duloxetine (Cymbalta)
This drug is authorized to treat recurrent musculoskeletal pain. However, as a medicine taken off-label, it treats adult depression, including prenatal and postnatal depression. Because multiple studies have demonstrated its usefulness in such processes, it is used unconventionally (Khanghah et al., 2020). It is classified as a Class C medication, which means that even though there are side effects, the benefits exceed the unwanted effects (Jahan et al., 2021). By raising the levels of serotonin and noradrenaline in the brain, the selective serotonin and norepinephrine reuptake inhibitor duloxetine enhances brain function.
Non-pharmacological Intervention: Cognitive-Behavioral Therapy
The most specific psychosocial intervention for treating mental illnesses is this one. It operates on the tenet that our thoughts influence our moods and behaviors. CBT enables patients to recognize and replace negative ideas with positive ones. The patient can consequently have an improved mood (Frieder et al., 2018). It also aids the patient in developing stronger coping mechanisms. In many cases, CBT is said to be more effective than medicine. Combination therapy is strongly advised, nevertheless.
Risk Assessment for Duloxetine and Wellbutrin
Wellbutrin has not been linked to any known adverse effects when used to treat pregnant women. However, it has been linked to sleeplessness, headaches, constipation, mouth dryness, tachycardia, weight gain, and vomiting. However, there is a slight possibility of experiencing negative effects (Kaufman et al., 2022). According to reports, duloxetine might result in nonteratogenic side effects such as cyanosis, sleep apnea, seizures, eating problems, vomiting, hypoglycemia, and hypertonia (Khanghah et al., 2020). However, because it falls under group C, its advantages exceed these negative effects.
Clinical Guidelines
Consensus recommendations for treating depression during pregnancy were recently released by the American Psychiatric Association and the American College of Obstetricians and Gynecologists. The objective was to thoroughly analyse the literature and treatment suggestions from authorities in prenatal psychiatry and obstetrics (Frieder et al., 2018). Given the rising concerns about using antidepressants during pregnancy and the growing, somewhat confused body of literature covering this topic, this significant publication comes at a critical moment.
If a pregnant woman has depression, treatment should be suggested. Psychotherapy is advised as the first line of treatment for mild to moderate depression. Although there is research specifically looking at the effectiveness of psychotherapy for depression during pregnancy, there is much evidence to support its use in the general population (Frieder et al., 2018). Psychotherapy referrals are based on the patient’s willingness, availability of qualified professionals, and financial ability. The final two obstacles must be removed because pregnant individuals are probably more inclined to prefer psychotherapy over drugs. But not every patient, not even those with a comparable ailment, will benefit from a single recommended medication, which includes psychotherapy (Khanghah et al., 2020). To provide alternatives if necessary, a patient who is referred for psychotherapy should continue to have her progress monitored.
Antidepressant use during pregnancy is the main emphasis of the American Psychiatric Association/American College of Obstetricians and Gynecologists guidelines. According to scientists, there is evidence linking the usage of selective serotonin reuptake inhibitors with tiny for gestational age newborns (Khanghah et al., 2020). The absolute difference in birth weight is minor and of uncertain clinical relevance, and it is unclear if this depends on the duration of exposure (Jahan et al., 2021). Although there is evidence linking antidepressant usage during pregnancy to preterm birth (defined as occurring before 37 weeks gestation), the differences between exposed and unexposed groups are minor.
References
Frieder, A., Fersh, M., Hainline, R., & Deligiannidis, K. M. (2019). Pharmacotherapy of postpartum depression: Current approaches and novel drug development.
CNS drugs
,
33
(3), 265–282.
https://doi.org/10.1007/s40263-019-00605-7
Links to an external site.
Jahan, N., Went, T. R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I. A., & Alfonso, M. (2021). Untreated depression during pregnancy and its effect on pregnancy outcomes: A Systematic Review.
Cureus
,
13
(8), e17251.
https://doi.org/10.7759/cureus.17251
Links to an external site.
Kaufman, Y., Carlini, S. V., & Deligiannidis, K. M. (2022). Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants.
Therapeutic Advances in Psychopharmacology
,
12
, 20451253211065859.
https://doi.org/10.1177/20451253211065859
Links to an external site.
Khanghah, A. G., Khalesi, Z. B., & Hassanzadeh, R., Afagh (2020). The importance of depression during pregnancy.
JBRA Assisted Reproduction
,
24
(4), 405–410.
https://doi.org/10.5935/1518-0557.20200010
Links to an external site.
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Sward Kamarah
Jan 23, 2023 8:20pm
| Last reply Jan 28, 2023 9:05am
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Wk9DiscussionKamarahS6675.docx
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Shawn Osborne
Jan 23, 2023 7:29pm
| Last reply Jan 28, 2023 9:17pm
Reply from Shawn Osborne
According to Mitchell and Goodman (2018), up to 10 percent of pregnant women will be prescribed an antidepressant while pregnant. There have been some studies that suggest risks including birth defects and health problems with antidepressant use during pregnancy, however, this is controversial and is not supported by strong evidence. The FDA recommends that women do not use antidepressants, but if needed, providers should follow their regular prescribing methods. In the following assignment, I will utilize literature and evidence to make treatment choices ,appropriate for a pregnant woman.
FDA-approved drug, off label drug, and nonpharmacologic intervention
I chose sertraline for my FDA approved drug, which is labeled category C. Use of antidepressants is more likely to cause possible harm in early and late stages of pregnancy, so with this in mind, I felt a drug that was easy to stop and restart as needed would be beneficial. Many others are difficult to wean off, and can cause distressful symptoms. Sertraline is less known to cause such problems, and can often be weaned without difficulty.
Molenaar et al., (2018) Share that treatment
guidelines
for practice are either neutral, or lack evidence when recommending wether to continue or stop antidepressants during pregnancy. When depression is a new occurrence during pregnancy they found recommendations for CBT or other psychotherapy, and if severe, the preferred antidepressant that most prescribed was Sertraline. The authors discuss the controversy over the safety of SSRI’s during pregnancy, and conversely, the possible harm and negative outcomes that may result from no treatment, such as increased suicide, interrupted or poor bonding, and post-partum depression. They report that some possible but not proven effects from taking an SSRI during pregnancy can result in: heart defects, pulmonary hypertension, premature birth, and low birth weight. They also share that depression without treatment can result in: premature birth, low birth weight, and fetal death. This is important to consider when making treatment decisions, and assessing risk in pregnant patients. The risks are similar in treatment vs. non-treatment. But it appears that with treatment, postpartum outcomes may be preferential. A discussion of risks and benefits with the patient is essential, so that an informed decision can be made. The patient is taking all the risk, and needs to have accurate and comprehensive education to make this decision.
An off-label drug I would use is Buspar, which is FDA pregnancy label B. The NIH (2022) highlights the use of Buspirone as an augmenting agent to help with depression, as well as evidence that Buspirone can be effective as monotherapy for depression. The risks of Buspar in pregnancy is unknown but considered safer than others, as it is a category B drug. Nervousness, agitation, and activation can be experienced with Buspirone as well as headaches and dizziness. The benefits are similar to Sertraline, as the negative effects of non-treatment are avoided.
A non-pharmacologic intervention I would use is psychotherapy. Specifically, cognitive behavioral therapy, or interpersonal therapy, which according to Li et al., (2020), are considered the gold standard for treating depression and anxiety during pregnancy. The authors performed a meta-analysis and found evidence for psychotherapy as beneficial during pregnancy at decreasing depression and increasing quality of life. They found results could be maintained, and had positive effects on cognitive processes and self-monitoring abilities. And notable, is the side effects and complications that can be avoided if therapy is sufficient and medication is not needed.
Conclusion
Choosing medications is a complex task, as there are usually risks and benefits for each. Sharing the information with the patient and discussing the preferences and outcome desires, can aid the decision process. Informed consent, and an informed decision are imperative concepts that must be assured for our patients, as they are personally taking the risk.
References
Li, C., Sun, X., Li, Q., Sun, Q., Wu, B., & Duan, D. (2020). Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life.
Medicine
,
99
(27), e20947.
https://doi.org/10.1097/md.0000000000020947
Links to an external site.
Mitchell, J., & Goodman, J. (2018). Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: A systematic review.
Archives of Women’s Mental Health
,
21
(5), 505–516.
https://doi.org/10.1007/s00737-018-0844-z
Links to an external site.
Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review.
Australian & New Zealand Journal of Psychiatry
,
52
(4), 320–327.
https://doi.org/10.1177/0004867418762057
Links to an external site.
NIH. (2022). Buspirone.
National Library of Medicine
. Retrieved January 22, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK531477/
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Teresa Kangethe
Jan 23, 2023 5:53pm
| Last reply Jan 29, 2023 9:10pm
Reply from Teresa Kangethe
Student Name: Teresa Kangethe
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan II
Faculty Name: Dr. Reyes
Discussion on Pregnant mothers on psychotropic medications.
There is no extensive testing that has been done on pregnant and lactating mothers. To treat a pregnant woman suffering from the anxiety, gabapentin is one of the FDA approved medications. According to the study gabapentin has no increased risk of major congenital malformations but one study showed increase preterm birth, low birth weight and NICU admission. Monitor gabapentin level due to metabolic changes that occur during pregnancy. An off label anxiety medication is Clonidine and psychotherapy is the nonpharmacological treatment. Other medication mentioned is Pregabalin then buspirone that has no data in human but has had congenital malformations in animals (Fryane, 2021).
The biggest problem is that there is no enough study extensively done with pregnant mothers and babies. In Arizona when a mother become pregnant, they are suppose to call
1-866-961-2388
number to register. This is one way that is used to collect data and do research in most psychotropic medications during pregnancy. The study follows them even after delivering so they can monitor the effects of psychotropic at long run. Pregnant mothers are vulnerable to relapse during the pregnancy. There is a tendency of reducing the dosing especially during the first trimester but this brings more harm to the mother and baby. Patient taking psychotropic are at risk factors of taking street drugs, alcohol, over the counter medications than patient with other medical sickness like hypertension. This may affect the study outcome when other drugs interfere with the prescribed psychotropic doses. During pregnancy body changes including weight gain, metabolism is known to affect dosing,
There is no most recommended psychotropic medication for pregnant women. It is the work of the provider to study the medication they are on and weigh the pro and cons. If the mother relapse or is not mentally stable the harm is as worse as prescribing the psychotropic during pregnancy “one pregnant mother stated, I don’t want to hear my baby is fine in labor and delivery ward, I want to hear that my baby life is normal all his life and my psychotropic medication I took did not harm the baby” (Payne, 2016)
Reference
Frayne, J., Watson, S., Snellen, M., Nguyen, T., & Galbally, M. (2021). The association between mental illness, psychotropic medication use and hypertensive disorders in pregnancy: A multicentre study.
Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health
,
24
, 22–26. https://doi.org/10.1016/j.preghy.2021.02.002
Byatt N, Hicks-Courant K, Davidson A, et al. Depression and anxiety among
high-risk obstetric inpatients. Gen Hosp Psychiatry 2014;36:644-9
Thiels C. Pharmacotherapy of psychiatric disorder in pregnancy and
during breastfeeding: a review. Pharmacopsychiatry 1987;20:133-46.
Chisolm , M. S., & Payne, J. L. (2016).
Management of psychotropic drugs during pregnancy
Links to an external site.
.
British Medical Journal
,
352
. https://doi.org/10.1136/bmj.h5918
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Laura Assanga Eyong
Jan 22, 2023 4:43pm
| Last reply Jan 27, 2023 8:47pm
Reply from Laura Assanga Eyong
Accessing, Diagnosing, and Treating of Depression in Pregnant Women
A DSM-5 definition for depression is a lack of enjoyment or interest in life, low energy, weight gain or loss, mood swings, sleep difficulty, guilt, suicidal thoughts, etc. Numerous medications are teratogens during pregnancy, increasing the risk of congenital disabilities, spontaneous abortions, stillbirths, and maternal mortality. Pregnancy-related treatment and pharmaceutical use are restricted and necessitate knowledge of the pharmacodynamics and effects of the medicine on the expectant mother.
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women
The preferred medication for treating personality disorders and mental impairment is typically an antidepressant. Selective Serotonin Reuptake Inhibitors (SSRIs), including Citalopram, are a class of drugs that have received FDA approval (Celexa). It prevents serotonin (5-HT) reuptake by neurons in the synaptic cleft. However, it can also cause drowsiness, vertigo, and sweating (Bérard et al., 2017). Vortioxetine is an off-label medication that has demonstrated its effectiveness. However, it is not yet approved due to its recent regulatory approval into the antidepressant family (Shweiki et al., 2021). Although the medicine is still being studied and has not yet received praise, it has demonstrated strength and had positive results when used to treat depressive episodes in pregnancy.The most effective non-pharmacological treatment for a major depressive illness during pregnancy is psychotherapy (Snapper et al., 2018). It improves function and well-being by helping to eliminate and regulate bothersome symptoms.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of FDA-approved medicine? What are the risks and benefits of the off-label drug?
Antidepressants’ teratogenicity and effects on the developing fetus, such as heart abnormalities, primary pulmonary hypertension in newborns, or poor neonatal adaption syndrome, are the main risks associated with using them during pregnancy. After prolonged use, especially in the third trimester, drugs can cause fetal mortality. A non-teratogenicity prescription should guide the medicine selection.
According to Berard et al. (2017), there is a link between Citalopram (an FDA-approved drug) and a higher incidence of poor newborn adaption syndrome. It can result in changes in crucial genes for development during the embryogenic stage, resulting in congenital disabilities. On the other side, vortioxetine increases the chance of injury to the infant and the mother relapsing into depression (Shweiki et al., 2021). However, it offers the advantage of lessening and stopping depressive episodes while having fewer adverse effects. Nevertheless, it is effective in treating pregnancy-related depression.
Explain whether clinical practice guidelines exist for this disorder and if so, use them to justify your recommendations. If you still need to, explain what information you need to consider.
There are clinical practice recommendations for mental retardation and personality problems in pregnancy. These include prescription drugs and counseling. Remission is emphasized as the primary objective of psychotherapy. Medication, however, specifies the drug combinations for treating severe depressive disorder. These include combining tricyclic antidepressants (TCAs) like imipramine, amitriptyline, or nortryptyline with SSRIs like citalopram, escitalopram, fluoxetine, or paroxetine. Therefore, to treat major depressive disorder during pregnancy, I advise utilizing both medication and psychotherapy.
References
(1). Austin, M.-P., Frilingos, M., Lumley, J., Hadzi-Pavlovic, D., Roncolato, W., Acland, S., … Parker, G. (2008). Brief antenatal cognitive behavior therapy group intervention to prevent postnatal depression and anxiety: A randomized controlled trial. Journal of Affective Disorders, 105(1–3), 35–44.
https://doi.org/10.1016/j.jad. 2007.04.001
Links to an external site.
(2). Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant Use during Pregnancy and the Risk of Major Congenital Malformations in a Cohort of Depressed Pregnant Women: An Updated Analysis of the Quebec Pregnancy Cohort. BMJ Open, 7(1), e013372.
https://doi.org/10.1176/appi.ajp.2010.09121743
Links to an external site.
(3). Shweiki, S., & Diav‐Citrin, O. (2021). Pregnancy Outcome after First-Trimester Exposure to Vortioxetine: A case series. Birth Defects Research, 113(6), 511-515.
(4). Snapper, L. A., Hart, K. L., Venkatesh, K. K., Kaimal, A. J., & Perlis, R. H. (2018). A Cohort Study of the Relationship between Individual Psychotherapy and Pregnancy Outcomes. Journal of affective disorders, 239, 253-257.
(5). Sangini S. Sheth, Jenell Coleman, Tirza Cannon, Lorraine Milio, Jean Keller, Jean Anderson & Cynthia Argani (2015) Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV, AIDS Care, 27:3, 350-354, DOI:
10.1080/09540121.2014.998610
Links to an external site.
10.1080/09540121.2014.998610
Download 10.1080/09540121.2014.998610
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NRNP 6675 Final Exam – Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply.
Question 2 1 pts
Curriculum content that supports the NP scientific foundation competency area includes which of the following? Select all that apply.
Group of answer choices
Comparison of patient data sets with evidence-based standards to improve care
Science from other disciplines relevant to health care
High-reliability organization principles.
Compliance issues related to patient privacy with use of technology.
Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
In 2–3 pages, address the following:
Florida state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released
.
There are two ways a person can be held involuntarily in Florida when safety is compromised. The Baker Act (BA) is a short-term involuntary placement of a person with questionable cognition who appears to be a danger to self and others in a designated psychiatric facility until the need for extended hospitalization is determined. It should be at most 72 hours. The second is the Marchman Act (MA) which is meant to assist those struggling with substance abuse and should not exceed 72 hours. During the 72-hour psych hold for BA or MA, a specific set of guidelines is geared towards stabilizing the individual and validating the case to determine if there is a need for a more extended stay in the facility. In Florida, if a competent court adjudicates a person incapacitated under part V of chapter 744 of the Mental Health Act, a guardian is appointed to make health decisions on behalf of the individual. A child’s biological parents or court-appointed legal guardians should make decisions for the minor. Due to the significance of involuntarily placing a person in a treatment facility, specific measures must be met by the individual to qualify. These measures include the person’s inability to make a rational decision about self. If the person declines examination, the person is at risk of harming himself or manifesting adverse effects from self-neglect, and the person poses a risk of harming others. It also includes when the person is using substances that could cause harm to him or others and cannot decide on his own to seek help for addiction. Those authorized to file and place a hold on a patient include a doctor, law enforcement officer, spouse, parents, or a close relative of the person involved. In some extreme conditions, a non-relative, such as a roommate, can get a patient involuntarily admitted to a drug rehabilitation facility if two other witnesses can confirm the risk to self or others’ claim. Physical examination on arrival rules out a person’s immediate physical distress and must be done within minutes of arrival but not exceeding 24 hours. It includes drug tests and other assessments to validate possible reasons for a patient’s escalated behavior. A confidential psychological examination is also carried out within 72 hours of the person’s hold. The information gathered will help the facility make a professional recommendation to the court regarding whether to continue an extended hold on the person. Most individuals calm down within 72 hours of stabilization, can make a more definitive decision, and are allowed to seek voluntary treatment, which changes their status.
Explain the differences between emergency hospitalization for evaluation/psychiatric hold, inpatient, and outpatient commitment in your state
Under the Florida Mental Health Act, which is also known as the Baker Act and Marchman Act (MA) sections 394-451, addressed as legislative intent, the Department of Children and Families (DCF) is the parastatal designated with the permission to evaluate, research, plan, and recommend to the governor and the legislature programs designed to reduce the incidence, severity, duration and disabling aspects of mental, emotional and behavioral health issues. Severe mental health can affect a person’s ability to make sound or reasonable decisions. In Florida, involuntary outpatient commitments are court orders mandating persons with severe mental illness and repeated hospitalization to adhere to community-based treatment. To take a patient involuntarily, all available less restrictive treatment alternatives which would offer an opportunity to improve the patient’s condition would have been judged appropriately. There should be sworn statements of experts testifying in involuntary inpatient placement hearings about the availability and appropriateness of less restrictive community alternatives (394.467(b), FS). The person must meet the statutory criteria for admission to a state treatment facility. The Baker Act also specifies in s.394.461(2), FS, that it governs the designation of receiving and treatment facilities that a civil patient shall not be admitted to a state treatment facility without undergoing a transfer evaluation. A mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), FAC, the process for conducting such transfer evaluations shall be developed by the community mental health center or clinic and approved by the district or regional office of the department where the center or clinic is located shall be completed.
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Explain the difference between capacity and competency in mental health contexts.
A clinician or hospitalist familiar with a patient can make a specific decision based on a functional assessment of the patient to assist with clinical determination. Capacity is usually defined by state law and varies by jurisdiction. It is evident when a patient’s functional assessment is questionable, and the hospitalist has to decide independently of a consultant. Four cardinal components are assessed in evaluating functional capacity assessment: communicating a choice, understanding, appreciation, and rationalization/reasoning. Capacity is variable, on hand, and not static. A clinician who has earned rapport with the patient and is familiar with the case details can make the determination. In contrast, competency in mental health is a global assessment and legal determination made by a judge in court. The MacArthur Competence Assessment Tools for Treatment (MacCAT-T) serves as a yardstick to measure capacity assessment aid.
Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy.
The vulnerability of patients living with mental health poses a lot of legal and ethical issues. Providers and clinicians must apply ethical reasoning when faced with clinical challenges to improve patient outcomes. In psychiatric emergencies, when a patient requires involuntary placement, his autonomy and ability to make a sound decision are queried and removed. It is legally binding under the emergency to assess the decision-making capacity of the patient using the four criteria communication, understanding, appreciation, and reasoning. The goal of placing a patient involuntarily is to protect him from harm, not to expose him to where he is capable of autonomous decision-making, not dangerous, or not impaired by their psychiatric illness using the least restrictive means possible. It is, therefore, ethically and legally required to re-assess the patient after the acute phase to determine his mental status and possible removal of his involuntary status.
Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified
The Columbia-Suicide Severity Rating Scale (C-SSRS) is one evidence-based suicide risk assessment tool used to assess suicidal behaviors. It uses questions to detect patients at risk for suicide through the intensity of the suicide ideation, potentially self-injurious act committed with at least some wish to die due to the act and thought of as a method to kill oneself. It is important to note that the intent does not have to be 100%; instead, the intent/desire to die associated with the act can be considered an actual suicide attempt. Potential for injury or damage without any actual injury or damage is considered a suicidal attempt, for example, a headshot or jumping from the window of a high floor/story. A highly destructive act is not an accident but is considered intent for suicide, and the same applies to when one denies intent to die but thinks that what he did could be lethal; intent may be inferred. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.
The violence risk assessment screening tool is used to identify patients prone to violent attacks on caregivers and providers, thereby creating avenues for prompt interventions. According to research, about 90% of doctors, nurses, and patient caregivers encounter violent attacks from their patients. The V-RISK-10 checklist uses the rater to collect information about the potential violent intentions of the patient expressed in a yes or no response. It is from the responses that the severity of the intent to inflict injury will be rated in degree terms as severe, low, or no risk.
References:
King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk.
Journal of clinical psychology in medical settings
,
24
(1), 8.
https://doi.org/10.1007/s10880-017-9486y
Anderson, K. K., & Jenson, C. E. (2019). Violence risk-assessment screening tools for acute care mental health settings: A literature review.
Archives of psychiatric nursing
,
33
(1), 112–119. https://doi.org/10.1016/j.apnu.2018.08.012
Doyle M, Dolan M: Predicting community violence from patients discharged from mental health services. Br J Psychiatry. 2006, 189: 520-526. 10.1192/bjp.bp.105.021204.
Sjöstrand, M., Sandman, L., Karlsson, P., Helgesson, G., Eriksson, S., & Juth, N. (2015). Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists.
BMC medical ethics
,
16
, 37.
https://doi.org/10.1186/s12910-015-0029-5
Link– https://pubmed.ncbi.nlm.nih.gov/30663614/
Link –
[HTML]
Patient health questionnaire depression scale as a suicide screening instrument in depressed primary care patients: a cross-sectional study
source: Ganzini L, Volicer L, Nelson WA, Fox E, Derse AR. Ten myths about decision-making capacity.
J Am Med Dir Assoc.
2004;5(4):263-267.
https://app.grammarly.com/ddocs/1903514634
Legal and Ethical Issues Related to Psychiatric Emergencies
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
To Prepare
Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
The Assignment
In 2–3 pages, address the following:
Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
Explain the difference between capacity and competency in mental health contexts.
Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
Identify one evidence-based suicide risk assessment that you could use to screen patients.
Identify one evidence-based violence risk assessment that you could use to screen patients.
By Day 7 of Week 8
Submit
your Assignment. Attach copies of or links to the suicide and violence risk assessments you selected.
submission information
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To submit your completed assignment, save your Assignment as
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Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
Rubric
NRNP_6675_Week8_Assignment_Rubric
NRNP_6675_Week8_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
In 2–3 pages, address the following: • Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
15
to >
13.0
pts
Excellent 90%–100%
The response includes a thorough and well-organized explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
13
to >
11.0
pts
Good 80%–89%
The response includes an accurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies.
10
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of student’s state laws for involuntary psychiatric holds for child and adult emergencies. Or the response is missing.
15
pts
This criterion is linked to a Learning Outcome
• Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
15
to >
13.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
13
to >
11.0
pts
Good 80%–89%
The response includes a well-organized explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
10
to >
0
pts
Poor 0%–69%
The response includes a vague explanation of the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state. Or the response is missing.
15
pts
This criterion is linked to a Learning Outcome
• Explain the difference between capacity and competency in mental health contexts. Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
10
to >
8.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the difference between capacity and competency in mental health contexts.
8
to >
7.0
pts
Good 80%–89%
The response includes an accurate explanation of the difference between capacity and competency in mental health contexts.
7
to >
6.0
pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of the difference between capacity and competency in mental health contexts.
6
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of the difference between capacity and competency in mental health contexts. Or the response is missing.
10
pts
This criterion is linked to a Learning Outcome
• Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
15
to >
13.0
pts
Excellent 90%–100%
The response accurately and concisely explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
13
to >
11.0
pts
Good 80%–89%
The response accurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
11
to >
10.0
pts
Fair 70%–79%
The response somewhat vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies.
10
to >
0
pts
Poor 0%–69%
The response vaguely or innacurately explains one legal and one ethical issue related to the selected topic, within the context of treating psychiatric emergencies. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
•Identify one evidence-based suicide risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.
15
to >
13.0
pts
Excellent 90%–100%
The response identifies and explains an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
13
to >
11.0
pts
Good 80%–89%
The response identifies an appropriate, evidence-based suicide risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
11
to >
10.0
pts
Fair 70%–79%
The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.
10
to >
0
pts
Poor 0%–69%
The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
• Identify one evidence-based violence risk assessment that you could use to screen patients. Attach a copy or a link to the assessment you identified.
15
to >
13.0
pts
Excellent 90%–100%
The response identifies and explains an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
13
to >
11.0
pts
Good 80%–89%
The response identifies an appropriate, evidence-based violence risk assessment that could be used to screen patients. A copy of or a link to the assessment is included.
11
to >
10.0
pts
Fair 70%–79%
The risk assessment identified is somewhat inappropriate for the intended use or dated. A copy of or a link to the assessment may be missing.
10
to >
0
pts
Poor 0%–69%
The risk assessment identified is inappropriate for the intended use, not evidence based, or dated. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
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. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5
to >
4.0
pts
Excellent 90%–100%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4
to >
3.5
pts
Good 80%–89%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5
to >
3.0
pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.
3
to >
0
pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5
to >
4.0
pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors
3
to >
0
pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5
pts
This criterion is linked to a Learning Outcome
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
to >
4.0
pts
Excellent 90%–100%
Uses correct APA format with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 APA format errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 APA format errors
3
to >
0
pts
Poor 0%–69%
Contains five or more APA format errors
5
pts
Total Points:
100 Legal and Ethical Issues Related to Psychiatric Emergencies – NRNP-6675 Week 8: Assignment
NRNP 6675 Final Exam The independent credentialing body for the ANA is known as which of the following?
Question 1 1 pts
The independent credentialing body for the ANA is known as which of the following?
Group of answer choices
ANCC
AECN
ACCN
CCNE
Walden University Nurs 6050 week 1 Presidential Agendas discussion post and responses
Presidential Agendas
Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)
Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.
Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?
Reference:
New York State Department of Health. (n.d.).
Making New York the healthiest state: Achieving the triple aim
. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Resources and reflect on the importance of agenda setting.
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.
By Day 3 of Week 1
Post
your response to the discussion question: Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?
By Day 6 of Week 1
Respond
to at least
two
of your colleagues
* on two different days
by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.
Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
COVID-19- Health Issue
A great deal of different health issues has risen to the presidential agenda level for decades. Various cases of health issues rise to the presidential level because of high significance and need for immediate resolution. The health topic of Covid-19 greatly rose to the presidential agenda level due to significant illness and death, which led to widespread lockdowns, and disruptions to global supply chains; severely impacting the economy (Anselm et al., 2021). This pandemic led to a combination of economic, public health, and political crisis. The covid-19 pandemic crisis dominated news cycles, putting pressure on the government to address the situation (Anselm et al., 2021). These factors combined to elevate COVID-19 to the level of a presidential agenda item, requiring direct leadership, policy development, and public communication.
I
mpact of Social Determinants of Health
The social determinant of health that mostly affected Covid-19 pandemic was socioeconomic status. Social economic status intersects with many other factors, including access to healthcare, living conditions, and occupation. For instance, people with lower income levels often have limited access to healthcare, and during the pandemic it made it extremely difficult to get tested or receive timely treatment for COVID-19 (Garrett, 2023). During these times, economic pressure forced people to work even when sick, which was further spreading the viruses. Individuals in lower socioeconomic brackets were mostly living in crowded housing conditions, where social distancing was difficult (Garrett, 2023). This then increased the risk of transmission within households and communities. In addition, most citizens had jobs that required close physical proximity to others, increasing exposure to the virus (Garrett, 2023). Overall, lower socioeconomic status had less access to reliable information about the virus, prevention measures, and vaccines, leading to higher rates of infection and vaccine hesitancy (Garrett, 2023)
GET WRITING HELP HERE
Past President’s Approaches
Presidents Joe Biden and Donald Trump approached the COVID-19 pandemic differently, in respect to their distinct leadership styles and policy priorities. President Trump’s initial approach to the covid 19 pandemic was inconsistent while downplaying the virus. It was treated like a flu with the prediction that it would disappear. Citizens were disappointed with the inadequate distribution of testing kits and personal protective equipment (Park, Haynes, & Gasper, 201). In March 2020, Trump initiated and signed the CARES Act which provided $2.2 trillion in economic relief. This included direct payments to individuals, expanded unemployment benefits, and support for small businesses (Park, Haynes, & Gasper, 2021). In addition, Trump emphasized on state autonomy in handling the pandemic, which led to disorganized enforcement of policies across the country (Park, Haynes, & Gasper, 2021). Federal mandates on issues like mask-wearing were not strongly imposed. Overall, Trump was a strong advocate for reopening the economy, which clashed with public health officials who recommended more cautious approaches.
President Biden’s initial approach was consistent and emphasized on the seriousness of the pandemic. He encouraged mask-wearing, social distancing, and vaccination, and was modeling these behaviors in public appearances. Biden implemented a national strategy to combat COVID-19, focusing on vaccine distribution, testing, and public health measures. His administration placed a strong emphasis on following scientific guidance. Biden’s administration prioritized the mass distribution of vaccines. By March 2021, vaccines were widely available, and were administered (Park, Haynes, & Gasper, 2021). Initiatives like mobile vaccination units were widely available while partnerships with pharmacies to increase access (Park, Haynes, & Gasper, 2021). Biden implemented several federal mandates, including a mask mandate on federal property and for interstate travel. His administration also pursued vaccine mandates for federal workers and contractors, as well as for large employers, though some of these mandates faced legal challenges. Overall, Biden’s administration took a more centralized, federal approach to managing the pandemic, whereas Trump emphasized state autonomy and limited federal intervention.
What I would do differently
What I would do differently as an individual at the presidential level who will be handling COVID-19 case will initially be to establish a dedicated pandemic response team early on to monitor global health threats. I will implement comprehensive Lockdowns and travel restrictions in the early stages to prevent widespread transmission (Anselm et al., 2021). My early on approaches will be to prioritize mass production and distribution of testing kits, ensuring widespread and easy access to testing from the outset. I will provide clear, consistent, and science-based communication to the public. I will be regularly updating citizens through briefings, ensuring that the information is accessible and transparent. I will develop a response plan that specifically addresses the needs of vulnerable populations. This will include racial and ethnic minorities, low-income communities, and frontline workers (Garrett, 2023). Also, I will work closely with community leaders and organizations to reach underserved populations with specific public health messages and support. I will ensure equal distribution of vaccines, treatments, and healthcare resources to all. In addition, I will implement economic relief measures that support both individuals and businesses. These could include direct payments, expanded unemployment benefits, and small business grants. Overall, I will rely mainly on the advice of public health experts and scientists in my decision-making processes, ensuring that policies are informed by the best available evidence. By focusing on these areas, as a presidential-level leader I could potentially manage a pandemic more effectively, and maintain public trust.
Reference
Anselm J.M. Hennis, Anna Coates, Sandra del Pino, Massimo Ghidinelli, Rodolfo Gomez Ponce de Leon, Edwin Bolastig, Luis Castellanos, Renato Oliveira e Souza, & Silvana Luciani. (2021). COVID-19 and inequities in the Americas: lessons learned and implications for essential health services. Revista Panamericana de Salud Pública, 45(130), 1–5. https://doi.org/10.26633/RPSP.2021.130
Garrett, T. M. (2023). Border securocracy: Global expansion of the U.S. Department of homeland security bureaucratic apparatus before, during and beyond covid-19. Administrative Theory & Praxis (Taylor & Francis Ltd), 45(3), 230–246. https://doi.org/10.1080/10841806.2022.2112454
Park, H. J., Hu, D., Haynes, E., & Gasper, K. (2021). When a lack of passion intertwines with thought and action: Neutral feelings about COVID-19 are associated with US presidential candidate attitudes and voting behavior. Emotion, 21(8), 1796–1800. https://doi.org/10.1037/emo0001051
Reply from Tamika Cheatham
The topic that I will be considering is mental health. As such, mental health becomes a priority concern of the presidency due to the fact of its broad ramifications affecting not only the individual but social levels as well. Socioeconomic status is one of the most common socio-ecological contributors to mental disorders that affect care availability, accessibility, adequacy, and, hence, overall outcome (Horn et al., 2021). Low income and a lack of education are some typical aggravating factors in mental health decreases, which ultimately lead to an increased risk for significant disorders such as depression and anxiety. Addressing these disparities remains important if improvement in mental health outcomes at the population level is to be realized.
During his term, Former President Donald Trump passed the Mental Health Parity and Addiction Equity Act so that similar coverage could be provided to mental health and substance use disorder services as would be provided for services of physical health (Presskreischer et al., 2022). His administration increased funding for programs in mental health and augmented access through the Affordable Care Act. Former President Donald Trump continued to keep mental health in the forefront, calling for programs such as the National Suicide Prevention Lifeline. However, he gave most of his attention to mental health regarding substance abuse. By contrast, some of the programs dealing with mental health received reduced funding during the presidency of Trump.
Presently, Joe Biden has made mental health part of his broader health agenda. His administration has sought to expand access to mental health services through initiatives like the American Rescue Plan, which, among many other things, allocated significant funding to mental health and substance use disorder services. Biden has also tried to underscore that an approach will be necessary to help ease the mental health crisis worsened by the COVID-19 pandemic to create access to more care, particularly in under-resourced communities.
If I had to approach mental health from the presidential level, I would increase the funding of mental health services and integrate mental health care into the primary setting. Because stigma plays such a huge role, the expansion of mental health education and awareness campaigns is imperative in reducing stigma and increasing access. Finally, socioeconomic determinants would be addressed through policy changes promoting access to education, jobs, and affordable housing (Adabre & Chan, 2019). If we address these social determinants, it would lead to the construction of a holistic approach toward mental health and support all individuals, especially those coming from a disadvantaged background. Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
References
Adabre, M. A., & Chan, A. P. C. (2019). Critical success factors (CSFs) for sustainable affordable housing. Building and Environment, 156, 203–214. https://doi.org/10.1016/j.buildenv.2019.04.030
Horn, R., Arakelyan, S., Wurie, H., & Ager, A. (2021). Factors contributing to emotional distress in Sierra Leone: a socio-ecological analysis. International Journal of Mental Health Systems, 15(1). https://doi.org/10.1186/s13033-021-00474-y
Presskreischer, R., Barry, C. L., Lawrence, A. K., McCourt, A., Mojtabai, R., & McGinty, E. E. (2022). Factors Affecting State-Level Enforcement of the Federal Mental Health Parity and Addiction Equity Act: A Cross-Case Analysis of Four States. Journal of Health Politics, Policy and Law, 48(1).
https://doi.org/10.1215/03616878-10171062
Links to an external site.
Short, N. M. (2022).
Milstead’s health policy and politics: A nurse’s guide
(7th ed.). Jones & Bartlett Learning.
The White House. (2023, May 18).
Fact sheet: Biden-Harris administration announces new actions to tackle nation’s mental health crisis
. The White House. Retrieved August 28, 2024, from https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/fact-sheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/
The White House. (2020, October 5). President Donald J. Trump is safeguarding Americans’ mental health and preventing the tragedy of suicide. The White House. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/
Initial Post on the Opioid Crisis in America
The opioid crisis in the United States has emerged as a significant public health emergency, rising to the level of a presidential agenda due to its widespread impact. Over 80,000 people succumbed to opioids in 2022.
(CDC, 2023)
The epidemic, characterized by the over-prescription and misuse of opioid medications, such as, Hydrocodone and Oxycodone, has resulted in a dramatic increase in opioid-related overdoses and deaths. The opioid crisis has disproportionately affected rural areas just as much as urban areas. In some rural communities, the overdose death rate is nearly twice that of urban areas. A critical social determinant of health that significantly affects this issue is socioeconomic status, and access to healthcare. Individuals in lower-income brackets are more likely to experience chronic pain, have limited access to healthcare, and consequently are more susceptible to opioid misuse. Communities with high unemployment rates and limited economic opportunities are disproportionately affected by the opioid crisis as well.
Current President Biden
The Biden Administration has prioritized addressing the opioid crisis, recognizing it as a significant public health issue that demands immediate action. A critical social determinant affecting this crisis is access to healthcare. Many individuals, particularly those in underserved communities, lack adequate access to comprehensive healthcare services, including mental health and addiction treatment. This lack of access exacerbates the misuse of opioids as individuals may turn to these substances for unmanaged pain or untreated mental health issues.
President Joe Biden’s approach to the opioid crisis involves a multi-faceted strategy focusing on prevention, treatment, and harm reduction. His administration has allocated significant resources to expand access to evidence-based treatment, including medication-assisted treatment, and has emphasized the importance of reducing the stigma associated with addiction. The administration is working to increase access to naloxone, a life-saving medication that can reverse opioid overdoses, and to improve support systems for individuals in recovery.
Past Presidents
Two past U.S. Presidents have taken different approaches to addressing the opioid crisis. President Barack Obama, during his tenure, focused on expanding access to treatment and recovery services. The Comprehensive Addiction and Recovery Act (CARA), signed into law in 2016, was one of his administration’s key legislative efforts. This act aimed to expand prevention and education efforts while also improving access to treatment for those struggling with addiction. Obama’s approach recognized the need for a multi-faceted response that included both public health and criminal justice components.
President Donald Trump, on the other hand, declared the opioid crisis a public health emergency in 2017 and focused on stricter law enforcement as well as expanding access to treatment. The SUPPORT for Patients and Communities Act, signed into law in 2018, was a comprehensive package that included measures to increase access to addiction treatment, support prevention efforts, and reduce the supply of opioids. Trump’s administration also emphasized the importance of securing the U.S. borders to prevent the flow of illegal drugs into the country.
What could be done differently
While all approaches made strides in addressing the opioid crisis, there are areas where improvements could be made. If given the opportunity to tackle this issue, I would advocate for a more vigorous emphasis on prevention through education and community-based interventions. By addressing the root causes of opioid misuse, such as poverty, mental health issues, and lack of economic opportunities, a more sustainable solution could be developed. I would also focus on expanding access to non-opioid pain management alternatives such as massage and acupuncture. And increasing funding for research into new treatments for chronic pain that do not involve addictive substances. These efforts would help reduce the demand for opioids and provide long-term relief for those affected by this crisis.
References
https://www.cdc.gov/drugoverdose/deaths/index.html
Links to an external site.
Jones, C. M., et al. (2018). Trends and key correlates of prescription opioid injection misuse in the United States. Addictive Behaviors, 76, 53-61.
Kolodny, A., et al. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559-574.
Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263.
Expand discussion thread from Stephania A Senter
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Tracy M Chaves
Aug 28, 2024 9:01pm
| Last reply Sep 1, 2024 2:16pm
Reply from Tracy M Chaves
Per the Health Policy and Politics Nurse’s Guide, there are four categories that influence what issues would make it to a presidential agenda level. Actors refer to people or groups that draw attention to problems; ideas refer to the power or value an issue has with polls or surveys; interests are related to the benefits such as reelection addressing an issue has; and lastly institutes are the “organizational structure” or the setting where the agenda is discussed (Short, 2022).
There has been models developed to address explain how a policy rises to the presidential agenda level and change occurs, these models are the Iron Triangle Model, The Punctuated Equilibrium Model, The Advocacy Coalition Model, The Path Dependent Model, and the most popular Kingdom Model as described in the text (Short, 2022). When a problem coupled with the right timing and the right interest group leading the way an agenda gets on a presidential level.
A popular health topic that rises to presidential agenda level is the topic of health insurance. Social determinants most affected by this health issue are economical stability and healthcare access and quality. There has been numerous presidential administrations that have tried reform with difficulty. The difficulty comes on the political views and goals of each political party. A good example of this is the Affordable Care Act. Implemented by democrats in 2010, later changed by republicans, and now currently going through different change again by democrats. For the 2024 elections, health policy issues will continue to be a main debate (Emory Rollins, n.d.).
It is hard to say what I would do as no one has been successful in addressing the affordable healthcare issue. However, I would start with implementing health care professionals, such as nurses into the discussion as members. Unfortunately the decisions about our health is being made by those with little knowledge about it. “Nurses and IPHCWs bring a unique and trusted perspective to policy deliberation and development because of their training, values, ethics, and experience”(Short, 2022).
A policy briefing would also be beneficial. Due to politicians usually not coming from a healthcare background, it would be important to assess their level of understanding, give clear explanations of the significance of the policy, give the actions that are needed, and the research evidence to back it all up (DeMarco, 2014).
I know I would also would like to incorporate more preventative coverage research. On a personal level I have seen changes being made to CMS related to home health that I feel is not preventative but reactive. Insurance type also plays a factor on what services are covered or not, both with private insurance coverage and Medicare coverage.
References
DeMarco, R., & Tufts, K.A. (2014). The mechanics of writing a policy brief.
Nursing Outlook,
62(3), 219-224.
Emory’s Rollins School of Public Health. (n.d.) Health policy and the 2024 elections. Retrieved Aug 28 2024, from https://sph.emory.edu/features/2024/presidential-election/health-policy/
Short, N.M. (2022).
Milstead’s health policy and politics: as nurse’s guide.
Seventh edition, 57-71. Burlington, MA, Jones and Bartlett Learning.
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Mihret Ghebreamlak
Aug 28, 2024 9pm
| Last reply Sep 1, 2024 4:17am
Reply from Mihret Ghebreamlak
COVID-19 and the Impact of Social Determinants of Health
Main Post
The COVID-19 pandemic has underlined the profound influences that social determinants of health, broadly socio-economic status, have on population health. SES, measured by income, education, and employment, is important in determining health outcomes. The pandemic has made the low-income population face higher risks from limited access to healthcare, living in overcrowded environments, and employment in essential but high-exposure jobs (Abrams & Szefler, 2020). Each of these factors has contributed to higher COVID-19 infection rates, hospitalizations, and mortalities in marginalized communities. The disparities in health outcomes underline the need for more significant investments in public health infrastructure, notably in underserved communities, to mitigate the effects of such social determinants during future health crises (Maani & Galea, 2020).
Past President’s Approaches
President Donald Trump had earlier focused on economic measures and vaccine development. The administration initiated Operation Warp Speed to accelerate vaccine development, production, and distribution (Kellogg & Overton, 2021). His administration had been criticized for minimizing the severity of the virus and issuing confusing guidance on public health (Parker & Stern, 2022). Trump’s policies were generally directed toward opening up the economy, which made lower-income individuals particularly vulnerable as they could not work from home.
President Joe Biden came into office with a pledge for a coordinated federal approach. His administration has emphasized widespread vaccination, public health guidance, and direct financial support to individuals and businesses. Biden also moved to address health inequity, targeting vaccination efforts in underserved communities, increasing funding for public health infrastructure, and extending unemployment benefits and stimulus payments to help those facing economic hardship due to the pandemic (The White House, 2021).
What Could Be Done Differently
While both administrations took necessary steps, addressing SES as a determinant of health would have led to improved outcomes. Such policy measures would include enhancing healthcare access for the uninsured or underinsured segments of society, supporting essential workers, and investing in public health infrastructure in low-income communities. Public health messaging must remain consistent and ensure that all communities receive accurate and proper information and resources to manage future health crises.
References:
Abrams, E. M., & Szefler, S. J. (2020). COVID-19 and the impact of social determinants of health.
The Lancet Respiratory Medicine
,
8
(7), 659–661. https://doi.org/10.1016/s2213-2600(20)30234-4
Kellogg, K., & Overton, H. (2021, June 4).
Operation Warp Speed: Innovating Vaccine Development While Addressing a National Crisis
. Americafirstpolicy.com. https://americafirstpolicy.com/issues/operation-warp-speed-innovating-vaccine-development-while-addressing-a-national-crisis
Maani, N., & Galea, S. (2020). COVID-19 and Underinvestment in the Public Health Infrastructure of the United States.
The Milbank Quarterly
,
98
(2). https://doi.org/10.1111/1468-0009.12463
Parker, C. F., & Stern, E. K. (2022). The Trump Administration and the COVID-19 crisis: Exploring the warning-response problems and missed opportunities of a public health emergency.
Public Administration
,
100
(3). https://doi.org/10.1111/padm.12843
The White House. (2021, January 20).
President Biden Announces American Rescue Plan
. The White House. https://www.whitehouse.gov/briefing-room/legislation/2021/01/20/president-biden-announces-american-rescue-plan/
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Kayla Rena Davis
Aug 28, 2024 8:52pm
| Last reply Sep 1, 2024 4:50am
Reply from Kayla Rena Davis
A widely discussed health topic that will be discussed in this post is the cost of prescription drugs and what Presidents Biden and Trump have done to assist Americans in lowering this cost. Biden and Trump aimed to bring down prescription drug prices and end surprise billing, even agreeing on some interventions to help this initiative.
President Joe Biden’s Inflation Reduction Act (IRA) grants Medicare the authority to negotiate the prices of specific prescription drugs, thereby introducing a significant shift in federal healthcare policy. Initially, the negotiations encompass ten selected drugs, with a maximum of 20 drugs per year; however, President Biden aims to expand this number to 50 drugs annually (The White House, 2024). The newly negotiated prices are slated to take effect in 2026, with projected savings estimated at $1.5 billion in prescription drug costs (Centers for Medicare & Medicaid Services [CMS], 2024). In addition to drug price negotiations, the IRA imposes a cap on out-of-pocket expenses for Medicare beneficiaries, expected to yield an average savings of $400 per year (The White House, 2024). The Act also extends the insulin price cap introduced under the Trump administration, transitioning it from voluntary to mandatory and establishing a $35 monthly cap on insulin costs.
President Donald J. Trump implemented several executive orders to reduce the cost of prescription medications and enhance access for Americans. One executive order extended the drug rebates that manufacturers offer to private insurers, making them available to Medicare beneficiaries (Robertson, 2023). Another order focused on making insulin and epinephrine more affordable for low-income individuals, reducing their cost to $35 or less. Initially voluntary, President Biden codified this measure into law (The White House, 2020). Additionally, President Trump signed an order permitting the importation of drugs from other states or countries to foster competitive pricing and abolished gag clauses, which had previously prevented pharmacists from discussing the most cost-effective options with consumers (The White House, 2020).
To build upon the efforts of the current and previous administrations in reducing prescription drug costs for Americans, I propose extending negotiated drug prices to individuals without Medicare or Medicaid coverage. Additionally, to prevent price gouging, a pricing benchmark should be established based on the prices negotiated by Medicare and the prices paid by other countries for the same medications. This approach would ensure that negotiated prices are accessible to all, enhancing affordability and equity in healthcare.
Reference:
Centers for Medicare & Medicaid Services (CMS). (2024, August).
Medicare prescription drug inflation rebate program part …
https://www.cms.gov/files/document/fact-sheet-part-b-rebatable-drug-coinsurance-reduction.pdf
Robertson, L. (2023, September 19).
Trump’s executive orders on prescription drugs
. FactCheck.org. https://www.factcheck.org/2020/07/trumps-executive-orders-on-prescription-drugs/
The White House. (2020, July).
FACT SHEETS President Donald J. Trump Is Taking Action to Lower Drug Costs and Ensure That Americans Have Access to Life-saving Medications
. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-taking-action-lower-drug-costs-ensure-americans-access-life-saving-medications/
The White House. (2024, March 8).
Fact sheet: President Biden takes new steps to lower prescription drug and health care costs, expand access to health care, and protect consumers
. https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/06/fact-sheet-president-biden-takes-new-steps-to-lower-prescription-drug-and-health-care-costs-expand-access-to-health-care-and-protect-consumers/
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Hiedi Wurster
Aug 28, 2024 8:37pm
| Last reply Aug 31, 2024 6:07pm
Reply from Hiedi Wurster
The Opioid Crisis
The opioid epidemic is one of the most devastating crises of our time. Since opioids became widely prescribed in the 1990s, at least 500,000 people in the U.S. have died from an opiate overdose (Uncovering the Opioid Epidemic, n.d.). An estimated 2.5 million Americans have opioid use disorder (Abuse, 2023), and approximately 10 million Americans twelve years old and older have misused opioids in the past year (Association, 2023). This crisis has manifested in three waves (Feldscher, 2022). Oxycontin, which has a high risk for dependency, was the first legally prescribed opioid that brought on the first wave of deaths that were linked to opioids (Feldscher, 2022). The second wave came from heroin, which appealed to people who were already addicted (Feldscher, 2022). We are currently in the third wave, which is attributed to illegally obtained opioids such as fentanyl (Feldscher, 2022). In 2021 alone, close to $1.5 trillion was spent in combatting the crisis (Beyer, 2022). Opioid abuse not only takes a toll on its victims and their families, it costs society as well. Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
Trump Administration Response
Trump’s strategy appeared to take a reactive approach. He allocated $1.8 billion in grants to be given to states to fight opioid abuse (Trump Whitehouse Archives, n.d.) He has contacted countries, such as China, to appeal to them to stop the flow of drugs to the U.S. (Trump Whitehouse Archives, n.d.). He has even been able to quell the distribution of drugs over the internet by getting rid of one of the biggest online distributors (Trump Whitehouse Archives, n.d.). He also expanded access to treatment for opioid use disorder by creating the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act in October 2018 (CMS, 2019).
Biden Administration Response
The Biden administration appears to be taking a more proactive approach. They have certainly allocated money to the states to combat this epidemic. But they have also taken some specific action. They enacted legislation that has allowed nearly two million more medical professionals to be able to prescribe medication to treat opioid use disorder (Whitehouse, 2024). He has prioritized keeping drugs out of the country by providing the latest drug detection technology to our federal agents who protect our ports of entry (Whitehouse, 2024). Although the Trump administration contacted China concerning their illicit exports, the Biden administration was able to convince them to close down the sources of drug manufacturing and to share information with the U.S (Whitehouse, 2024). This administration also went global by bringing over 140 countries together to fight this epidemic (Whitehouse, 2024).
Social Determinants of Opioid Abuse
Social determinants play a large role in our health and well-being. There are five main categories of determinants that are known as upstream factors (Nicholson, 2023). These five categories refer to our environment. They are economic stability, education access and quality, health access and quality, neighborhood and build environment, and social and community context (HHS, n.d.). People with lower education, lower incomes and are participating in some manner in a government program, are more likely to use opioids (Nicholson, 2023).
What Would I Do Different
I would have acknowledged the problem much earlier. But as of now, I would start locally by educating students about opioids. This would include all levels of school using age-appropriate materials. I would also contact many of the employers in this area to offer information sessions on it. I would like to allocate more resources to our local law enforcement so they can be more pro-active in getting dealers off the streets. At a state level, I would like to have more education as well as treatment available at colleges as well as in prisons. It would be great to have more affordable housing options for people with SUD who are struggling with homelessness. As Maslow has reminded us, shelter is one of our basic needs, and we cannot achieve anything unless we have the safety of housing.
References
Abuse, N. I. (2023, August 7).
Only 1 in 5 U.S. Adults with opioid use disorder receive medications to treat it in 2021
. Retrieved from nida.nih.gov: https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021#:~:text=News%20Release-,Only%201%20in%205%20U.S.%20adults%20with%20opioid%20use%20disorder,to%20treat%20it%20in%
Association, A. P. (2023, August 28).
The Opioid Crisis: Impact, Challenges, and Paths to Recovery.
Retrieved from Psychiatry.org: https://www.psychiatry.org/news-room/apa-blogs/opioid-crisis-impact-challenges-recovery
Beyer, D. (2022, September 28).
JEC Analysis Finds Opioid Epidemic Cost U.S. Nearly $1.5 Trillion in 2020.
Retrieved from beyer.house.gov: https://beyer.house.gov/news/documentsingle.aspx?DocumentID=5684#
CMS. (2019, November 1).
Trump Administration takes Steps to Expand Access to Treatment for Opioid Use Didorder.
Retrieved from cms.gov: https://www.cms.gov/newsroom/press-releases/trump-administration-takes-steps-expand-access-treatment-opioid-use-disorder
Feldscher, K. (2022, February 9).
What led to the opioid crisis-and how to fix it.
Retrieved from Harvard T.H. Chan School of Public Health: https://www.hsph.harvard.edu/news/features/what-led-to-the-opioid-crisis-and-how-to-fix-it/#:~:text=It%20started%20in%20the%20mid,use%20of%20legal%20prescription%20opioids.
HHS. (n.d.).
Healthy People 2030
. Retrieved from healthy.gov: https://health.gov/healthypeople/priority-areas/social-determinants-health
Nicholson, H. L. (2023). Social determinanats of opioid use behaviors among adults in the United States.
Journal of Substance Use
, 371-378.
Only 1 in 5 US Adults With Opioid Use Disorder.
(n.d.). Retrieved from National Institute on Drug Abuse.
Trump Whitehouse Archives.
(n.d.). Retrieved from Trump Whitehouse Archives: https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-dedicated-administration-fighting-back-opioid-crisis/
Uncovering the Opioid Epidemic.
(n.d.). Retrieved from CDC: https://www.cdc.gov/museum/pdf/cdcm-pha-stem-uncovering-the-opioid-epidemic-lesson.pdf
Whitehouse. (2024, march 8).
Fact Sheet: President Biden’s Unity Agenda for the Nation
. Retrieved from whitehouse.gov: https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/08/fact-sheet-president-bidens-unity-agenda-for-the-nation/
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Hiedi Wurster
Aug 28, 2024 8:21pm
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WU_6050_Discussion_Draft2-2.docx
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Hiedi Wurster
Aug 28, 2024 8:19pm
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Mehal Patel
Aug 28, 2024 7:16pm
| Last reply Aug 31, 2024 10:13pm
Reply from Mehal Patel
Social determinants of health
According to Healthy People 2030, there are five determinants of social health, among them, neighborhood and safe environment are critical for a person’s wellbeing and quality of life. Due to the rise in gun violence, one of the five social determinants is in jeopardy. According to NICHM (National Institute of Healthcare Management), “Gun violence is a major public health problem, and a leading cause of premature death”.
Gun violence issue
On average, 118 people a day were killed from gun-related incidents in 2023. Gun violence, on average costs $557 billion annually, and among that $2.8 billion is spent on medical care, mental health services, and emergency services. For taxpayers in the United States of America, each non-fatal gun costs over $25000 and each gun death injury costs approximately $ 274,000. Its average cost is $1700 per taxpayer.
How President Trump and Biden addressed this issue
Former President Donald Trump offered one of the steps to prevent gun violence. He provided police protection to minorities. As per Donald Trump, minorities need police protection because of the hate crime. He understands what going into inner cities and need of police protection for minorities.
On the other hand, President Biden stated that he will do everything he can, to prevent such crisis after mass shooting at Texas Elementary school in May 2022. According to a Washington D.C post released by Rhode Island senator Jack Reed, President Biden needs to take long overdue steps toward keeping firearms out of the hands of dangerous people, crack down on gun trafficking, and invest significant funding in mental health and school safety measures.
How Gun Violence can be prevented
In May 2022, a horrific incident happened in Texas Elementary School which suggests that gun violence issue needs to be taken seriously and politicians and leaders across the country need to make strict laws when it comes to gun access. Addressing mental health issues in the communities and removing stigma related to mental health issues is a critical component. Nurses can play an important role by joining professional organizations to address this issue.
Nurses can join ANA and the American Academy of Nursing as it supports nurses’ engagement with family and community health screening, counseling work, and prevention training. In June 2023, ANA built upon its long-lasting advocacy with a resolution recommending heightened support and legislation, improved mental health services, and research specific to the healthcare arena. ANA has a large campaign related to violence against nurses in the workplace thus joining ANA will also help create more awareness about this issue and build networking to fight against this issue.
References
Sheehan, A. (2024). Nursing Power through Advocacy. Advocacy 101: Staying Connected with Your Legislators.
Pediatric Nursing
,
50
(3), 143–146.
https://doi.org/10.62116/PNJ.2024.50.3.143
Links to an external site.
Office of Disease Prevention and Health Promotion. (n.d.).
Social determinants of health
. Healthy People 2030; Office of Disease Prevention and Health Promotion. https://health.gov/healthypeople/priority-areas/social-determinants-health
https://nihcm.org/publications/gun-violence-the-impact-on-society
Links to an external site.
Gartley, C. E. (2023, November 4).
The role of nurses in firearm safety
. American Nurse. https://www.myamericannurse.com/the-role-of-nurses-in-firearm-safety/
Black Americans want new gun laws to curb gun violence. Trump offers more police. (2017, October 12).
Washingtonpost.com
.
https://link.gale.com/apps/doc/A509302219/OVIC?u=minn4020&sid=ebsco&xid=da661830
Links to an external site.
BIDEN SIGNS SWEEPING GUN VIOLENCE PREVENTION BILL INTO LAW. (2022, June 25).
States News Service
NA. https://link.gale.com/apps/doc/A708422887/EAIM?u=minn4020&sid=ebsco&xid=647ab7a1
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Amy Simmons
Aug 28, 2024 6:54pm
| Last reply Aug 31, 2024 11:10am
Reply from Amy Simmons
Main Post
Prescription Drug Prices
Prescription drug costs have emerged as a significant concern in presidential discussions, mirroring the public’s growing anxiety about the increasing price of medications in the U.S. The debate centers on ways to lower drug costs for consumers while allowing pharmaceutical companies to continue investing in research and development. Although this issue has received support from both political parties, their proposed solutions can differ widely. It remains a key focus in healthcare reform debates, with many voters considering it a critical priority.
According to Vincent Rajkumar (2020), about 25% of American citizens struggle to pay for their medications, which, in turn, causes those Americans to be non-compliant, increasing their healthcare needs and costs due to the worsening of their health conditions.
Present Presidents Approach
Our current President, Joe Biden, views health care as a fundamental right rather than a luxury, which I completely agree with. From the outset, he has expanded access to health care for millions of Americans and worked to reduce costs. He remains committed to enhancing and safeguarding Medicare, Medicaid, and the Affordable Care Act. Due to the President’s initiatives, more Americans have health insurance compared to any previous administration. This commitment is reflected in his support for legislation like the American Rescue Plan Act and the Inflation Reduction Act, aimed to decrease prescription drug prices and lower monthly health insurance costs (The White House, 2022).
Past President’s Approach
Trump consistently spoke out about the high costs of prescription drugs, aiming at pharmaceutical companies and pharmacy benefit managers. Although he made the issue a focal point in political discourse, his administration made limited strides in reducing drug prices. The Trump administration tried to get the co-pays lowered to $35 for Americans with Medicare and Medicaid, but even that was ultimately denied. The Trump administration has faced many challenges meeting major campaign promises, especially those requiring legislative or administrative changes (Levitt, 2024).
What could be Done Differently?
As an advanced practice provider, I will advocate for legislative and policy changes to lower drug prices and express support for bills allowing Medicare to negotiate drug prices, increase transparency, or promote generics and biosimilars. I will educate patients on the importance of preventative care, medication compliance, and healthy lifestyles to keep healthcare costs to a minimum Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
References
Levitt, L. (2024, February 15).
What would another Trump presidency
mean for health care?
JAMA Health Forum. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815369
The White House. (2022, October 14).
Executive order on lowering prescription drug costs for Americans
. The White House.
https://www.whitehouse.gov/briefing-room/presidential-
Links to an external site.
actions/2022/10/14/executive-order-on-lowering-prescription-drug-costs-for-americans
/
Vincent Rajkumar, S. (2020). The high cost of prescription drugs: Causes and solutions.
Blood Cancer Journal
,
10
(6). https://doi.org/10.1038/s41408-020-0338-x
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John Dulko
(He/Him)
Aug 28, 2024 6:35pm
Reply from John Dulko
The topic considered that rises to the presidential agenda is mental health. Kirkbride et al. (2024) assert that the social determinants of mental health are socioeconomic disadvantage, early life adversity, childhood adversity, migration, ethnoracial discrimination, inequalities experienced by the LGBTQ+ community, sex-based inequalities, loneliness and social isolation, neighborhood socioeconomic disadvantage and inequality, social capital, fragmentation, and ethnic density, and physical environment.
A limiting factor for any project is money. The Biden administration funded several projects to expand access to mental health services. Some of these services include the 988 Suicide and Crisis Lifeline, FindSupport.Gov, the Mental Health at Work Initiative launched by the Department of Labor, the Workplace Stress Toolkit rolled out by the Occupational Safety and Health Administration (OSHA), the TodayIAm Campaign for veterans’ mental health, and the 24/7 hotline, 1-833-TLC-MAMA (The White House, 2023). All these efforts aimed to increase access to care and offer resources, which was made possible by the Biden administration’s funding and support.
The Trump administration also offered funding for mental health improvement in the United States. “The President allocated approximately $425 million in emergency funds to address mental and substance abuse disorders” (The White House 2020). The Trump administration also repealed the individual mandate of the Affordable Care Act, declared the opioid crisis a public health emergency, signed the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act, and released emergency grants to states to improve access to treatment for substance use disorders and other mental illnesses during the COVID-19 pandemic (The White House 2020).
Walden University (2020) recommends strengthening system capacity, connecting more Americans to care, and supporting Americans by creating healthy environments to improve the mental health crisis in the United States. In addition to what has already been done to improve access to care during the Trump and Biden administrations, all health plans could cover behavioral health services, and some could offer three visits per year without a copay. Another suggestion is to embed these professionals within the community, such as libraries, community centers, and homeless shelters. Telehealth services also must be invested in to improve access to care. To create healthy environments, the effect of social media should be studied, and the number of early childhood and school-based interventions should be increased (Walden University 2020).
References
Kirkbride, JB., Anglin, D.M., Colman, I., Dykxhoorn, J., Jones, P.B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., Griffiths, S.L. (2024) The social determinants of mental health and disorder: evidence, prevention and recommendations.
World Psychiatry
, 23(1):58-90. 10.1002/wps.21160.
Walden University. (2022). America’s agenda for addressing the mental health crisis. Walden University. https://www.waldenu.edu/online-doctoral-programs/phd-in-clinical-psychology/resource/americas-agenda-for-addressing-the-mental-health-crisis
The White House. (2023, May 18).
Fact sheet: Biden-Harris administration announces new actions to tackle nation’s mental health crisis
. The White House. Retrieved August 28, 2024, from https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/fact-sheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/
The White House. (2020, October 5). President Donald J. Trump is safeguarding Americans’ mental health and preventing the tragedy of suicide. The White House. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/ Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
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Qiana Felder
Aug 28, 2024 3:58pm
| Last reply Aug 30, 2024 9:21pm
Reply from Qiana Felder
Topic
The healthcare issue I chose is mental health, a pressing concern in the United States. Shockingly, nearly 50 million Americans are currently dealing with mental health issues, with over half of them not receiving any treatment (Mental Health America, 2022). This alarming trend persists due to various barriers, including limited coverage and socioeconomic status, making mental health a significant problem within our communities.
Current President’s Approaches
Current: The Biden administration has taken some necessary steps to prioritize mental health. In 2022, the administration launched the nationwide 988 hotline to ensure people could access support for mental health crises and suicide prevention more easily. President Biden also made more funding available for school-based mental health services and proposed a rule to make it easier for schools to bill Medicaid by reforming the billing processes (Affairs, 2023). Lastly, he intends that all insurance plans cover behavioral health services, including at least three visits yearly (The White House, 2022).
Past President’s Approaches
An emphasis was placed on improving mental health and the opioid crisis during the Trump administration. Legislation was signed to address mental health and substance abuse disorders, which allocated emergency funds to improve access to treatment (The White House, 2020). An executive order was also signed to make suicide prevention a priority for veterans. In addition, he signed the Substance Use Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT). This law increases access to treatment for citizens with mental health and substance abuse disorders.
What Could Be Done Differently
I see the impact of mental health far too often working as a nurse. Both Presidents have accomplished a great deal of change to improve the crisis. However, the need for more comprehensive mental health services is urgent. Mental health services would benefit from being integrated into primary care practices to make it easier for a behavioral health and primary care team to collaborate on the patient’s needs. Integrating care would also eliminate the need for the patient to find a provider, which can be stressful. With the available funding, the focus should be on prevention and awareness. More public health campaigns should be utilized to educate and reduce the stigma around mental health to encourage people to get treatment and the support they need.
References
Affairs (ASPA), A. S. for P. (2023, September 25).
Biden-Harris Administration Announces More Than $200 Million To Support Youth Mental Health
. HHS.gov. https://www.hhs.gov/about/news/2023/09/25/biden-harris-administration-announces-more-than-200-million-support-youth-mental-health.html
Mental Health America. (2022).
Quick Facts and Statistics About Mental Health
. Mental Health America. https://mhanational.org/mentalhealthfacts
The White House. (2020, October 5).
President Donald J. Trump Is Safeguarding Americans’ Mental Health and Preventing The Tragedy of Suicide – The White House
. Trumpwhitehouse.archives.gov. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/
The White House. (2022, March 1).
FACT SHEET: President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union
. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/
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Lailat Andu
Aug 28, 2024 9:11am
| Last reply Aug 31, 2024 3:44pm
Reply from Lailat Andu
Opioid Epidemic
Opioid abuse presents a significant challenge to the public, requiring a multifaceted response that includes education, direct patient care, and public health interventions. It is a crisis that has been described as a public health emergency, with more than 70,000 overdose deaths recorded in 2019 alone, largely driven by synthetic opioids like fentanyl (Scholl et al., 2020). I believe the opioid epidemic underscores the need for a comprehensive approach to population health strategies to address the root causes of the opioid epidemic. Numerous socioeconomic factors, such as economic instability and access to healthcare, have been identified to have a major impact on the opioid epidemic. Implementing comprehensive healthcare reforms that ensure coverage for addiction treatment services is also vital to curbing opioid epidemics (Bachhuber et al., 2023).
Social Determinant
Economic Instability plays a crucial role in the opioid epidemic by exacerbating vulnerabilities that lead to substance misuse. Patients facing unemployment, low wages, and poverty often experience chronic stress, anxiety, and feelings of hopelessness, which can increase the likelihood of turning to opioids as a coping mechanism. Economic hardships also limit access to education and job opportunities, creating a cycle where patients are trapped in environments with fewer prospects for upward mobility. In economically distressed communities, the lack of resources and support systems further contributes to the spread of opioid misuse, as people have fewer avenues for seeking help and more exposure to drug use.
Access to Healthcare is another key factor influencing the opioid epidemic. Patients in economically unstable situations often lack health insurance or have limited access to healthcare services, including mental health and substance abuse treatment. This barrier prevents early intervention, leading to the progression of addiction and increasing the risk of overdose. Even when healthcare is available, stigma, cost, and transportation issues can prevent patients from seeking or maintaining treatment. The lack of accessible, affordable, and integrated healthcare services exacerbates the opioid crisis by leaving many without the necessary support to recover and manage their addiction.
Presidential Response to Opioid Epidemic
Both President Joe Biden and former President Donald Trump have addressed the opioid epidemic as a significant public health issue, but they have taken different approaches based on their administrations’ priorities, strategies, and political contexts.
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President Trump’s approach to the opioid crisis focused heavily on law enforcement, border security, and public health emergency declarations. Here are some key aspects; In October 2017, Trump declared the opioid crisis a public health emergency. This declaration allowed for the mobilization of resources and directed federal agencies to prioritize the crisis, though it did not unlock significant new funding. President Trump emphasized the need to strengthen law enforcement and border security to combat the influx of illegal opioids, particularly fentanyl, from other countries like Mexico and China. His administration increased funding for the Drug Enforcement Administration (DEA) and other agencies to crack down on drug trafficking. His administration also focused on prosecuting opioid manufacturers and distributors that were believed to be contributing to the crisis. He Also launched multiple public awareness campaigns to educate Americans about the dangers of opioid abuse, often framing it within the context of law and order. The campaigns emphasized the importance of prevention, and the risks associated with opioid misuse.
President Biden’s administration’s approach to the opioid crisis has been more focused on public health, treatment, and harm reduction, while also maintaining an emphasis on law enforcement and border security. Under President Biden’s administration, the American Rescue Plan allocated significant funding to address the opioid crisis, including $4 billion for behavioral health and substance use disorder services. This funding aimed to expand access to treatment, recovery services, and harm reduction programs. The administration has also emphasized harm reduction strategies, such as supporting syringe service programs, expanding access to naloxone, and advocating for medication-assisted treatment (MAT) for opioid use disorder. Biden’s approach is more public health-oriented, focusing on reducing the stigma associated with addiction and ensuring that those affected have access to the care they need. President Biden’s administration also focused on reducing overdose deaths by promoting overdose prevention sites, supporting community-based interventions, and ensuring that emergency medical services are equipped to respond to overdoses.
I believe both of the last two presidential approaches to the opioid pandemic are very good. However, I would have combined the two approaches with more funding allocated to prevention and treatment for opioid abuse. A study by Volkow and Blanco (2021) highlights that improving physician training on pain management and the risks of opioid addiction can significantly reduce the number of new cases of opioid misuse. I believe curbing the opioid pandemic requires a holistic approach that combines prevention, treatment, harm reduction, and policy reform. By addressing the issue from multiple angles, society can reduce the incidence of opioid misuse and provide support to those affected by addiction.
References
Bachhuber, M. A., et al. (2023). Healthcare reform and opioid use disorder: A review of evidence. Journal of Substance Abuse Treatment, 146, 108-115. https://doi.org/10.1016/j.jsat.2023.01.012
Centers for Disease Control and Prevention. (2022). Prescription drug monitoring programs (PDMPs). Retrieved from https://www.cdc.gov/drugoverdose/pdmp/index.html
Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2020). Drug and opioid-involved overdose deaths—United States, 2013–2019. Morbidity and Mortality Weekly Report, 69(11), 290–297. https://doi.org/10.15585/mmwr.mm6911a4
Volkow, N. D., & Blanco, C. (2021). The changing opioid crisis: Development, challenges, and opportunities. Molecular Psychiatry, 26(1), 218-233. https://doi.org/10.1038/s41380-020-00841-6
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Julia N Taylor
Aug 28, 2024 7:57am
| Last reply Aug 30, 2024 2:04pm
Reply from Julia N Taylor
More than 1.8 million new cancer cases are expected to be diagnosed. About 607,000 Americans are expected to die of cancer in 2024, which translates to about 1,660 deaths per day, of which lung cancer makes up almost 25% of all cancer deaths (American Cancer Society [ACS], 2020a; ACS, 2020b). The estimated national expenditures for cancer care in 2017 were $147.3 billion (National Cancer Institute [NCI], 2018). The cost of treatment significantly impacts patients when deciding which treatment to use. The question is proposed which is safer and more cost-effective, alternative medication and/or conventional treatment for lung cancer, with the intent of comparing their effectiveness. Both cancer treatment approaches are beneficial and available; therefore, exploring treatment options using evidence-based sources and provider recommendations is critical. The clinical issue is the existence of competing options in treating lung cancer. People with cancer are interested in trying anything that may help them. Some people prefer alternative medication and others conventional treatment because each approach has benefits and limitations that suit the preferences or perceptions of an individual (Johnson, Park, Gross, & Yu, 2018a).
Biden-Harris Administration’s goal is to reduce the cancer death Rate by at least 50 % over the next 25 years and improve the experience of living with and Surviving Cancer. This administration is said to put up $150 million in new federal funding to develop technology to help surgeons successfully remove cancerous tumors (white house). The issue is important in healthcare because a more practical option needs to be identified and recommended. Lung cancer has ravaged the population in terms of deaths and illnesses. Therefore, there is a need to identify effective evidence-based solutions to help the patients (ACS, 2020).
While President Biden tried to reduce the cancer death rate, Former President Trump stated, “We’re going to get to the cure for cancer and Alzheimer’s and so many other things.” (med page today). I feel if finding the cure for cancer was that easy, then it would have been done a long time ago. Looking back on this administration, Trump talked a good game when he spoke about finding the cure for cancer, but it doesn’t seem as though he took it seriously. I say this because Trump is a money guy, and there is no money in the cure, but it is in the treatment. So the question remains: was his statement from the heart, or was it something his team put together for him to say? Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
As cancer is a terrifying disease, and patients would be interested in anything that may help, the existence of competing options for curing the disease or achieving good palliation increases the dilemma and anxiety when deciding the treatment approach that needs to be used. I personally would explore different treatment options, such as alternative medication versus other conventional treatments, which are widely used and likable treatment approaches, with the intent of comparing their effectiveness on lung cancer. Evidence supports the use of AM compared to CCT, but more research with more excellent quality and evidence supports CCT over AM. The unintended finding on this topic is that using CCT combined with AM is the most effective approach for treating lung cancer because CCT is more effective in reducing tumors. At the same time, AM is more appropriate for enhancing general wellness during treatment.
American Cancer Society. (2020a). Cancer facts & figures 2020. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf
American Cancer Society (2020b). Key statistics for lung cancer.
https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html
Links to an external site.
Johnson, S. B., Park, H. S., Gross, C. P., & Yu, J. B. (2018a). Use of alternative medicine for cancer and its impact on survival. JNCI: Journal of the National Cancer Institute, 110(1), 121-124.
https://doi.org/10.1093/jnci/djx145
Links to an external site.
https://www.medpagetoday.com/washington-watch/electioncoverage/111158
National Cancer Institute. (2018, April 27). Cancer Statistics.
https://www.cancer.gov/about-cancer/understanding/statistics
Links to an external site.
https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/02/fact-sheet-president-biden-reignites-cancer-moonshot-to-end-cancer-as-we-know-it/
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Miriane Meigueu
Aug 28, 2024 7:46am
| Last reply Sep 1, 2024 1:22am
Reply from Miriane Meigueu
The rising cost of healthcare has been a persistent and significant issue in the United States, frequently reaching the presidential agenda due to its profound impact on the nation’s overall well-being (Galvani et al., 2020). Among the various social determinants of health, economic stability stands out as the most critical factor influencing this issue. The ability of individuals and families to afford healthcare services directly affects their access to necessary medical care, preventive services, and overall health outcomes. When healthcare costs are prohibitively high, it exacerbates health disparities, particularly among low-income populations, leading to worse health outcomes and increased mortality rates. Economic stability, or the lack thereof, plays a pivotal role in determining whether individuals can afford insurance, pay for out-of-pocket expenses, or access necessary treatments without facing financial ruin (Rahman et al., 2022). This determinant directly impacts the overall health of the population, making it a crucial focus area in addressing the cost of healthcare.
In addressing the cost of healthcare, two recent U.S. presidents, Barack Obama and Donald Trump, approached the issue with differing policies and strategies. President Obama’s approach was primarily centered around the Affordable Care Act (ACA), which aimed to increase access to healthcare while attempting to control costs. The ACA expanded Medicaid eligibility, established health insurance marketplaces, and provided subsidies to make health insurance more affordable for low- and middle-income individuals (Terrizzi et al., 2022). One of the ACA’s significant achievements was its provision preventing insurance companies from denying coverage based on pre-existing conditions, thereby improving access to care for many Americans. However, while the ACA made strides in increasing coverage, it did not fully address the rising costs of healthcare services and prescription drugs, which continued to burden many Americans.
On the other hand, President Donald Trump’s administration sought to dismantle many aspects of the ACA, arguing that it imposed excessive government regulation and led to increased premiums for many consumers. Trump’s approach included efforts to repeal the ACA, which ultimately failed in Congress, and the promotion of short-term health plans and association health plans as more affordable alternatives (Levitt, 2024). These plans, however, often provided less comprehensive coverage, leaving consumers vulnerable to high out-of-pocket costs. Additionally, Trump signed executive orders aimed at increasing price transparency in healthcare and reducing prescription drug costs, but these measures had limited impact on the overall cost trajectory of healthcare in the United States.
While both presidents addressed the issue of healthcare costs, their approaches highlight the complexity of the problem and the challenge of finding a comprehensive solution. The ACA’s expansion of coverage was a significant step forward, but it fell short in controlling the underlying factors driving healthcare costs, such as high prices for services, administrative expenses, and prescription drug prices. Conversely, Trump’s emphasis on deregulation and market-driven solutions failed to provide meaningful relief for those struggling with high healthcare costs, as these measures did not address the systemic issues contributing to the problem (Vogenberg & Marcoux, 2018).
If I were to approach the issue of healthcare costs differently, I would advocate for a multi-faceted strategy that addresses both the affordability and the underlying cost drivers of healthcare. First, I would prioritize the implementation of a public option within the existing healthcare framework. A public option would provide consumers with a government-run insurance plan that competes with private insurers, potentially driving down premiums and out-of-pocket costs through increased competition (Geruso & Layton, 2020). This approach would maintain the consumer choice inherent in the current system while providing a more affordable alternative for those struggling to afford private insurance.
Additionally, I would focus on addressing the underlying cost drivers in the healthcare system. This would include efforts to negotiate lower prices for prescription drugs, as well as implementing payment reforms that incentivize value-based care rather than fee-for-service models. By shifting the focus from the volume of services provided to the quality and outcomes of care, healthcare providers would be encouraged to deliver more efficient and effective care, ultimately reducing costs. Finally, I would invest in preventive care and public health initiatives aimed at addressing the social determinants of health that contribute to high healthcare costs. By improving access to preventive services, promoting healthy behaviors, and addressing factors such as housing, education, and food security, we can reduce the incidence of chronic diseases and other costly health conditions, ultimately lowering the overall demand for healthcare services and reducing costs. Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
References
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA.
The Lancet
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395
(10223), 524–533.
https://doi.org/10.1016/s0140-6736(19)33019-3
Links to an external site.
.
Geruso, M., & Layton, T. J. (2020). Selection in health insurance markets and its policy remedies.
The Journal of Economic Perspectives
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31
(4), 23–50.
https://doi.org/10.1257/jep.31.4.23
Links to an external site.
.
Levitt, L. (2024). What would another Trump presidency mean for health care?
JAMA Health Forum
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5
(2), e240262.
https://doi.org/10.1001/jamahealthforum.2024.0262
Links to an external site.
.
Rahman, T., Gasbarro, D., & Alam, K. (2022). Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature.
Health Research Policy and Systems
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20
(1).
https://doi.org/10.1186/s12961-022-00886-3
Links to an external site.
.
Terrizzi, S., Mathews-Schultz, A. L., & Deegan, M. M. (2022). State versus federal health insurance marketplaces: A bigger deal for Medicaid and a smaller deal for the individual mandate.
Health Policy OPEN
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3
, 100059.
https://doi.org/10.1016/j.hpopen.2021.100059
Links to an external site.
.
Vogenberg, F. R., & Marcoux, R. (2018, September 1).
Challenges to the U.S. health care system from legal and regulatory changes in the Donald Trump era
. PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110638/
Links to an external site.
.
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Chhinderpal Kaur
Aug 28, 2024 5:54am
| Last reply Aug 29, 2024 3:36pm
Reply from Chhinderpal Kaur
Presidential Issue
One of the topics of presidential concern is mental health. Mental health is a subject that has grown over the decades and gained much awareness among populations. In the USA, mental health is an important part of everyday life and therefore must be given the attention it deserves. According to a study by the Centers for Disease Control and Prevention (CDC), about 51 million US adults 18 years and above were suffering from a mental illness in 2019 (McKnight-Eily, 2021). According to the same report, the COVID-19 pandemic contributed to an increase in mental disorders, with 40.9% of people aged 18 and above reporting having mental issues during the pandemic (McKnight-Eily, 2021).
Related Social Determinants of Health
According to Santamaria-Garcia et al. (2020), there are negative and positive factors that influence mental health. In the research, adverse factors include different forms of violence, inadequate access to resources, and discrimination (Santamaria-Garcia et al., 2020). Positive aspects include social and family support (Santamaria-Garcia et al., 2020). Another study by Anglin et al. (2021) identifies broader factors including neighborhood, trauma, racial disparities in antenatal and postnatal care, and discrimination. The study further discusses these in broader detail as social determinants of health that are related to psychosis in the USA.
Actions of USA presidents
President Donald Trump
During his presidency, Donald Trump implemented several initiatives and policies related to mental health in the United States. First, he signed into law the SUPPORT Act, which stands for Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities. This Act addressed mental health by targeting opioid use which usually is a cause for mental health disorders. Second, he signed an executive order creating PREVENTS (President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide). This service was targeted to help veterans cope by improving their access to mental health services to reduce suicide rates among them. Lastly, he improved mental healthcare in schools to help in diagnosing and treating mental health issues in school-going students after the Parkland shooting of 2018 (Yan et al., 2021).
President Joe Biden
In 2021, The American Rescue Plan (ARP) was signed as an initiative to improve American health care by increasing funding for mental health due to the increase in mental illnesses posed by the Covid 19 pandemic. This initiative was meant to benefit especially the underserved communities as they were the most affected by the pandemic. The ARP also addressed funding for mental health care accessibility in schools. A second initiative by Biden was that he supported the full implementation of the 988 Suicide & Crisis Lifeline, which launched in July 2022. The hotline is toll-free and meant to help people 24/7 get access when they are in a mental crisis or are suicidal. President Biden also addressed the Surgeon General Advisory on Mental Health by directing funds toward mitigating issues such as bullying and social media that cause mental illnesses among the youth (Mezuk et al., 2022).
What I Would Do Differently
Mental health according to my understanding, begins at the basic unit of society, which is a family. I would focus my interventions on the community level. I would increase access to mental health services in the community and make them affordable. I would increase community mental health workers to improve mental health service delivery. This will help to address other factors that lead to mental illnesses at the community level which will generally improve health outcomes.
References
Anglin, D. M., Ereshefsky, S., Klaunig, M. J., Bridgwater, M. A., Niendam, T. A., Ellman, L. M., … & van der Ven, E. (2021). From womb to neighborhood: a racial analysis of social determinants of psychosis in the United States. American Journal of Psychiatry, 178(7), 599-610. https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2020.20071091
Mezuk, B., Maust, D., & Zivin, K. (2022). A Response to the President’s Call to Support Public Mental Health. American journal of preventive medicine, 63(4), 660-663.
McKnight-Eily, L. R. (2021). Racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance use among adults during the COVID-19 pandemic—United States, April and May 2020. MMWR. Morbidity and mortality weekly report, 70. https://www.cdc.gov/mmwr/volumes/70/wr/mm7005a3.htm?ACSTrackingID=USCDC_921-DM48285&ACSTrackingLabel=This%20Week%20in%20MMWR%20-%20Vol.%2070,%20February%205,%202021&deliveryName=USCDC_921-DM48285
Santamaría-García, H., Baez, S., Gómez, C., Rodríguez-Villagra, O., Huepe, D., Portela, M., … & Ibanez, A. (2020). The role of social cognition skills and social determinants of health in predicting symptoms of mental illness. Translational psychiatry, 10(1), 165. https://www.nature.com/articles/s41398-020-0852-4 Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
Yan, B. W., Hsia, R. Y., Yeung, V., & Sloan, F. A. (2021). Changes in mental health following the 2016 presidential election. Journal of general internal medicine, 36, 170-177. https://link.springer.com/article/10.1007/s11606-020-06328-6
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Romel Suason
Aug 27, 2024 11:45pm
| Last reply Sep 1, 2024 9am
Reply from Romel Suason
Covid 19 Pandemic
I will be discussing Covid 19 Pandemic. This is the topic I chose because Covid19 started when President Trump was still in office and ended in the President Biden Administration. Covid 19 crippled the whole world. Crashed economies of multiple countries. People resorted to using social media platforms to get their opinions across to family, friends, government agencies and the whole world.
President Donald Trump initial Approach
President Trumps saved millions of lives because of his decisive response to Corona Virus Pandemic. Even with all the negative and positive feedback from a lot of people he stopped unnecessary travel to foreign countries. A Corona Virus task force was immediately created to guide the country and everyone to prevent the spread of the virus. President Trump made sure that front line workers have all the necessary equipment (PPE, Gloves, Mask and Face shield) to protect frontline workers and their families and everyone. At first very little was known about Corona Virus.
President Joseph Biden
President Biden followed through with what President Donald Trump started. Testing sites were doubled. He made sure that social distancing was Implemented, vaccines, test kits were made available to everybody. Families, Schools, Small Businesses were guided properly on how to combat Corona Virus. The Biden Administration invested $25 billion dollars in vaccine manufacturing and distribution plan that it will get to all the states, cities and families. Elderly and immune compromised people were protected to reduce the mortality rate. Prepared for any pandemic threats that may or may not happen.
Reflections
I respect and believe both President Trump and President Biden did what they think was necessary to prevent the Spread of this deadly disease. They have succeeded in preventing this disease from getting worst.
Being a Front Liner during the said pandemic. I will always be biased in the protection of health care workers. I have read in the Nursing, Health, & the Environment electronic book that was given to us as one of the references that really struck me.
Among health care providers, registered nurses occupy a unique position. In both rural and urban settings, nurses are often the initial, and sometimes the only, point of contact for people seeking medical care. They are also the largest group of professional health care providers in the United States: an estimated 2.2 million. In occupational health practice, nurses outnumber physicians by six to one. Yet the vast majority of nurses have had no formal training in occupational or environmental health.
If environmental health hazards and health effects are to be recognized and dealt with effectively, it is of fundamental importance that all health care providers have a clear understanding of the association between the environment and health. Toward that end the committee makes a series of recommendations for the integration and enhancement of environmental health in nursing education, practice, and research.
What I would do differently if I was in the position to make a change is educate people first on how to prevent the spread of an infectious disease. Social media is being utilized for sports, news, music, people’s daily lives and all you can think of. It is part of people’s daily lives now a days. I would urge people from Centers for Disease Control and Prevention to post on every page in Facebook, twitter, Instagram ways to prevent spread of diseases. Rather than report about how many people have been infected. Communities and Schools should have periodic exercises about disease prevention. So, in the in the future if something like this pandemic happens again people will be equipped with the knowledge of prevention. Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
Reference
Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing Practice, Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.).
Nursing health, & environment
Links to an external site.
Links to an external site.
:
Strengthening the relationship to improve the public’s health.
https://trumpwhitehouse.archives.gov/issues/coronavirus/
Links to an external site.
https://www.whitehouse.gov/priorities/covid-19/
Links to an external site.
Walden University NURS 6050 week 1 Presidential Agendas discussion post and responses
Reflection on AI Integration in Advanced Practice Nursing week 1 Discussion Post
Artificial intelligence tools and technologies can enhance the competency of patient assessment by AI-driven algorithms can identify subtle patterns, support different diagnosis, which can improve diagnostic accuracy and effectiveness, especially in complex or high-volume settings. For example, the new stethoscopes Nurses and Dr.’s use are digital they give a heart rate and rhythm, which in turn sends the reading to a cell phone in which can prevent early signs of deterioration or disease.
The potential benefits of integrating AI into patient assessment include improved diagnostic accuracy, early detection of diseases, and reduced clinical cognitive overload in high-stress environments. Reflection on AI Integration in Advanced Practice Nursing week 1 Discussion Post
Challenges include a lack of transparency and ethical issues, such as patient autonomy. Patient Data must be shared with AI systems. This raises issues of HIPAA compliance, data breach, and confidentiality.
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In summary, AI can help clinicians perform at a higher level by augmenting core competencies, improving patient outcomes, and reducing disparities; however, ongoing education and intentional design to ensure safe outcomes. It could have the potential to equip you with advanced digital literacy as a APRN, enhancing clinical fluency.
References
Khosravi, M., Zare, Z., Mojtabaeian, S. M., & Izadi, R. (2024). Artificial intelligence and decision-making in healthcare: a thematic analysis of a systematic review of reviews.
Health services research and managerial epidemiology
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11
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Li, Y. H., Li, Y. L., Wei, M. Y., & Li, G. Y. (2024). Innovation and challenges of artificial intelligence technology in personalized healthcare.
Scientific reports
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14
(1), 18994.
Olawade, D. B., David-Olawade, A. C., Wada, O. Z., Asaolu, A. J., Adereni, T., & Ling, J. (2024). Artificial intelligence in healthcare delivery: Prospects and pitfalls.
Journal of Medicine, Surgery, and Public Health
,
3
, 100108.
Reflection on AI Integration in Advanced Practice Nursing week 1 Discussion Post response instructions
Post to colleague’s main post that is reflective and justified with credible sources. 9 to >8.0 ptsExcellent Point range: 90–100Response exhibits critical thinking and application to practice settings. … Responds to questions posed by faculty. … The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 to >7.0 ptsGood Point range: 80–89Response has some depth and may exhibit critical thinking or application to practice setting.
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Reflection on AI Integration in
Advanced Practice Nursing week 1 Discussion Post
Reflection on AI Integration in Advanced Practice Nursing week 1 Discussion Post response
Reflection on AI Integration in Advanced Practice Nursing
A superb discussion, Lewis! Your exploration of the application of artificial intelligence (AI) tools and technologies in the healthcare setting is perfectly evaluated. You have highlighted the importance of AI and related technologies in enhancing patient assessment in helping identify major diagnoses accurately, even in settings with huge amounts of data (Bajwa et al., 2021). Through the discussion, you have provided important examples the way AI helps in supporting effectiveness in care provision. For instance, the emerging stethoscopes Nurses and Doctors are digitally linked such that they are able to give heart rate and rhythm, which directly sends these messages to the cellphones, hence helping identify early signs and address them before the disease deteriorates. You have also provided the benefits of linking the AI into patient assessments since it helps in accurate diagnosis, early illnesses detection, and reducing clinical cognitive overload (Maleki, 2024). Additionally, there are evident challenges that arise due to the continued use of AI in healthcare facilities. For instance, AI might lead to a lack of transparency since only a few experts in IT and nurse informatics are able to access these systems. In addition, ethical issues including patient autonomy are at risk since the systems shares patient information with other are providers, hence data breach is possible. Such incidences might harm the continued use of AI systems in care facilities due to issues with HIPPA regulations that ensured patient data of protected (Alhejaily, 2024). Additionally, the AI systems might be hacked and leading to mass losses of essential data for patients and care facilities, which can lead to huge losses and safety issues. The discussion is perfectly written and clearly brings out the importance of AI in clinical settings and its challenges. The most important practice is to ensure there is digital literacy among the APRNs towards improving their clinical fluency. Reflection on AI Integration in Advanced Practice Nursing week 1 Discussion Post
References
Alhejaily A. G. (2024). Artificial intelligence in healthcare (Review). Biomedical reports, 22(1), 11. https://doi.org/10.3892/br.2024.1889
Bajwa, J., Munir, U., Nori, A., & Williams, B. (2021). Artificial intelligence in healthcare: transforming the practice of medicine. Future healthcare journal, 8(2), e188–e194.
https://doi.org/10.7861/fhj.2021-0095
Maleki Varnosfaderani, S., & Forouzanfar, M. (2024). The Role of AI in Hospitals and Clinics: Transforming Healthcare in the 21st Century. Bioengineering (Basel, Switzerland), 11(4), 337.
https://doi.org/10.3390/bioengineering11040337
Reflection on AI Integration in Advanced Practice Nursing week 1 Discussion Post
Reflection on AI Integration in Advanced Practice Nursing Essay
Week 1 Discussion Post
The integration of artificial intelligence (AI) in healthcare offers several potential benefits that can significantly enhance clinical practice. One key advantage is the increased efficiency and precision that AI brings to patient care. By reducing human error, AI facilitates quicker, evidence-based decision-making, which is vital for improving patient outcomes (Li, 2025). Furthermore, advancements such as telemedicine and AI-powered triage platforms have notably improved access to care, particularly for individuals in remote or underserved areas. This is crucial for patients who might otherwise encounter obstacles due to limited healthcare resources (Balakrishnan et al., 2025).
However, alongside these benefits, there are significant challenges to consider. One of the most critical hurdles is the demand for robust infrastructure; high-quality data and reliable digital systems are essential for AI to function effectively. Unfortunately, these resources are not always available, especially in rural or resource-limited settings (Dankwa-Mullan, 2024). Additionally, trust and transparency are pivotal issues, as many AI systems operate as “black boxes.” This lack of transparency can lead to hesitance among providers who are keen to understand the rationale behind AI-driven decisions (Weiner et al., 2025).
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Ethical considerations also loom large in the conversation about AI in healthcare. For example, there is a risk of bias and inequity, as algorithms trained on non-diverse datasets may reinforce existing health disparities rather than alleviate them (Gurevich, 2022). Concerns about privacy further complicate the landscape, as the processing of patient information by AI systems raises important questions regarding confidentiality and informed consent. Moreover, accountability remains a pressing issue; when AI recommendations lead to poor outcomes, it becomes unclear who should bear the responsibility—the healthcare provider, the AI system’s developer, or the system itself (Weiner et al., 2025). Hence, addressing these ethical complexities is crucial for ensuring that AI supports safe and equitable care. Reflection on AI Integration in Advanced Practice Nursing Essay
In summary, while AI holds great promise for improving patient outcomes through early detection and personalized care, it is vital to thoughtfully consider the implications of its integration within the healthcare system.
References
Balakrishnan, K., et al. (2025). Artificial intelligence in rural healthcare delivery: Bridging gaps and enhancing equity through innovation.
ArXiv.
https://arxiv.org/abs/2508.11738
Dankwa-Mullan, I. (2024). Health equity and ethical considerations in using artificial intelligence in public health and medicine.
Preventing Chronic Disease, 21
(245).
https://www.cdc.gov/pcd/issues/2024/24_0245.htmLinks to an external site.
Gurevich, E. (2022). Equity within AI systems: What can health leaders expect?
Journal of Medical Systems, 46
(8), 1–9. https://doi.org/10.1007/s10916-022-01787-3
Li, D. M. (2025). A critical look into artificial intelligence and healthcare.
Frontiers in Artificial Intelligence, 8
, 1545869. https://doi.org/10.3389/frai.2025.1545869
Weiner, E. B., et al. (2025). Ethical challenges and evolving strategies in the integration of artificial intelligence into clinical practice.
ArXiv.
https://arxiv.org/abs/2412.03576Links to an external site.
This criterion is linked to a Learning OutcomeFirst Response:Post to colleague’s main post that is reflective and justified with credible sources. 9 to >8.0 ptsExcellent Point range: 90–100Response exhibits critical thinking and application to practice settings. … Responds to questions posed by faculty. … The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 to >7.0 ptsGood Point range: 80–89Response has some depth and may exhibit critical thinking or application to practice setting.
7 to >6.0 ptsFair Point range: 70–79Response is on topic, may have some depth.
6 to >0 ptsPoor Point range: 0–69Response may not be on topic, lacks depth
Discussion Response: Reflection on AI Integration in Advanced Practice Nursing
Your discussion post offers an insightful and well-balanced overview of the promises and pitfalls of artificial intelligence (AI) integration in healthcare in general, and advanced practice nursing (APN) in particular. While well presented, I would like to further explore that issues identified, particularly the philosophical and systemic dimensions underpinning the technological shift towards AI as it related to equity, epistemology, and the evolving role of clinical judgment.
First, the discussion post notes that AI-powered tools like triage and telemedicine platforms have expanded care access and improved equity, especially in underserved regions. While this is demonstrated, it is important to interrogate the inclusivity and sustainability of the AI-powered tools. The digital divide has exacerbated health inequities as seen digital literacy, device availability, and internet access disparities. For instance, populations in rural regions may benefit from the use of AI-powered tools, such as AI-driven diagnostics, only of they possess the infrastructure to support such technologies. This then raises concerns regarding whether the AI-powered tools and system are designed with contextual adaptability, or if they are perpetuating a one-size-fits-all model that simply privileges technologically advanced settings (Carroll, 2024). Additionally, the algorithmic bias noted in the discussion is a good point, but can be advanced to indicate that it is not mere a technical flaw, but a reflection of the broader societal inequities. Gurevich (2022) supports these sentiments, highlighting that training datasets may lack representation from marginalized communities, resulting in skewed risk assessments and diagnostic inaccuracies. There is a need to address this through a paradigm shift in data governance towards informed data collection, with a focus on prioritizing participatory design and community.
Second, the discussion post explores the need to reframe clinical judgement and epistemic authority. Many AI systems have a “black box” nature that introduces a profound epistemological tension in clinical practice. Traditionally, decision-making in the healthcare environment is grounded in the combination of patient narratives, clinical experience, and empirical evidence. By contrast, AI operates using opaque algorithms that may not be aligned with human reasoning. This creates a disconnect that may erode the confidence of clinicians, and compromise shared decision-making (Kudyba, 2022). Weirner et al. (2025) underscore the need to have explainable AI systems, but acknowledge that this is difficult to achieve since it extends beyond a technical challenge to become a philosophical challenge. There is a need for AI to reconcile the machine-generated insights with nuanced, context-dependent nature of human health. A promising solution to this challenge is to develop “human-in-the-loop” models, in which clinical judgement is augmented by, rather than replaced with, AI. This presents a hybrid mode that helps to preserve the epistemic authority of healthcare providers while leveraging the computational strengths of AI (Carroll, 2024).
Third, the discussion post is salient on ethics and accountability. AI-mediated care diffuses responsibility between institutions, clinicians, and developers. This poses a significant ethical dilemma. There is a need to establish a clear framework for oversight and accountability, and cultivate a culture of ethical reflexivity. This may involve providing ongoing education to clinicians about AI ethics, having transparent communication with patients about AI being involved in their care, and interdisciplinary collaboration between healthcare professionals, ethicists, and technologists (McGonigle & Mastrian, 2024).
In conclusion, the discussion post makes it evident that AI offers transformative potential for healthcare. However, AI integration must be guided by principles of equity, transparency, and ethics. The goal should not be for AI to replace human care. Rather, the goal should be for AI to be fused in technological innovation, while remaining anchored in justice, context, and compassion. Overall, your discussion post is well presented, but can be improved by including the above mentioned points.
References
Carroll, W. (2024).
Nursing Informatics: Truths, Talent, and Transforming the Future
. Taylor & Francis.
Gurevich, E. (2022). Equity within AI systems: What can health leaders expect?
Journal of Medical Systems, 46
(8), 1–9.
https://doi.org/10.1007/s10916-022-01787-3
Kudyba, S. P. (2022).
Healthcare Informatics: Improving Efficiency Through Technology, Analytics, and Management
. Taylor & Francis Group.
McGonigle, D., & Mastrian, K. (2024).
Nursing Informatics and the Foundation of Knowledge
(6th ed.). Jones & Bartlett Learning.
Weiner, E. B., et al. (2025). Ethical challenges and evolving strategies in the integration of artificial intelligence into clinical practice.
ArXiv
.
https://arxiv.org/abs/2412.03576
Reflection on AI Integration in Advanced Practice Nursing Essay
NRSE 4545 – Informatics and Safety Essentials – Healthcare Technology Innovation Project
Case Scenario Description and Problem Identification
A hospital located in an urban area has an emergency room where the reason behind the huge time wastage in recording the patient information was the lack of interconnectivity between the triage entries, vital signs, and the physician’s prescriptions. Such disorder will extend patient wait times and enhance the rate of error in the process of offering care, which infuriates staff and encourages fatigue. Poor record keeping prevents collaboration between nurses and doctors, resulting in overlaps and time wastage (Ibrahim et al., 2022). In order to overcome such barriers, it is crucial to implement technology that assists in flow control of records, fewer repetitive operations, and additional financial outcomes as per the results in the emergency room.
Technology Identification and Relevance
Two crucial tools that can be used to solve the problems of processing data and keeping records in a simple way are enhanced EHR systems that are enhanced to facilitate smooth data transfer between platforms or mobile apps that will allow the nurses to make data on the move using voice command. One will enhance precision in medical records and also instill consistency in the understanding of records of care; the other will expedite the flow of patients in the clinics, as it will help the clinics make faster decisions at the point of care. NRSE 4545 – Informatics and Safety Essentials – Healthcare Technology Innovation Project
Advanced EHR Integration with Interoperability Enhancements
The current networked health records can carry out the automatic synchronization of patient information in the check-in, testing, and treatment areas. Once one team has entered information like temperature, drugs given, or blood test results, then that is shown in the places where it is needed without including the same data. That will decrease the frequency of repetitions and help the doctors, nurses, and specialists keep pace.
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Accurate Documentation:
Electronic health records involve better use with automatic upgrading rather than typing some information manually, reducing errors. As an example, as soon as a nurse fills in the background details of a patient, the figures will autofill every place the numbers are required. Physicians access correct information immediately (Murray, 2022). The system also has alerts that identify discrepancies, such as drugs incompatible with others or a lack of allergy records, enabling patient records to be more trustworthy in general.
Use of Standardized Nursing Data:
Electronic health records use set nursing terms such as SNOMED CT or LOINC to maintain consistency in notes and increase the compatibility of the system across clinics. At the same time, unified data input improves the cooperation of teams and gives them a chance to analyze big data and achieve better outcomes and insights (Gade, 2021). In EDs, making the data format consistent implies that nurses record the assessment or actions in a similar manner, which does not contribute to confusion, and that can facilitate the reporting of inaccurate rules.
Improved Individual Patient Outcomes:
Clinicians can make smarter decisions in real time when they are aware of the entire, updated patient information immediately. Since care is initiated sooner due to instant access that enables them to see the triage records and test results simultaneously, there is no waiting time. This will mean that there will be an increased number of people being seen within a shorter period of time, and the lines in the ER will be reduced, and the more important cases, such as heart attacks or some severe injuries, will be treated, for which time is everything.
Mobile Nursing Documentation Tools with Voice Recognition
Mobile documentation solutions enable nurses to record and access patient information in the field of care using a tablet or a handheld device. A voice recognition technology allows even further simplification of this process since nurses can dictate notes directly into the EHR system, preventing the need to lose focus on the patient.
Accurate Documentation:
Voice-assisted mobile technologies enhance promptness and fulfillment of record-keeping through instantaneity in charting in situ or as soon as the patient is encountered. This reduces the use of memory and post-shift note-taking, eliminating the chance of omissions or lack of accuracy. The research demonstrates that the area of mobile documentation minimizes the average time of documentation, and it also enhances the quality of nursing records (Morgan, 2023).
Improved Individual Patient Outcomes:
This will enable nurses to make more time to attend to patients since they are able to save time that would have been spent on keying in data by hand. Live documentation is applied in order to ensure that vital signs and assessments are instantly provided to the entire care team, which enhances the immediate response in cases of emergency. Indicatively, the inappropriate readings that would be typed in the mobile tools would trigger automatic signals to the providers, prompting immediate remedies.
Population Health Planning:
Mobile documentation tools make it possible to combine the data and find patterns in patient demographics, conditions, and treatment outcomes to assist in managing population health. They can help us in the allocation of resources and preventive health practices by monitoring the trends of respiratory diseases in the season or the local cases of trauma. These tools are incorporated together with electronic health records (EHR), which increases the data interoperability and precision to enhance the efficiency and safety of emergency departments.
Technology Analysis and Application
The identified technology is addressing the slow decision of documents, and the other technology is the correction of broken messages in the ERs. The EHR of the modernized version helps in the smooth flow of the entire patient data, yet the mobile applications speed up the task of treatment where it is provided.
Documentation Improvement:
The information between the check-in and release is made easier with the help of the handheld device and its respective health records. As an example, with the assistance of nursing notes, when the workers give the information about the gadgets used around, the information will automatically be transferred to the main server, so there will be no need to repeat the work, though the information about the latest changes will be ready at once for all individuals.
Data Use and Outcome Enhancement:
The tracking of live data embedded in EHRs can determine the slow parts of work, including the busiest time during check-in, and base workflow changes on it. The speech-to-text system helps cut down on paperwork and boosts the morale of the staff, which decreases stress and turnover of employees.
Population Health Impact:
This data has been consistent and can assist the hospital managers in monitoring the health of the masses, such as the rates of illness or injury, as they attempt to respond promptly. That can be aligned with larger objectives in the healthcare industry: the use of digital data to inform community health-related decisions.
Ethical and Safe Use Proposal
Moral guidelines, compliance with rules, and the protection of information are connected with the rollout of these tools, which are aimed at protecting patient rights and ensuring that technologies are used correctly.
Data Privacy and Confidentiality:
The two systems are to adhere to the HIPAA regulations as well as the data safety policies of individual organizations. Any data sent or stored must be encrypted to prevent unauthorized persons from viewing it. Role-based entry builds in only allow authorized employees to access private health records.
Risk Mitigation and Security Strategies:
Staff practice and cybersafety checks should be regularly updated; otherwise, an opportunity to commit fraud, attempts at hacks, or poor management of equipment increases. Rather than using passwords, fingerprints should be used with timed, induced word locks on handheld record systems; in case one is lost, the information is always secured.
Ethical Standards and Professional Accountability:
By documenting the data at the appropriate time and place, the nurses would have to do what is good and avoid what is harmful. Training must not be concentrated on the teaching of skills only, but also on the necessity of proper records and the repercussions of wrong or delayed information. And in that regard, hospitals should also have clear policies regarding the applications of voice technology to correct mistakes even before they are even stored in the account of a single patient.
Legal and Regulatory Considerations:
The groups are to make sure that their technology suppliers take into account the local demands concerning the communication between the equipment and its safety. These updates of the electronic health record should be in line with the existing laws and the ONC laws on system compatibility. It is necessary to have regulations for phone or tablet applications in patient care; they help maintain concentration and prevent poor etiquette. NRSE 4545 – Informatics and Safety Essentials – Healthcare Technology Innovation Project
Workplace Policy and Ethical Oversight:
The hospitals ought to have digital oversight solutions, such as recording technology malfunctions and developing ethical boards to screen novel applications. Honesty with the patient regarding data collection creates trust, and it is necessary to focus on the value of the individual choice and consent. Prudent use of digital records and mobile applications can make health groups safer and effective if they are empowered with good values and principles, and avoid the traps of being unable.
Conclusion
Information management in the emergency rooms is important to provide quality care with improved efficiency and safety. Voice technology combined with connected medical records will increase the accuracy of the records, improve the speed of team communication, and improve patient outcomes (Elhadad et al., 2024). Ethical implementation of the new tools is possible by adhering to regulations and protecting confidential information. With the innovative digital approach and proper management, clinics will modernize emergency treatment and support the health improvement of communities.
References
Elhadad, A., Hamad, S., Elfiky, N., Alanazi, F., Taloba, A. I., & El-Aziz, R. M. A. (2024). Advancing Healthcare: Intelligent Speech Technology for Transcription, Disease Diagnosis, and Interactive Control of Medical Equipment in Smart Hospitals.
AI
,
5
(4), 2497-2517.https://www.mdpi.com/2673-2688/5/4/121
Gade, K. R. (2021). Data-driven decision making in a complex world.
Journal of Computational Innovation
,
1
(1).https://researchworkx.com/index.php/jci/article/view/2
Ibrahim, I., Sultan, M., Yassine, O. G., Zaki, A., Elamir, H., & Guirguis, W. (2022). Using Lean Six Sigma to improve timeliness of clinical laboratory test results in a university hospital in Egypt.
International Journal of Lean Six Sigma
,
13
(5), 1159-1183.https://www.emerald.com/insight/content/doi/10.1108/IJLSS-08-2021-0138
Morgan, A. S. (2023). Improving Timeliness of Nursing Documentation.https://arch.astate.edu/dnp-projects/39/
Murray, L. (2022).
Unified Documentation and Information Retrieval for Electronic Health Records
(Doctoral dissertation, Massachusetts Institute of Technology).https://dspace.mit.edu/handle/1721.1/143410 NRSE 4545 – Informatics and Safety Essentials – Healthcare Technology Innovation Project
In this assignment, students will create a comprehensive Healthcare Technology Innovation Proposal designed to enhance patient care delivery, data management, and ethical use of technology in healthcare.
For this assignment, please complete the following steps:
Step 1: Choose one of the Case Scenarios provided
Scenario 1: Telehealth Delivery in a Rural Community Health ClinicDownload Telehealth Delivery in a Rural Community Health Clinic
Scenario 2: Emergency Department Patient Flow and EHRDownload Emergency Department Patient Flow and EHR
Scenario 3: Social Media Boundaries and Patient PrivacyDownload Social Media Boundaries and Patient Privacy
*Clearly describe the scenario, in your own words. Identify and describe current challenges related to patient data management, documentation accuracy, population health considerations, and care delivery efficiency.
Step 2: Technology Identification and Analysis
Identify two (2) current technologies (e.g., EHR, mobile health apps, telehealth platforms, multimedia communication tools, etc.) relevant to your scenario.
For each of the two (2) technologies you select, explain how it contributes to at least two (2) of the following:
Accurate Documentation – Describe how the technology supports clear, timely, and precise clinical documentation (e.g., auto-populated fields, decision-support prompts, error reduction).
Use of Standardized Nursing Data – Explain how it helps nurses collect or use standardized terminology and classifications to improve consistency and interoperability.
Improved Individual Patient Outcomes – Discuss how the technology improves patient care at the individual level, such as through better tracking, early detection, personalized care, or clinical decision support.
Population Health Planning – Describe how data collected from this technology can be used to identify trends, allocate resources, or inform health policy for broader populations.
Step 3: Ethical and Safe Use Proposal
Outline a detailed proposal addressing the ethical, responsible, and safe use of your chosen technologies.
Include specific strategies to mitigate common risks, adhere to professional nursing standards, legal/regulatory requirements, workplace policies, and promote patient rights concerning personal data and medical records. NRSE 4545 – Informatics and Safety Essentials – Healthcare Technology Innovation Project
Guidelines
Please include a properly formatted APA 7th Edition STUDENT Title PageLinks to an external site. (includes page numbers; NO running head).
Your submission should be 3-5 pages in length, double-spaced,
Please include 2-3 scholarly references to support your paper; only 1 reference can be a website (must be credible).
APA 7th Edition documents should be double-spaced, including the reference page.
Please use Times New Roman, Arial, or Calibri 12-pt font with 1-inch margins
Do NOT write in first-person.
Please use!
Scenario 2:
Focus: Data Management
In a busy urban emergency department, nurses are experiencing delays in documenting care due to poor integration between triage notes, vital signs, and provider orders in the electronic health record (EHR). These delays lead to communication errors, repeated tests, and extended patient wait times, affecting both patient outcomes and staff burnout.
Challenge: How can improved EHR functions and supporting technologies (e.g., voice
recognition, mobile documentation tools) streamline documentation and improve patient flow and safety?
NRSE 4545 – Informatics and Safety Essentials – Healthcare Technology Innovation Project
Networking Opportunities NURS-6003 Module 1: 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. Finally, you will explain the importance of networking and how it can help you achieve your professional and academic goals.
Note
: Unless otherwise noted, initial postings to Discussions are due on or before Day 3, and response postings are due on or before Day 6. You are required to participate in the Discussion on at least three different days (a different day for main post and each response). It is important to adhere to the weekly time frame to allow others ample time to respond to your posting. In addition, you are expected to respond to questions directed toward your own initial posting in a timely manner.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Walden and College of Nursing mission and vision statements, Walden’s goals and University Outcomes, and the MSN and PMC 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.
Consider the importance of networking and how it may help you achieve your professional and academic goals.
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. Finally, explain why networking is important and how it may help you achieve your professional and academic goals.
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.
Latrina Shonta Jurrell
Sep 1 10:52pm
| Last reply Sep 6 7:47pm
Reply from Latrina Shonta Jurrell
My name is Latrina Jurrell. Previously I worked as an analytical technician for 10 years. I have worked at Buckamn Laboratories, Cargill, Sherwin Williams, LMP, and Eurofins. I changed by career. I have been a Registered Nurse with 17 years of diverse experience. I have worked in critical care, pediatrics, oncology, and ambulatory settings. I am skilled in intensive care nursing, sedation and anesthesia recovery, infusion therapy, and patient navigation. I have worked in leadership as Charge Nurse and Patient Care Coordinator, with a strong record of fostering collaboration across multidisciplinary teams to improve patient outcomes. I educate patients and families on complex treatment plans, guiding them through challenging diagnoses, and ensuring continuity and quality of care throughout the healthcare journey.
Walden University’s mission aligns closely with my professional goal of becoming a Nurse Practitioner. I have seen firsthand how advanced practice providers can transform patient care through evidence-based practice and patient education. Walden’s emphasis on preparing scholar-practitioners resonates with my desire to deepen my clinical knowledge, engage in research-informed practice, and contribute to positive social change. By advancing my education at Walden, I will be equipped not only to provide high-quality, holistic care to diverse populations but also to advocate for health equity, mentor future nurses, and support initiatives that improve outcomes in underserved communities.
As I pursue my goal of becoming a Nurse Practitioner, networking will be essential. Engaging with professional organizations such as oncology or critical care nursing associations will allow me to stay current with best practices and emerging research. I also plan to leverage my existing relationships with colleagues and mentors at institutions to gain insight into advanced practice roles and patient care innovations.
Networking will not only support my academic journey but also position me to advocate for patients, mentor other nurses, and contribute to positive social change within the healthcare system. By building and maintaining these professional relationships, I will be better prepared to transition into the Nurse Practitioner role and provide the highest quality of care to diverse patient populations.
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Bridget Wingate
Aug 29 3:45pm
| Last reply Aug 30 9:06pm
Reply from Bridget Wingate
Hi, my name is Bridget Wingate and I live in Ellijay, Georgia. I finally knew what I wanted to be when I grew up in my mid-30s, and I graduated at 39. This December will be my 10-year Registered Nursing anniversary and all 10 years have been in the aesthetic field. I specialize in treating patients with dermal fillers and wrinkle relaxers, threads, sclerotherapy and various lasers at a facial plastics office in Atlanta. I also own and operate a boutique medspa in my little town where I provide aesthetic treatments to clients seeking natural, safe enhancements. Together, my husband and I have 6 children (3 still at home), 2 dogs (Harley and Willy), 30+ chickens and 5 turkeys (2 are babies and they are precious). Life is busy but blessed.
I chose Walden University because it aligns with my goals professionally and personally. The online platform allows me to juggle my life and school and family. Also, Walden’s desire to empower nurses as change agents through advanced knowledge and ethical practice reflects the goals I have set for myself; I want to expand my clinical scope, gain autonomy, and ensure regulatory protection for my business in the evolving legal landscape of medical aesthetics (Walden University, n.d.). Walden MSN Program Outcomes – applying evidence-based practices to enhance patient outcomes and leading systemic change collaboratively – reflect my academic and professional goals to grow from merely providing services to safeguarding patient safety while offering innovative care in aesthetics. As the American Nurses Association (ANA) explains, nurses must be prepared to meet “the rapidly shifting expectations of practice” with critical thinking and lifelong learning (ANA, 2021, p. 9). For me, that means gaining the credentials and evidence-based tools I need to stay current in both clinical excellence and state law compliance to protect my patients, my license, and my business.
Networking is beneficial in both clinical nursing and entrepreneurship. First of all, I find that the camaraderie of like-minded individuals, all juggling life with its ups and downs in pursuit of a common goal, creates a sense of family-like unity. Local networking will help me locate preceptor sites and networking with fellow medspa owners helps keep services offered fresh and updated (Schmidt, n.d). Lastly, I value networking with those that have legal industry insight because compliance is a top priority to protect my investment of time and money and to grow with confidence.
I aim to build not only a successful medspa, but one grounded in strong clinical ethics, safety, and professional autonomy. I believe partnering with Walden will help me achieve my goals. I look forward to this journey with all of my colleagues.
Warm Regards,
Bridget Wingate, RN
References
American Nurses Association. (2021).
The nursing scope and standards of practice
(4th ed.). ANA.
Schmidt, K. (n.d.).
5 reasons nurses should engage in professional networkingLinks to an external site.
Links to an external site.
Retrieved November 14, 2018, from https://blog.bluepipes.com/5-reasons-nurses-should-take-professional-networking-seriously/
Walden University. (n.d.).
Vision, mission, and goals.
https://www.waldenu.edu/about/who-we-are/mission-vision
Links to an external site.
IMG_0014.jpg
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Diana Lynn Nix
Aug 27 11:14pm
| Last reply Aug 30 9:36pm
Reply from Diana Lynn Nix
Initial Post
My name is Diana Nix RN, BSN, VA-BC. I am a vascular access RN with previous experience in Neuro Trauma ICU and ER. I have worked with all age groups across many demographics as a travel nurse. My professional and academic goals are to achieve a lifetime of learning, advancing my skills as I go, sharing my knowledge, providing the best care possible to my patients, and to have a great working relationship with the interdisciplinary teams I work with. Like Walden, I value my contributions to society and the impact I can have (Walden University, n.d.). I also strive for professional excellence through research projects and collaboration. I will always treat my patients with dignity and respect, and hope to make a difference in my community by providing culturally competent care and improving the health outcomes of those that need it the most. I want to make a difference by improving the care that patients receive by overcoming challenges in the hospital setting and creating positive changes. I will strive to always be ethical in my decisions and helping patients and their families come to informed and educated decisions about their care or the care of their loved one (Walen University, n.d.). I want to educate my patients and families on ways to contribute to their health and how to improve their diseases and outcomes by compliance with instructions and medications, and access to community resources when needed.
Networking as a practitioner is important. You have to have good working relationships with other practitioners and doctors, as well as other staff members. Taking care of patients is a team approach, often with different specialties and levels of expertise (Schmidt, K., n.d.). Networking also helps us to grow and change as we challenge ourselves personally and professionally. This is how we change specialties or start a new position. We also network when we join professional organizations to learn from the experts in our field and to stay up-to-date on best practices. Networking can also lead to positive changes through committees to improve practices, policies,and procedures. Networking will help me to better care for my patients by taking a collaborative approach to diagnostics and treatment. I can also learn and grow from the experts in my field with learning conferences and trainings.
References
Schmidt, K. (n.d.). 5 reasons nurses should engage in professional networkingLinks to an external site. [Blog post]. Retrieved November 14, 2018, from https://blog.bluepipes.com/5-reasons-nurses-should-take-professional-networking-seriously/
Walden University. (n.d.). Walden University catalogLinks to an external site.. Retrieved Aug 27, 2025, from https://catalog.waldenu.edu
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Ndidi Joan Egemonu
Aug 27 10:51pm
| Last reply Aug 30 2:18pm
Reply from Ndidi Joan Egemonu
My Goals and Walden University Vision and Mission Discussion DQ
Main DQ
Hello everyone, I am Ndidi Joan Egemonu, and I live in Jacksonville, Florida. As a nurse with many years of experience in different nursing specialties, a career that started in my home country, Nigeria, I still needed to give more. My academic goal has always been to achieve higher education and use the knowledge to impact lives, especially those from my community. As a community leader in the greater Nigerian community in Jacksonville, I have been fortunate to give talks to my community on multiple health topics. During this, I discovered two areas that most of the community does not like talking about: hospice and mental health. Many of the members are aware of the end-of-life journey and preparations, and the resources available to help them grieve positively, but occasionally remain in denial. The aspect that shocked me most was the level of denial about mental health despite its ravaging impact on the people. There are many reported cases of domestic abuse, spousal homicide, and much more. This was where I discovered the void that motivated me to advance my career in mental health. The knowledge I will acquire in this career will be used to impact people individually and collectively. I understand that a holistic approach to life must be employed to achieve stability. I started searching for a college with a similar Vision and Mission to acquire this knowledge. I shared my desire to get into a college willing to invest in me to help me achieve my goal, and my friend recommended Walden University.
I chose Walden University because its vision and mission align with mine, and its curriculum and academic program are rich, focusing on its depth, breadth, and stimulating learning environment. It offers an abundance of opportunities and a high-quality, comprehensive experience that goes beyond a standard curriculum. Walden’s PMHNP curriculum is exhaustive and robust, covering a wide range of subjects and topics in a thorough and well-organized manner, ensuring students receive a broad and deep education. Through Walden’s interdisciplinary approach that connects and integrates multiple fields of study, students can see the relationships between different subjects, which helps them to foster a more holistic understanding, a vision I hold dearly.
Master of Science in Nursing (MSN) Outcome
Walden’s MSN program is skills- and outcomes-focused, preparing students to be broad communicators who apply critical thinking in real-world situations. Knowledge acquired at Walden is less discipline-specific but embraces the wider concerns of the humanities and social sciences”(Walden University,2025). It offers students more synergistic, integrated, and coherent paths to experimental and active learning, preparing them to become scholar-practitioners. MSN curriculum in Walden addresses significant and enduring questions and prepares students to think like historians, political scientists, psychologists, sociologists, literary critics, anthropologists, etc. (Walden University,2025). The scholar-practitioner prepared at Walden is a package with holistic knowledge to impact the world. This aligns with my vision to foster change through a holistic approach. The experiential and active learning in Walden offers the MSN students expanded opportunities for mentored research with both proactive academic and non-academic advising and support, and this fosters a sense of community, cohorting, and promotes belonging and connection, and helps build confidence in a scholar-practitioner.
My vision for social change
is to use the holistic knowledge acquired at Walden to correct the knowledge deficit in understanding the need to seek help instead of focusing on the stigma associated with mental health. I will achieve this by engaging people and educating them with every encounter.
Explain why networking is essential and how it may help you achieve your professional and academic goals.
There is a common saying that knowledge is power. No single person monopolizes knowledge; brainstorming, collaborative interactions, and mentorships are ways to learn and improve ourselves. This cannot be achieved without networking. Walden University’s mission and vision cover this aspect and make the faculty, academic, and non-academic staff available to the students for networking. This includes the library resources, the technical support, the enrollment, and the financial officers. There are alum associations, professional groups, and some social media platforms one can join and learn from. Networking is crucial and will help me achieve my professional and academic goals by giving me access to job opportunities, receiving mentorship and support from peers, staying informed about new advancements and best practices, and fostering collaboration to improve patient care. It will provide a vital support system for me when facing challenges and burnout, helping the broader profession evolve through shared knowledge and advocacy for better healthcare policies and environments.
Walden University. (2025).
College of Nursing: Mission
. Walden University Catalog and Handbook.
https://academics.waldenu.edu/catalog/nursing
Walden University. (2025).
Vision and Goals.
Walden University Student Handbook.
https://academics.waldenu.edu/handbook/vision-goals#s-lg-box-30140618Links to an external site.
Links to an external site.
Walden University. (2025b).
Academics: College of nursing: Master of science in nursing (MSN)
. Master of Science in Nursing (MSN) – College of Nursing – Academics at Walden University.
https://academics.waldenu.edu/catalog/nursing/master-science/nursing#s-lg-box-29662482
Links to an external site.
Wofford, P. (2018).
10 networking tips for nurses who hate networking
. Nurse.org. Retrieved from
https://nurse.org/articles/tips-for-nurse-networking/Links to an external site.
Links to an external site.
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Crystal Prado
Aug 27 9:33pm
| Last reply Aug 30 10:16pm
Reply from Crystal Prado
Hello everyone, my name is Crystal Prado, and I’m based in Miami, Florida. I’ve dedicated the last 17 years to growing my career in healthcare, starting as a CNA, then becoming an LPN, and eventually an RN. I’m currently working toward my MSN at Walden University with the goal of becoming a Nurse Practitioner. I’ve had the opportunity to work in several clinical areas, including MedSurg, Telemetry, Stepdown, ER, and Surgery. Emergency medicine, however, has always been my true calling, and I plan to specialize as a Trauma Nurse Practitioner after completing my degree.
What drew me to Walden University is its strong focus on addressing real-world challenges through education. The university’s commitment to creating positive social change and supporting learners from all backgrounds aligns with the kind of nurse I strive to be (Walden University, n.d.). In emergency settings, I often see how social and economic issues affect patient care, and I believe that with the right education and tools, I can make a meaningful impact.
Walden encourages its students to think critically and act with purpose. This focus on reflection, inquiry, and community improvement supports my goal to become more than just a skilled clinician; I want to be a leader who advocates for improved healthcare access and better outcomes, especially for underserved populations (Walden University, n.d.).
The MSN program is designed to build advanced clinical knowledge, leadership abilities, and a deep understanding of evidence-based practice, all of which are essential for my future role as a trauma nurse practitioner. The program outcomes also emphasize collaboration, ethical decision-making, and system-level thinking, which will prepare me to not only care for patients at the bedside but also contribute to broader healthcare initiatives (Walden University, n.d.).
Professional networking is something I’ve learned to value more as I advance in my career. Forming connections with other nurses, faculty members, and healthcare leaders provides opportunities for mentorship, support, and collaboration. According to Schmidt (n.d.), networking can help nurses stay current, grow professionally, and open doors to new roles. Even for those who may feel shy or unsure about networking, there are ways to approach it that feel genuine and comfortable, such as participating in professional organizations or engaging in online communities (Wofford, 2018).
By building a strong network, I hope to gain insights from others in the field, share my own experiences, and grow both personally and professionally.
References:
Schmidt, K. (n.d.).
5 reasons nurses should engage in professional networking
[Blog post]. BluePipes. Retrieved November 14, 2018, from https://blog.bluepipes.com/5-reasons-nurses-should-take-professional-networking-seriously/
Walden University. (n.d.).
Walden University catalog
. Retrieved October 4, 2019, from https://catalog.waldenu.edu
Wofford, P. (2018).
10 networking tips for nurses who hate networking
. Nurse.org. Retrieved from https://nurse.org/articles/tips-for-nurse-networking/
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Abimbola Adegborioye
Aug 27 8:14pm
| Last reply Aug 30 6:01pm
Reply from Abimbola Adegborioye
Introduction and How School Mission Aligns with Being a Psych NP
Introduction
Hello, class. My name is Abimbola (Abi) Adegborioye. I live in Plantation, Florida, and I am originally from Nigeria, West Africa. I am a wife and mother of three beautiful children: 22 years old, 19 years old, and 18 years old—two boys, and the last, a girl. Currently, I work as a Board Certified family Nurse Practitioner in a skilled nursing facility that specializes in geriatric nursing in South Florida. My focus is on Pulmonology and pain management.
The issue of mental health care has become one of the most urgent problems in the modern healthcare system, and particularly among vulnerable and underserved groups of people. As a student in Walden University’s Psychiatric-Mental Health Nurse Practitioner (PMHNP) program,’ I aim to integrate evidence-based practice with compassion to ensure more individuals get access to care. This discussion describes how the mission and vision of Walden, the MSN initiative or program outcomes, and networking with others can help me as a scholar-practitioner to realize my academic and professional aspirations (goals) and ambitions.
‘
How the Walden Mission, Vision, Goals, and Social Change Initiatives Match with My Goals
’
The ‘mission and vision at Walden University’ are compliant with my professional and academic intentions and plans of becoming a ‘Psychiatric-Mental Health Nurse Practitioner.’ Walden aims to build a diverse learning community that tackles the issues faced by society and also create outstanding social changes (Walden University, n.d.). Such devotion is aligned with my objective of broadening psychiatric services to underserved groups of the population, including homeless veterans and rural adolescents with untreated depression. Through an emphasis on quality, integrity, and student-centeredness, Walden can enable me to apply knowledge to the creation of transformational changes in the outcomes of mental illnesses.
How My Goals Align and Relate to MSN Initiative or Program Results
The ‘outcomes of the MSN’ initiative or program available at Walden will also help me in the professional practice as a Psych NP. The program is geared toward evidence-based practice, advancing equity in health, and life-long education (Walden University, 2025). The findings also match my interest in implementing trauma-informed CBT therapy in community clinics and the use of telepsychiatry to attend to adolescents in remote settings with a lack of accessibility. The focus on reflective practice will enhance my abilities to become a qualified and ethical scholar-practitioner capable of doing innovative and advocacy work within the mental health environment across various contexts.
The Value of Networking to Meet Academic and Professional Goals
Networking will be fundamental in achieving my academic and professional goals as a Psych NP. Interactions and networking with faculty, peers, and interdisciplinary health teams will help establish cooperation and mentoring and facilitate engagement and the exchange of knowledge (Hamlin, 2024). Networking will open career opportunities, professional references, and tips to help me develop a long-term practice. Networking is a crucial aspect and competency emphasized by professional organizations, such as the ‘American Association of Nurse Practitioners,’ as a method of becoming a leader, advocate, and expanding the NP association to the healthcare system (Fernandez, 2022). These affiliations will foster or promote my growth and advancement as a student and professional practitioner. Networking Opportunities NURS-6003 Module 1: Discussion
Conclusion
Finally, the mission and social change efforts at Walden, the program outcomes of the MSN program, and the different networking opportunities all fit my academic and career pursuits as a future ‘Psychiatric-Mental Health Nurse Practitioner.’ All materials (resources) and strategies (plans or approaches) will enhance mental health care and lead to my personal or individual accomplishment. As a scholar-practitioner, I will be able to transform individuals’ lives and make mental services accessible to them, and become part of Walden’s dream as an assurance to deliver and achieve desirable social changes.
References
Fernandez, A. (2022, June 16).
The benefits of networking for nurse practitioners.
American Association of Nurse Practitioners. Retrieved August 27, 2025, from
https://www.aanp.org/news-feed/the-benefits-of-networking-for-nurse-practitioners
Links to an external site.
Hamlin, K. (2024).
Professional networking in nursing.
NurseJournal.
https://nursejournal.org/resources/networking-in-nursing/
Links to an external site.
Walden University. (2025).
Online Master of Science in Nursing (MSN) degree | Walden University.
Waldenu.edu.
https://www.waldenu.edu/online-masters-programs/master-of-science-in-nursing
Links to an external site.
Walden University. (n.d.).
Academics: Student handbook: Vision, Mission, and goals.
Retrieved August 27, 2025, from Waldenu.edu.
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
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William Statum
Aug 27 7:14pm
| Last reply Aug 30 1:58pm
Reply from William Statum
Hi Classmates!
My name is William David Statum; my father and I have the same first name, so people call me David. I am a proud dog dad to Baby Bella, a beautiful Chihuahua; she is sleeping in my lap while I write this post. I live in southern Middle Tennessee. Nursing school was a midlife career change for me. I have been a nurse for 13 years. I have spent the majority of my nursing career focusing on substance abuse and addictions, food insecurity, and hunger. I worked with local drug treatment court programs, and my family and I started a food bank in my rural community; the COVID-19 pandemic dramatically changed things quickly. We began by helping a few families, and literally overnight, we have been serving more than 1,500 families each week for the past seven years. I have learned that all things derive from relationships, so I spend a considerable amount of time establishing them. With this networking model, I can obtain the resources I need to help people. In all things that I do, whether through faith or profession, communication has been a driving force, and I am excited to begin this post-MSN PMHNP certification, where I can grow into my calling.
Walden’s vision of a community that values knowledge and professional competencies is important to me. We all have things to offer, and when we build an inclusive, knowledge-based environment, we can learn from one another. Not so much as touting our own accomplishments, but, instead, using that knowledge from those accomplishments to bring change where change is needed, growth where it is required, and inclusion to learn and resources to solve critical societal challenges where greater global goodness is necessary.
Walden’s goals to adhere to that vision provide a safe, academic environment that demonstrates tangible learner-centered, process-centered approaches toward achieving academic excellence. It feels good to be learning in an environment that appreciates my educational and professional background and uses it as a catalyst to help me reach my goals. I enjoy learning and growing, so this learning model resonates with me. I looked at several similar programs, but most of them are test-based courses; I learn better by discovery, research, and critical thinking than by learning only to pass one exam per course. I get so nervous in those other environments that it hinders my progress toward achieving my learning goals and helping build positive social change.
A significant portion of my daily activities involves promoting a safe environment to foster social change. Our feeding program operates efficiently each day, so we have deliberately based all conversations on whether they add value to the mission of the food bank. That concept is not original with me. Dolly Parton is quite a positive force in Tennessee. I actually met her once at Walmart. In an interview, when promoting an album in England, the interviewer told her that one of their princesses invited her to tea. Ms. Parton’s response was in the form of a question. Is the princess helping her promote her album? Since the answer was no, she suggested that perhaps they could get together at another time. She was trying to effect social change within her own immediate environment, respecting the time and talents of those who were helping her achieve her goals while there.
Walden’s initiatives to support positive social change through the development of principled, knowledgeable, and ethical scholar-practitioners have had a profound impact on me, as this word-mapping has already influenced how I lead, set goals, and contribute to making society better (Walden, 2025).
Walden’s MSN Program Outcomes, emphasizing evidence-based practice, leadership, advocacy for health equity, and social change, directly align with my goal of becoming a scholar-practitioner by providing a framework to synthesize theory and practice (2025). I anticipate that this emphasis toward scholarship and practice, supported by confidence gained from completing this program, will assist me in efforts to analyze health data, promote quality improvement, advocate for vulnerable populations, and lead change in diverse healthcare settings, ultimately advancing your professional and academic goals while contributing to societal well-being. This confidence will help me establish new networking relationships to advance my career with greater ease and less anxiety. (Savard, et. al., 2023) Networking with like-minded healthcare professionals could become a catalyst to begin nurturing relationships that offer access to hidden job opportunities, opportunities to find mentors and career guidance, emotional support, and a strong peer network to prevent burnout, increased knowledge about different specialties and new developments, and the chance to influence the healthcare system by advocating for change. Honestly, networking has been challenging for me, probably because I lack confidence sometimes. Knowledge and nursing skills foster professional confidence, so I am excitedly looking forward to shifting my mindset to that of a scholar-practitioner, which will enable me to reframe my understanding of networking and ultimately reach my goals of building a successful practice, helping my community, and developing relationships to offer significant and tangible assistance for those in need.
References:
Savard, I., Al Hakim, G., & Kilpatrick, K. (2023). The added value of the nurse practitioner: An evolutionary concept analysis.
Nursing open
,
10
(4), 2540–2551. https://doi.org/10.1002/nop2.1512
Walden University. (2025). Academics: Student handbook: Vision and goals. Vision and Goals – Student Handbook – Academics at Walden University. https://academics.waldenu.edu/handbook/vision-goals#:~:text=Walden%20University%20strives%20to%20produce,a%20commitment%20to%20lifelong%20learning.
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Thais Banos Silverio
Aug 27 5:27pm
| Last reply Aug 30 4:09am
Reply from Thais Banos Silverio
Main Post
My name is Thais Banos Silverio. I have been a registered nurse for more than five years, working in different departments. In recent times, I have worked in the emergency and critical care units providing healthcare services to the most vulnerable patient population. In my experience, I have recognized the value of nurses, especially in the management of high-stress situations and the ability to make informed, critical, and relevant decisions that can improve patient outcomes. As an individual who has worked in the emergency unit, I have also contributed to supporting both the patients and the family members through quality communication and interpersonal relationship skills. I am pursuing my education to continue improving my academic goals, championing diversity, collaboration, and strengthening my commitment to realizing opportunities for personal growth and professional development. My focus is on the best ways by which I can contribute to the general health and well-being of every member of society, especially those with mental health complications living in underserved communities.
Walden University operates on a vision, mission, and value statement that prioritize social change. Through this institution, it is easier to align my goals and academic restoration with its agenda because of the flexibility of the learning environment, allowing for continuous education and maintenance of my responsibilities as a nursing professional (Walden University, n.d.). My desire to join Walden University was also because of their ability to interact with scholars and other professionals who are dedicated to positive change and lifelong learning. The focus of this University is to ensure that healthcare personnel are capable of advancing the delivery of competent services across different life stages while also serving the interests of the community (Walden University, n.d.). In the capacity of a psychiatric mental health nurse practitioner, I am confident that I will be capable of contributing to the expansion of access to mental health care services, addressing issues of stigma, isolation, and discrimination through compassionate and evidence-based solutions.
The MSN program at Walden University is supportive of my development as a nurse leader. Through the course instructions, I will be part of the population that contributes to critical thinking, applying research, and making ethical decisions. I am confident that through these outcomes, it will be easier to align my operations and desires with an integrated approach to evidence-based art interventions and quality solutions targeting mental health care while enhancing the nature of outcomes for the community and clinical settings (Walden University, n.d.). Walden University also provides an opportunity to network with other students, the faculty, and academic advisors. These will be critical players in my journey as I build connections, access mentorship, academic support, and opportunities for professional collaboration.
References
Walden University. (n.d.).
Walden University catalog links to an external site
Links to an external site.
. Retrieved from
https://catalog.waldenu.edu
Links to an external site.
Walden University. (n.d.).
Walden University catalog links to an external site
Links to an external site.
. Retrieved from
https://catalog.waldenu.edu
Links to an external site.
Walden University. (n.d.).
The writing center links to an external site
Links to an external site.
. Retrieved from
https://academicguides.waldenu.edu/writingcenter
Links to an external site.
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Amanda Michelle Perez
Aug 27 4:56pm
| Last reply Aug 30 2:26pm
Reply from Amanda Michelle Perez
Hi everyone, my name is Amanda. I’m from Miami, Florida and have been working as an RN in the ER of a level one trauma facility for 3 years. Prior to becoming an RN, I was working as a medical assistant and office manager for a urgent care company down here in South Florida. Working in these urgent and emergent environments has trained my brain and body to always be ready and unfortunately for my family and friends, I never stop moving even when I’m off the clock. With this experience, I’ve been exposed to many different types of patient populations and disease processes at every stage of its progression.
As an RN pursuing an advanced degree, my idea of success is waking up each morning, healthy, feeling content with the choices I have made that led me to where I am. I don’t believe success can be measured, but can be the impact you leave on others, making sure it’s better than the way you found them.
I felt that continuing my education to become an FNP was my way of contributing back to my community with all the experiences and lessons I’ve learned whilst working in such a harsh environment. Coming from an immigrant family with a long line of nurses and nurse practitioners I not only felt it was my duty to continue on but I have this sense of passion and pride being given the opportunity to follow in my family’s footsteps. When it came to choosing a program to attend, Walden’s vision and one of their goals made it an easy and obvious choice. With a vision surrounded by creating an environment that values knowledge and professionalism to drive for a greater societal change (Walden University, 2025). Walden’s College of Nursing furthers the university’s vision by emphasizing their dedication to a diverse nursing population. This encapsulates my goals as a future FNP in one short sweet sentence. Being exposed to many patients who are unable to properly manage their care, my goals for future self are to be easily accessible to more patient populations.
When it comes to networking, in my personal opinion I feel that healthcare is a bit overlooked. Throughout my career, I joined the Emergency Nurses Association and was able to make friends and meet colleagues in my area with the same life and career interests. Because nursing is constantly evolving, maintaining professional relationships is especially important when your wish is to keep your knowledge fresh and relevant (Schmidt, n.d).
Schmidt, K. (n.d).
5 Reasons Nurses Should Engage in Professional Networking.
Links to an external site.
Links to an external site.
Links to an external site.
Walden University. (2025).
Academics: Student Handbook: About Walden
. Student Catalog, Student Handbook, and University Guidebooks – Student Catalog, Handbook, and University Guidebooks – Academics at Walden University. Retrieved August 27, 2025, from
https://academics.waldenu.edu/handbook/about-walden
Links to an external site.
Links to an external site.
Links to an external site.
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Zenia Alvarez
Aug 27 2:37pm
| Last reply Aug 29 9:25pm
Reply from Zenia Alvarez
Module 1 Discussion
My Professional Goals and Walden University’s Vision
Hello everyone! My name is Zenia, I graduated in 2013 as a Pharmacy Technician and worked in that field until 2020 before pursuing nursing, completing my degree in 2020, and gaining experience as a school nurse and in COVID testing. In 2023, I began working for Florida Blue as a Navigator Nurse, collaborating with a Community Specialist to help members and the community better understand and act on their health and basic needs. Most recently, I completed my FNP in June 2025, where I have recognized the growing need for mental health support in the community. In my pursuit of a career in nursing, I should select a college that drives excellence, equity, and social change. The mission and the vision of Walden University fit into my professional and academic goals since they will contribute to the creation of evidence-based practice, nursing leadership, and innovativeness. In this discussion, I outline how the philosophy of Walden and the results of my MSN program will enable me to develop as a scholar-practitioner and how networking can facilitate my long-term success.
The mission and vision of Walden University rest on setting up a multi-ethnic body of scholar-practitioners at the University, and in pursuing life-long learning and social change (Walden University, 2025). This complements my aspirations of becoming a Psychiatric Mental Health Nurse Practitioner (PMHNP) that lowers the disparities, which occur in relation to access to mental health care. The university also reflects my vision of social change, as I personally want to change the way in which poorly served groups can be helped in regard to mental health outcomes. The education that can facilitate the interaction of theory, research, and advocacy can help bring the much-needed change in the professional service as an academic.
The mission statement of the College of Nursing contains the description of the necessity of having education in nursing that is empirically relevant and academically demanding (Walden University, 2025). This will help me attain my objective of achieving cultural competence in practice, which must be achieved when dealing with patients of diverse backgrounds. It is established that culturally competent nursing mitigates disparities and enhances patient-provider interactions (Kamimura et al., 2020). As Walden offers a program design with the inclusion of contextual learning, I am certain that I will be able to develop the appropriate set of skills that would allow me to address the mental health needs of diverse populations and serve as a leader within a specific practice in the realm of psychiatric nursing.
My MSN program outcomes also match my academic and career plans. Particularly, the program targets the area of evidence-based practice execution and integration of the scientific evidence in the patient care process (Walden University, 2025). In psychiatry, a critical importance is placed on evidence-based care, given that the decision regarding the treatment process must be safer and effective, based on clinical principles and evidence (Varcarolis & Fosbre, 2020). Upon learning these outcomes, I will be in a position to administer high-quality and equitable care and meet my dream of facilitating mental wellness in populations.
Another of the program outcomes that can be directly associated with my professional development is the area of systems leadership and policy advocacy. Graduate-prepared nurses are expected to transform the healthcare systems and effect changes in policies that are aimed at improving patient outcomes (AlMekkawi & El Khalil, 2020). This is of utmost importance in psychiatric nursing, as the barrier to care that comes with stigma and structural disadvantage of the population with mental disorders is an obstacle to accessing care. I will use this training to influence the government in implementing policies that will make psychiatric services readily available in both urban and rural regions.
The importance of networking is also necessary both at the professional and academic levels. Investigations show that with professional networking, one can find mentorship, career growth, and assured partnering deals to enhance practice in their areas of medical care (Wani, 2024). Through networking, we are in a position to share the knowledge and support each other; these are two aspects that are critical in addressing the complex needs of patients. By developing their connections with both faculty members and other clinicians, and professional organizations, I will further position myself in the profession to be a clinician who can contribute more value to the community.
In conclusion, the MSN program outcomes of Walden University are well aligned with my personal and professional goals. The emphasis that they have on social change, evidence-based training, and culturally competent training assists me in growing as a psychiatric nurse practitioner. Networking and collaboration will go hand in hand to enable me to advance as a scholar-practitioner who will achieve better outcomes of mental health within diverse populations.
References
AlMekkawi, M., & El Khalil, R. (2020). New graduate nurses’ readiness to practise: a narrative literature review.
Health Professions Education
,
6
(3), 304-316.
https://doi.org/10.1016/j.hpe.2020.05.008
Links to an external site.
Kamimura, A., Higham, R., Rathi, N., Panahi, S., Lee, E., & Ashby, J. (2020). Patient–provider relationships among vulnerable patients: the association with health literacy, continuity of care, and self-rated health.
Journal of patient experience
,
7
(6), 1450-1457.
https://doi.org/10.1177/2374373519895680
Links to an external site.
Varcarolis, E. M., & Fosbre, C. D. (2020).
Essentials of psychiatric mental health nursing-E-book: A communication approach to evidence-based care
. Elsevier Health Sciences.
Walden University. (2025).
Academics: Student Handbook: About Walden
. Student Catalog, Student Handbook, and University Guidebooks – Student Catalog, Handbook, and University Guidebooks – Academics at Walden University. Retrieved August 27, 2025, from
https://academics.waldenu.edu/handbook/about-walden
Links to an external site.
Wani, P. (2024). Connecting for success: the role of networking in medical education.
Cureus
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16
(11). DOI: 10.7759/cureus 74643
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Marien Joanna Bomwell
Aug 27 2:18pm
| Last reply Aug 31 8:27am
Reply from Marien Joanna Bomwell
Hello everyone,
My name is Marien Bomwell, and I am excited to start the Nurse Practitioner program here at Walden. I have been a Registered Nurse for 4 years in the Emergency department. Before becoming a nurse, I worked in the ER for 6 years as an ER tech, and I loved the fast-paced environment, adrenaline, and excitement. Having that prior experience and the exposure to unpredictable situations and patients with a variety of medical needs motivated me to start my nursing career. I wanted to expand my skills and clinical knowledge, and help others through those demanding situations, which gave me a solid sense of purpose.
My goal now is to continue learning and broaden my professional nursing knowledge. In my opinion, becoming a Nurse Practitioner will strengthen my relationship with patients and have a considerable impact on the overall health of a diverse range of patients. For this reason, I picked Walden University. Its vision aligns with my professional goals, as it will enable me to manage the challenge of continuing to work with its adaptable learning alternatives. Walden’s mission will help me prepare with evidence-based practice to stand for the communities in need. Additionally, Walden’s social change initiatives to promote the worth and dignity of communities will guide me in managing health inequalities and supporting vulnerable populations (Walden University, 2025a).
At Walden, the MSN Program Outcomes and perspectives align with my professional and academic goals by helping me enhance my leadership skills and contribute to delivering better nursing care within society. The program outcomes will also enable me to communicate more efficiently in various ways when diagnosing, implementing a plan of care, and preventing illnesses for different populations (Walden University, 2025b).
In relation to networking while in Nurse Practitioner school, it is essential because it will enable me to exchange knowledge with others and provide a support system that motivates me and helps reduce my stress levels, thereby enhancing my performance. Professionally, networking will help me find the right mentor who can share their perspectives on what to do and what not to do for career growth, as well as establish the necessary connections for job opportunities (Schmidt, n.d). Networking Opportunities NURS-6003 Module 1: Discussion
References
Schmidt, K. (n.d).
5 Reasons Nurses Should Engage in Professional Networking.
Links to an external site.
Walden University. (2025a).
Vision and Goals
.
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
Walden University. (2025b).
Learning Outcomes.
https://academics.waldenu.edu/catalog/nursing/master-science/nursing#s-lg-box-29662482
Links to an external site.
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Nerlande Bellevue
Aug 27 1:40pm
| Last reply Aug 30 6:03pm
Reply from Nerlande Bellevue
Hello everyone,
My name is Nerlande, and I currently reside in Broward County, Florida. I have been working as a nurse for the past five years. In this period, I have acquired a strong passion for contributing to advancing positive health outcomes for my patients and the communities I serve. This course gives me an opportunity to advance my academic journey here at Walden and grow alongside each of you.
My goals as a nurse are in tandem with Walden’s mission and vision, which emphasize academic excellence, promoting social change, and the need for evidence-based practice. This aligns well with long-term commitment to providing patient-centered care (Walden University, n.d.). Walden’s vision serves as a guiding force in helping me become a scholar-practitioner who applies clinical expertise and, at the same time, advocates for equity, quality, and innovation in healthcare. In addition, the College of Nursing’s mission to prepare nurses for leadership and transformative practice will significantly help in expanding my influence beyond bedside care. This will go a long way to ensuring health promotion and patient education in my line of duty.
Consequently, the MSN program outcomes support my professional and academic development. With their heavy focus on leadership, collaboration, decision-making, and evidence-based practice, the outcomes serve as an integral path to my growth as I transition into advanced practice roles. Besides, I regard them as benchmarks for the knowledge and skills I am looking forward to acquiring. In the long run, they will be critical in strengthening my clinical competencies and help me contribute meaningfully to the nursing profession and the communities I serve.
Eventually, networking is truly a vital part of academic and professional success. As such, I believe that it is important to build and enhance relationships with faculty, peers, and other healthcare professionals. Such relationships are crucial in collaboration, mentorship, and the exchange of diverse perspectives (Wofford, 2018). Hence, as I navigate this program, these connections will be vital in engaging and expanding my professional opportunities in advanced practice nursing.
References
Walden University. (n.d.).
Walden University catalogLinks to an external site.
Links to an external site.
. Retrieved October 4, 2019, from https://catalog.waldenu.edu
Wofford, P. (2018).
10 networking tips for nurses who hate networkingLinks to an external site.
Links to an external site.
. Retrieved from https://nurse.org/articles/tips-for-nurse-networking/
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Kenneth Ejiofor Oruka
Aug 27 12:36am
| Last reply Aug 30 9:51pm
Reply from Kenneth Ejiofor Oruka
Hello everyone, my name is
Kenneth Ejiofor Oruka
(But you may simply call me Ken). I was born and raised in a one-room shack in the suburb of Enugu State, Nigeria. It was never easy for my parents, especially my mother, who was determined to see us succeed even as she had nothing to support six of us. She struggled and got severely depressed when I was still in elementary two. All hopes seemed to have vanished for all of us, but from that a young age, I knew I was different. I braced up the challenge, engaged in different childhood labor and petty trading. When other kids were playing, I would be thinking of what the next day would look like. I never watched any Television until adulthood, no childhood memories, and no friends. When others played, I studied borrowed textbooks under kerosene lamps, sketching every letter and words as if they were a map out of my poverty. I faced every post study assessment question with desperations and starvation of someone who hoped on knowledge as my only inheritance.
Why did I choose Nursing as a Profession?
I didn’t pursue nursing because it was simple—I chose it because it mattered. Of the many things that my mother laid her hands as a means of surviving, being an untrained/uneducated ‘home birth attendant’ was the one that earned her the most respect, as she was often referred to as ‘home nurse’. Hence, I believed that I could continue building on my mothers’ legacies by obtaining a degree in nursing. Interestingly, I simplified nursing as what my mother was doing and expected it to be a cheaper alternative to the other courses since I would be training myself.
Moreover, I viewed nursing as profession that is far beyond technical expertise. To me, it’s about truly hearing people when the world is too rushed to listen. It’s about being present—physically, emotionally, and ethically—when someone is at their most fragile. It’s about earning the profound trust to care for life itself; all of which my mother was known for in the community. Because of this, I was determined to enjoy the discipline of the training, the breadth of opportunities, and the universal importance of the role. It was my honest desire to help uphold that foundation—not just to treat disease, but to foster health, justice, and empathy. I chose a life of service, science, and strength that will build on my mothers’ effort and also make me different.
Across Nations: The Journey of an African Nurse
I am pleased to state that beyond all odds, I made it as a nurse—shaped by the pulse of Africa, where resilience isn’t optional, it’s instinctive. My training was forged in crowded wards and under constrained conditions, where care meant creativity and compassion meant everything. I have stood beside pain that had no diagnosis, relied on intuition honed by necessity, and spoken up even when my voice was dismissed. I’ve led quietly, persistently, even when the spotlight pointed elsewhere.
But my identity isn’t confined by geography. I realized that am not only an African nurse, but a nurse with a global calling. Having conquered hunger locally and escaped generational poverty, I knew that it was time for me to seek international recognition, not for praise, but for parity. I wanted my expertise to be acknowledged, my credentials to carry weight, and my insights to shape conversations beyond borders. I envision collaboration across nations, contributing to health systems worldwide, and bringing the depth of my experience to global platforms. This is a journey that I am committed to accomplishing.
Connecting Vision to Impact: How My Aspirations Reflect Walden’s Mission
Walden University’s commitment to empowering a diverse network of professionals to drive meaningful social change (Walden University, n.d) strongly aligns with my personal and professional path. Specifically, the University “envisions a premier, inclusive online learning community where knowledge and professional competencies are valued for their contributions to solving critical societal challenges and advancing the greater global good”. As a nurse trained in Africa, I’ve directly encountered the inequities in healthcare—limited access, under-recognition, and resource gaps. My mission extends beyond delivering compassionate, evidence-based care; I strive to champion equity and amplify the global presence of African-trained nurses.
The university’s dedication to cultivating scholar-practitioners who lead through service and innovation mirrors my academic aspirations. I’m eager to advance my nursing education, engage in impactful research, and guide others through mentorship. I view my role not only as a clinician, but as a catalyst—someone who leverages knowledge to dismantle systemic obstacles and empower communities.
Aligning The Walden University
College of Nursing Mission with My Aspirations
The College of Nursing’s dedication to providing education that is both academically rigorous and culturally attuned resonates with my aspiration for a learning space that respects my heritage and equips me for global impact. I’m drawn to Walden’s flexible, practitioner-driven approach, which empowers me to blend hands-on experience with scholarly advancement.
Their focus on social transformation and leadership cultivation aligns seamlessly with my vision of launching international health collaborations as a means of ‘take-it-back-home’ effort and driving policy changes that elevate African-trained nurses within the global healthcare landscape.
Becoming a Scholar-Practitioner: My Journey Toward Global Relevance
Embracing the scholar-practitioner path at Walden empowers me not only to learn but to lead in knowledge creation. My goal is to advance research that showcases the ingenuity and resilience of African healthcare systems, while fostering interdisciplinary collaboration to address urgent global health issues. Guided by Walden’s mission and vision, I pursue this work with integrity, intellectual rigor, and a deep sense of purpose.
Aligning Walden’s MSN Outcomes with My Vision as a Nurse
As a nurse committed to achieving global recognition, building on my mother’s unnoticed effort, and effecting meaningful change, I view the Walden MSN program not merely as a pathway to a degree, but as a transformative framework aligned with my professional aspirations. The program’s core competencies—advanced clinical practice, leadership development, evidence-based inquiry, policy engagement, and patient-centered care (Walden University, n.d.)—are directly supportive of my long-term goals. Ultimately, Walden prepares me not only to excel professionally, but to serve with purpose, lead with vision, and contribute to a legacy of equity and transformation in global health.
Professional Networking as Steppingstone to Realizing My Academic Goals
In today’s competitive personal, professional, and organizational landscapes, professional networking has emerged as a vital tool for individual success (Faizan, 2025). According to Akkas (2023), Scholars have also identified a range of variables, including networking, that significantly influence an individual’s career success. Networking goes beyond swapping business cards or adding LinkedIn contacts—it’s about forging meaningful connections that help propel you toward your aspirations, particularly in a profession as evolving and people-focused as nursing. Schmidt (n.d.) noted that Nurses occupy a vital and increasingly multifaceted role in patient care, contributing significantly to nearly every operational aspect of healthcare organizations. Their expertise positions them to influence the design and execution of institutional processes and protocols. When nurses are empowered to lead in these areas, the resulting improvements enhance both the organizational environment and overall system performance.
Schmidt (n.d.) further notes that professional networking encompasses structured interactions and affiliations that arise within occupational or career-related contexts. Fundamentally, professional networking serves as a conduit through which individual expertise evolves into broader impact. It enables the transition from practicing as a competent nurse within a localized setting to becoming a globally recognized leader contributing to the advancement of healthcare across international boundaries.
Sources of Professional and Social Networking
To cultivate meaningful connections and advance professional development, Walden University (n.d.) recommended that individuals may engage with a diverse array of networking channels, including:
Institutional and Educational Affiliations
University alumni networks (e.g., Walden University Alumni Association)
Student-led organizations and campus groups
Faculty, staff, and peers within academic institutions
Classroom-based interactions and cohort relationships
Professional and Civic Engagement
Industry-specific associations and credentialing bodies
Conference, seminar, and workshop participants
Volunteer and service-based organizations
Former colleagues and workplace contacts
Political and advocacy groups
Personal and Community-Based Networks
Friends and extended family members
Neighborhood and local community connections
Social clubs, hobby groups, and fitness communities
Faith-based institutions and religious communities
Military affiliations and veteran networks
Service professionals (e.g., legal, medical, financial, real estate, travel, veterinary)
Parent-related networks (e.g., PTA, youth sports, scouting organizations)
Digital and Online Platforms
Social media platforms such as Facebook (including university-specific groups), Instagram, Twitter
Professional networking sites like LinkedIn
Interest-based platforms including Meetup.com and Ted.com
Academic and research collaboration networks
Why Networking Matters
The motivations for nurse practitioners to cultivate professional networks are diverse and continually evolving. According to Goolsby and Knestrick (2017), engaging in networking fosters connections that facilitate access to emerging opportunities, enhance personal and professional growth, support collaborative research initiatives, promote involvement in health policy advocacy, and strengthen the implementation of evidence-based practices.
How Networking Would S
upports My Aspirations
Advancing Academically:
Building relationships with faculty, alumni, and peers at institutions like Walden opens doors to joint research, collaborative projects, and mentorship that deepen your development as a scholar-practitioner.
Growing Professionally:
Active participation in nursing organizations, conferences, and online communities keeps you informed, strengthens your professional identity, and prepares you for leadership opportunities.
Achieving Global Impact:
Engaging with international colleagues and institutions enables you to champion policy change, contribute to global health efforts, and ensure your insights shape conversations beyond borders.
References
Akkas, M. (2023).
Role of networking skill to career success
.
https://doi.org/10.57240/DUJMBK02
Links to an external site.
Faizan, R. (2025). The Importance of Professional Networking: A Pathway to Career Success,
Scientific Societal & Behavioral Journal, 1(1), 59-65.
DOI: 10.63329/av3nz1236
Goolsby, M. J., & Knestrick, J. M. (2017). Effective professional networking.
Journal of the American Association of Nurse Practitioners
,
29
(8), 441–445. https://doi.org/10.1002/2327-6924.12484
Schmidt, K. (n.d.).
5 reasons nurses should engage in professional networkingLinks to an external site.
Links to an external site.
[Blog post]. Retrieved August 26, 2025, from
Links to an external site.
Walden University. (n.d). Vision and Mission. Retrieved August 26, 2025 from
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
.
Walden University. (n.d.). Networking. Retrieved on August 26, 2025, from https://academicguides.waldenu.edu/careerservicescenter/networking/home
Walden University. (n.d.).
College of NursingLinks to an external site.
Links to an external site.
Retrieved August 26, 2025, from
https://academicguides.waldenu.edu/fieldexperience/son#s-lg-box-3837398
Links to an external site.
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Lavonia Nicole Landrum
Aug 26 9:47pm
| Last reply Aug 30 10:58pm
Reply from Lavonia Nicole Landrum
My name is Lavonia (Niki) Landrum. I am 33 years old and have been a nurse for 11 years. I have spent the majority of my career on a surgical orthopedic floor of a small, 100-bed, rural hospital in South Georgia. I also have experience as an OR circulator, mental health nurse, and spent the majority of the pandemic on our COVID-19 unit. I have been at my current facility for 11 years next month. I have a wonderful husband, and together we have two 15-year-old boys, a 14-year-old boy, and a 9-year-old girl. After many years as a charge nurse and full-time mom, I am finally ready to begin my journey to becoming a Family Nurse Practitioner.
Since graduating from nursing school in 2014, I have worked in many different roles. Each one brought a new set of challenges that I was eager to approach head-on. While working through the pandemic in 2020, I decided to return to school to obtain my Bachelor’s Degree, graduating in 2022. Although I thought this was the end of my educational path, just two years later, I began dreaming about furthering my education to become a Family Nurse Practitioner. This led me to researching many different schools and talking to numerous advisors while searching for the best fit for me. Walden University was one of the many schools that I contacted; however, it immediately ascended to the top of my prospect list.
Walden’s vision and mission statements mirrored my needs for an “inclusive online learning community” that provides the necessary knowledge and skills to make a positive impact on the public (Walden, 2025). This aligns perfectly with my goals, both short and long-term. I intend to work full-time while continuing my education, and upon completion, I will practice as a Family Nurse Practitioner in my community. I was also intrigued that I would be able to connect with like-minded nurses throughout the country, as “Walden University provides a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners (Walden University, 2025).” This connection with future Nurse Practitioners across the country will be invaluable throughout my upcoming career.
As a student, networking provides a vast wealth of knowledge and experience to be shared among like-minded individuals pursuing higher education. These relationships can not only assist in the successful completion of the program but also provide future collaboration for patient care. Networking amongst medical professionals “serve as an invaluable resource for knowledge that can be instrumental in advancing the nurse’s career (Schmidt, 2020).” This networking can assist in providing the best care to patients, ultimately improving their outcomes.
References:
Schmidt, K. (2020, September 4). 5 reasons nurses should engage in professional networking. BluePipes Blog. https://blog.bluepipes.com/5-reasons-nurses-should-take-professional-networking-seriously
Walden University. (2025). Academics: Student handbook: Vision and goals. Vision and Goals – Student Handbook – Academics at Walden University. https://academics.waldenu.edu/handbook/vision-goals#:~:text=Walden%20University%20strives%20to%20produce,a%20commitment%20to%20lifelong%20learning.
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Donna Carol-Baxter
Aug 26 9:08pm
| Last reply Aug 31 8:12am
Reply from Donna Carol-Baxter
My name is Donna Baxter. I have been a nurse for 15 years, with experience in Medical Surgical, Cardiac, ER, and Critical Care. I recently fulfilled my Doctor of Nursing Practice degree and have transitioned into academia as an undergraduate nursing professor, while maintaining my clinical skills in the acute care setting. I am excited to start the Psychiatric Mental Health Nurse Practitioner program and look forward to expanding my knowledge to contribute to the vulnerable populations.
I chose Walden University and the College of Nursing because their mission and vision closely match my goals as a DNP-prepared nurse, educator, and administrator. Their emphasis on social change, leadership, and lifelong learning aligns with my goal of improving mental health care and making a significant difference in vulnerable populations. (Walden University, n.d.-b)
As I develop my Academic Success and Professional Development Plan, I recognize the importance of engaging with the academic community. Faculty mentors me in refining my passion for working with mental health populations through teaching and enhancing my clinical skills. Support teams, such as advisors and library staff, assist me in accessing resources and staying organized. Fellow students provide collaboration and shared experiences that broaden my perspective. Connecting with practicing mental health professionals offers practical insights and helps me clarify best practices for patient care. (Turi et al.)
Networking is fundamental for achieving both professional and academic success. Building relations with faculty, peers, and experts provides mentorship, teamwork, and career opportunities. It also creates a reassuring community, offering encouragement and responsibility as I pursue my goals. Through networking, I can strengthen my impact as a nurse educator and administrator, ultimately advancing care for mental health populations. (Walden University, n.d.-b) Networking Opportunities NURS-6003 Module 1: Discussion
In summary, Walden’s mission and vision provide a background for aligning my academic journey with my professional goals. Leveraging my educational and professional networks will guide me in developing my blueprint for success and accomplishing my vision of improving mental health care through leadership, education, and practice. (Walden University, n.d.-b)
Reference:
Turi, Eleanor, et al. “The Effectiveness of Nurse Practitioner Care for Patients with Mental Health Conditions in Primary Care Settings: A Systematic Review.”
Nursing Outlook
, vol. 71, no. 4, 1 July 2023, pp. 1–23, www.sciencedirect.com/science/article/pii/S0029655423001008,
https://doi.org/10.1016/j.outlook.2023.101995
Links to an external site.
.
Walden University. (n.d.-b).
Vision, mission, goals, and social change
.
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
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Lauren Smith
Aug 26 8:40pm
| Last reply Aug 28 10:52pm
Reply from Lauren Smith
My name is Lauren Smith and I am currently a Pediatric Nurse Practitioner in a Pediatric Cardiac Intensive Care Unit in Tampa, Florida. I am pursuing my Family Nurse Practitioner Post-Master’s Certificate here at Walden University. I am very excited for this opportunity to further my education as a student enrolled at Walden University as its vision and goals resonate with me, particularly the goal “to produce graduates who are scholarly, reflective practitioners and agents of positive social change” (Walden University, 2025,
Goals
section). I believe that as an advanced practice provider I have the knowledge and skills to guide those in my community and society to shift toward health promotion and prevention. This is important to me because I want to lead a long, healthy life and focus on prevention rather than treatment so I can enjoy what the future has in store for me as I watch my 4 young children grow.
Similar to how Walden University’s goals impress upon me, the Mission of the College of Nursing excites me as it is “dedicated to excellence in nursing education, provides programs to transform diverse nursing professionals into champions of change who will improve health outcomes and advance health equity (Walden University, 2025,
College of Nursing, Mission
section). Despite my career as an intensive care nurse and nurse practitioner, recently I have been eager to interact and care for patients who are not critically ill. For well over a decade I have been taking care of acutely ill pediatric patients, which can weigh on a provider over time. I’m eager to start a new chapter and practice in Family health, which will allow me to shift from caring for the critically ill to promoting advancement in health and wellness to my patients.
As I progress on my new journey it will be essential to establish connections and networks where I can learn and grow continuously, as this avenue of Family practice is new to me. I plan to start with my local network and contacts in the medical community as I embark on the search for practicum sites. I recently learned about the Tampa Bay Advanced Practice Nurses Council, which is a resource for networking within my local community where they have meet ups and continuing education opportunities (TBAPNC Tampa Bay Advanced Practice Nurses Council, n.d.). Additionally, I anticipate associating myself with professional nursing organizations such as Nurse Practitioner Associates for Continuing Education (NPACE), which will be a great resource for continuing education (NPACE Nurse Practitioner Associates for Continuing Education, 2025,
Advance your career. Shape the future of healthcare).
Within the Walden University community, I plan to connect with my Academic Advisor to discuss my course curriculum and ensure I remain on track as this is a fast paced curriculum. I have signed up for a round table discussion on preparing and planning for my practicum.
References:
NPACE Nurse Practitioner Associates for Continuing Education. 2025.
Advance your career. Shape the future of healthcare.
https://www.npace.org/
Links to an external site.
TBAPNC Tampa Bay Advanced Practice Nurses Council. (n.d.).
https://tbapnc.enpnetwork.com/https://tbapnc.enpnetwork.com/https://tbapnc.enpnetwork.com/https://tbapnc.enpnetwork.com/
Links to an external site.
Walden University. (2025).
College of Nursing: Mission
. Walden University Catalog and Handbook.
https://academics.waldenu.edu/catalog/nursing
Walden University. (2025).
Vision and Goals.
Walden University Student Handbook.
https://academics.waldenu.edu/handbook/vision-goals#s-lg-box-30140618
Links to an external site.
SC
Sherry Clair
Aug 26 2:50pm
| Last reply Aug 30 2:30pm
Reply from Sherry Clair
I graduated from nursing school in 2009 and began my career as a Labor and Delivery Nurse—a role I once considered my dream job. I celebrated with families during their most joyful moments and provided comfort for some during the worst day of their lives. I shared with my family then that I planned to dedicate my entire nursing career to being an L&D nurse. However, after the birth of my middle child, my perspective—and ultimately, my professional goals—changed profoundly.
During my son’s medical visits, I encountered multiple instances of insensitive and uninformed remarks from healthcare providers. One of these remarks directed at me while the provider was examining my son on my lap; ‘You knew about it while you were pregnant, and you still continued the pregnancy?’. These experiences were heartbreaking coming from individuals that I held in high esteem. They were also illuminating compelling me to advocate for compassionate, unbiased care for individuals with disabilities. Motivated by these personal encounters, I have sought to influence positive change within my professional and local communities regarding the medical care for people with intellectual and physical disabilities.
Walden University’s vision to “solve critical societal challenges” and its goal of producing graduates who are “reflective and agents of positive social change” resonate deeply with me (Walden University, n.d.). As a mother and nurse passionate about this vulnerable population, I believe Walden’s mission fits perfectly with my academic journey and professional goals. Pursuing a Family Nurse Practitioner degree at Walden allows me to build on my foundation in nursing education and will give me the tools to provide holistic, respectful care to individuals with complex needs.
With approximately 13% of the population has intellectual or physical disabilities, and over 70% of this group require care from multiple medical specialties (Institute on Disability Rehabilitation Research and Training Center on Disability Statistics, n.d.), care unique to this population is needed. My goal is to be an advocate and provider who not only delivers compassionate primary care but also provides access to comprehensive, multi-disciplinary services specific to this population.
The Walden MSN Program Outcomes emphasizes the development of practitioners who combine evidence-based practice, demonstrate ethical leadership, and engage in social change initiatives (Walden University, n.d. ). Qualities that are essential to my growth as a clinician and advocate. These outcomes align with my commitment to reflective practice and lifelong learning, which are vital for delivering quality care and effecting systemic change within healthcare settings.
Networking is an important component of achieving these personal and practice goals. By connecting with peers, mentors, and professionals across specialties, I can expand my knowledge, advocate for best practices, and collaborate to improve care models for individuals with disabilities. Such professional relationships provide opportunities to influence policy, improve access to care, and support holistic, patient-centered approaches.
In summary, my personal experiences and professional aspirations align closely with Walden’s vision, goals, and MSN Program Outcomes. I am dedicated to becoming a practitioner who not only provides compassionate care but also contributes to positive social change in healthcare for individuals with intellectual and physical disabilities.
References
Institute on Disability Rehabilitation Research and Training Center on Disability Statistics. (n.d.).
Annual Disability Statistics Compendium 2025
.
https://files.eric.ed.gov/fulltext/ED673281.pdf
Links to an external site.
Walden University. (n.d.).
Walden University student handbook
.
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
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Harnell Seguerra
Aug 26 1:41pm
| Last reply Aug 26 8:30pm
Reply from Harnell Seguerra
Hi everyone, my name is Harnell, and I’ve been a nurse for 20 years.
After
I finished
my Bachelor’s Degree in Nursing, I
started
my career as an Operating Room Nurse.
Then I saw an opportunity to I could grow more with my knowledge, abilities, and skills in different settings. I decided to move to the Intensive Care Unit and stayed for 14 years.
Now is the time for me to advance my career to
a higher
level,
taking
my Master’s Degree.
To further my education, I decided to pursue a career as an Adult-Gerontology Acute Care Nurse Practitioner, and I found my online program at Walden University.
I was
very excited that I could go back
to school while working full-time.
To achieve this goal, I enrolled in Walden University and share the same vision, mission, and goals. As a student-centered program, it will help me enhance my academic abilities and skills (Walden University, n.d.a).
Being surrounded by multidisciplinary, I can
make
my knowledge and
skills
positive
.
Advancing my education will
nurture
my critical thinking skills and
help
me excel in my profession.
While I’m practicing in Critical care settings, this MSN program will cultivate me to demonstrate a high level of knowledge in
taking care of
critically ill patients. Walden University will help me get all the education I need and apply this learning to the issues and challenges in the workplace (Walden University, n.d.b).
Networking has been very important in the field of nursing. It plays a role in social interactions and personal relationships. We are all practicing in different nursing specialties, but we can narrow down ideas that can help ourselves and benefit our patients. Collaborating with all medical professions, including a former coworker, will develop a solid and strong relationship that may help me in the future (Wofford, 2018).
References :
Walden University. (n.d.a).
Walden University catalogLinks to an external site.
Links to an external site.
. Retrieved October 4, 2019, from https://catalog.waldenu.edu
Walden University. (n.d.b).
Walden University catalogLinks to an external site.
Links to an external site.
. Retrieved October 4, 2019, from https://catalog.waldenu.edu
Wofford, P. (2018).
10 networking tips for nurses who hate
networkingLinks
to an external site.
Links to an external site.
. Retrieved from https://nurse.org/articles/tips-for-nurse-networking/
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Reagan Bryant
Aug 26 12:09pm
| Last reply Aug 27 1:17am
Reply from Reagan Bryant
I have only cared for pediatric patients in Memphis, TN, and the surrounding areas throughout my nursing career. I currently work at a pediatric hospital on the surgical/orthopedics floor and at a psychiatric facility on the child/adolescent unit. The patients I work with have experienced different traumas such as abuse/neglect, gunshot wounds, and car wrecks. Caring for children from various backgrounds and experiences has ignited my passion to help children and families even more. My professional goal is to open a clinic as a pediatric mental health nurse practitioner alongside a licensed social worker and other medical professionals to serve those in my community.
Psychiatry and mental health have always piqued my interest. Mental health has been a controversial topic within the Black community, and I would like to help educate people and remove its stigma. To do that, I knew I had to further my education and find a school aligned with my own values. Walden’s MSN program had been recommended to me by a former student, but I also conducted my own research. According to Walden University (n.d.), their MSN program’s outcomes emphasize lifelong learning, supporting diversity and multiculturalism, and facilitating community social change. These values strongly align with my personal and professional goals.
The patient population I work with is often affected by socioeconomic barriers such as poverty, racism, and limited access to healthcare. These factors greatly influence mental health, and I want to understand better the social and psychological influences behind behavior to provide more effective care. Working at a behavioral health facility has allowed me to learn from psychiatric NPs, social workers, and therapists while observing the many factors that shape mental health outcomes. This experience, paired with Walden’s focus on social change, reinforces my decision to pursue advanced practice nursing to continue educating, advocating, and making meaningful change.
Networking has also played an essential role in my journey. Collaborating with psychiatric nurse practitioners, social workers, and therapists at my current facility has helped me expand my knowledge and gain new perspectives on treatment approaches. Beyond workplace connections, networking with peers, mentors, and professional organizations will help me stay updated on best practices and create opportunities to advance my career. Making myself open and available to others in this field will strengthen my ability to influence and serve my community.
References:
Walden University. (n.d.). Vision and goals: Student handbook – Academics at Walden University. Retrieved from
https://academicguides.waldenu.edu/
Links to an external site.
Schmidt, K. (n.d.).
5 reasons nurses should engage in professional networkingLinks to an external site. https://blog.bluepipes.com/5-reasons-nurses-should-take-professional-networking-seriously/
Links to an external site.
[Blog post]. Retrieved November 14, 2018, from
Hamlin, K. (2024, October 23). Professional networking in nursing. NurseJournal.org. Retrieved from
https://nursejournal.org/resources/networking-in-nursing/
Links to an external site.
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Sherley Alexandre
Aug 25 8:45pm
| Last reply Aug 27 7:13pm
Reply from Sherley Alexandre
Hi, my name is Sherley. I chose to attend Walden University because of its reputation for providing flexible online programs that fit well with my busy schedule. I was drawn to their focus on creating positive social change and helping students make a difference in their communities. I appreciate that Walden’s learning environment is supportive and designed to help working professionals succeed, which made it the perfect choice for me as I balance my job, family, and education (Walden University, n.d.).
I decided on Walden University because its mission to promote social good by educating ethical and innovative healthcare professionals aligns with my personal values. The Master of Science in Nursing program with a specialization as a Psychiatric Nurse Practitioner matches my goal of developing advanced clinical skills and taking on leadership roles in mental health care. Additionally, I valued Walden’s commitment to diversity and inclusion, which creates an environment that encourages growth and provides the necessary resources for success (Walden University, n.d.).
I hope to grow personally through my education at Walden by gaining more knowledge and skills in mental health care. My goal is to become a confident and skilled Psychiatric Nurse Practitioner who can provide comprehensive, compassionate treatment to my patients. I also want to enhance my research and critical thinking abilities so I can advocate effectively for my patients and make a meaningful impact in my community. I believe that Walden’s program will equip me with the tools needed to serve others better and improve mental health services (Nurse.org, n.d.).
Earning my MSN degree in Psychiatric Nursing from Walden University will help me reach my professional goals by preparing me for advanced practice roles. This degree will enable me to offer specialized mental health services and assume leadership positions within healthcare organizations. For example, I plan to work in community mental health clinics or outpatient facilities, helping patients recover and raising awareness about mental health issues. The skills I develop will also allow me to mentor other nurses and contribute to improvements in mental health care in my community (Walden University, n.d.).
Main Discussion Post
Hello, my name is Brinley! I am 25 years old and currently live in Georgia with my husband and our chocolate lab. I started nursing school at the start of the pandemic and have now been a nurse for 3 years. I started as a new graduate in the ICU, and I am still there currently. I love where I currently work, but I have always wanted to further my education. I am excited to gain my Acute Care Nurse Practitioner license ultimately. I am still uncertain about what specialty I want to work in after I graduate.
Walden’s vision, mission, goals, and social change initiatives align with my professional and academic goals in several different ways. The first way is that I am currently still working full-time, so I need to find a school that would be accommodating to my work schedule. I love that Walden University offers nurse practitioner programs exclusively online, so I can continue to work while furthering my education. Another perk of being online is being able to connect with peers from all different walks of life. Walden offers learner-centered programs that allow me to incorporate some of my own needs into my academics. Walden University emphasizes producing scholar-practitioners who produce a positive social change (Walden University, 2025a). This allows me to achieve my professional goals by learning how to improve my patients’ outcomes and promote equity for all. I hope that by choosing Walden, I can expand my knowledge of diverse groups and continue advocating for them as a practitioner.
Walden’s MSN program further supports my professional and academic goals by educating me on global perspectives, which allow me to continue to evolve as a healthcare professional. They also use nursing theories and ethical principles such as integrity, human dignity, and social justice (Walden University, 2025b). These principles directly align with the kind of nurse I am today and the type of nurse practitioner I want to be. My goal as a future nurse practitioner is to be able to give my patients a more comprehensive and diverse view of healthcare.
Networking is essential, no matter what career you choose. By networking, I can connect with peers and professionals in healthcare who have been in my situation and can enlighten me on what to expect and offer guidance on topics they wish they had known before expanding their education. Through networking with peers, I was introduced to Walden University. My peers can also provide me support through my academics and help alleviate stress (Hamlin, 2024). I can also gain potential mentors who can help shape how I will be as a nurse practitioner. Most job opportunities are also found by networking; 80% of jobs are filled by networking alone (Schmidt, 2020). Referral bonuses also offer a nice reward from networking. Starting to network now might lead to meeting people who can help me achieve my long-term professional goals.
References
Hamlin, K. (2024, October 23).
Professional networking in nursing
. NurseJournal.org.
https://nursejournal.org/resources/networking-in-nursing/
Links to an external site.
Schmidt, K. (2020, September 4).
5 reasons nurses should engage in professional networking
. BluePipes Blog. https://blog.bluepipes.com/5-reasons-nurses-should-take-professional-networking-seriously/
Walden University. (2025a).
Academics: Student handbook: Vision and goals
. Vision and Goals – Student Handbook – Academics at Walden University. https://academics.waldenu.edu/handbook/vision-goals#:~:text=Walden%20University%20strives%20to%20produce,a%20commitment%20to%20lifelong%20learning.
Walden University. (2025b).
Academics: College of nursing: Master of science in nursing (MSN)
. Master of Science in Nursing (MSN) – College of Nursing – Academics at Walden University. https://academics.waldenu.edu/catalog/nursing/master-science/nursing#s-lg-box-29662482
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Nathalie Candide Crevecoeur
Aug 25 3:24pm
| Last reply Aug 29 12:51pm
Reply from Nathalie Candide Crevecoeur
Hi everyone, my name is Nathalie, and I’m a PACU nurse with 10 years of experience in telemetry, medical-surgical, stepdown, and ICU settings. I’m beginning the Psychiatric-Mental Health Nurse Practitioner (PMHNP) track because I come from a culture where mental health has not traditionally been prioritized, and I want to help close that gap for patients and families in my community here in Florida.
Walden’s emphasis on positive social change and learner-centered education resonates with my purpose. The focus on quality, integrity, and student-centeredness mirrors how I practice at the bedside and how I aspire to lead as a future PMHNP, utilizing inquiry, reflection, and evidence to advocate for vulnerable populations and reduce mental health stigma. Walden University Outcomes, particularly facilitating positive social change, practicing legal and ethical integrity, and communicating effectively, align directly with the competencies I aim to develop as I transition from acute care to psychiatric practice (Walden University, n.d.-a).
The program’s call to build an individualized “blueprint” for academic and professional success fits my journey: I plan to integrate my critical-care assessment skills with advanced psychiatric assessment, psychopharmacology, and psychotherapy competencies. By engaging faculty, support teams, and peers, I aim to strengthen clinical reasoning, information literacy, and culturally responsive care, key to becoming a reflective scholar-practitioner who can translate evidence into equitable mental-health outcomes (Walden University, n.d.-b).
Networking will be essential as I pivot specialties. Within Walden, I’ll connect with faculty mentors and classmates across regions to exchange resources on PMHNP best practices. Professionally, I plan to join local and national psychiatric nursing organizations, attend grand rounds, and cultivate preceptor relationships. Effective networking helps clarify career goals, surfaces learning opportunities, and builds collaborative support systems, especially valuable for someone moving from PACU/ICU to behavioral health (Schmidt, n.d.; Wofford, 2018).
My vision is to deliver safe, dignified, evidence-based mental-health care while advocating for access and destigmatization. I’m excited to learn with you all and to contribute to a community that turns scholarship into meaningful social change.
References:
Schmidt, K. (n.d.).
5 reasons nurses should engage in professional networking
. {Blog post]. Retrieved November 14, 2018, from
Links to an external site.
Walden University. (n.d.-a).
University outcomes and values
.
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
Walden University. (n.d.-b).
Vision, mission, goals, and social change
.
https://academics.waldenu.edu/handbook/vision-goals
Links to an external site.
Wofford, P. (2018).
10 networking tips for nurses who hate networking
. Nurse.org. Retrieved from
https://nurse.org/articles/tips-for-nurse-networking/
Links to an external site.
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Amy Barlock
Aug 25 1:17pm
| Last reply Aug 29 12:54pm
Reply from Amy Barlock
Hi, my name is Amy and I’ve been a nurse for 5 years. I began my nursing career at the beginning of the covid-19 pandemic and the med-surg with a focus on orthopedic floor I worked on quickly turned into a step down unit. After about a year and a half I decided to move to Gilbert Arizona where my now husband was living. I worked at MD Anderson Cancer Center and did outpatient infusion for almost two years there. A few years later we moved to North Carolina and have an almost 2 year old boy. I work for Duke Health as PRN at their oncology infusion center in Durham. I have always held a passion for health and wellness and my goal is to become an advanced practitioner who works in the functional medicine field. We love to travel and am very happy this program is online to allow me to continue to do so.
Waldens vision, mission, goals, and social change initiatives relate to my professional and academic goals and to my becoming a scholar-practitioner because I believe that having a diverse community of career professionals is better than no diversity. “Walden University provides a diverse community of career professionals with the opportunity to transform themselves as scholar-practitioners so that they can effect positive social change (Walden University, 2025).” Every individual in the world has a different experience and knowledge base and we can learn so much from them. I want to make an impact on my community as an advanced practice provider and part of Waldens vision is to “prepare distinguished graduates to advance the greater good of global communities (Walden University, 2025).” Positive social change aims to improve human and social conditions by promoting the worth, dignity, and development of individuals and communities. As a professional, my goal is to join professional nursing organizations and advocate for my community.
The MSN Program outcomes and perspectives relate to my professional and academic goals by aligning with the type of advanced practice provider I want to be. One that stood out to me is “Integratively assess, diagnose, plan, implement, and evaluate cost-effective healthcare strategies that reduce health disparities by patient/population advocacy for access to specialist nursing care (Walden University, 2025).” Integrity is huge and having strong moral principles is something I don’t take lightly and was happy to see this on their program outcomes. My academic goals also consist of being able to evaluate health needs of diverse populations, ongoing commitment to professional development, which is highlighted under Waldens program outcomes. I strive to do this not only for myself, but to be a role model for my son.
Networking is so important in this field and it can help me achieve my professional and academic goals. Networking helps you hear about job openings before they’re even advertised, which can make you stand out. By making these connections with others you can learn more about new practices in the field. Networking also builds trust and communication among different specialties. “Professional networking can help nurses achieve the fundamental knowledge required to take the next step. For example, nurses can develop relationships with individuals who work in their desired fields or roles with the intent of gaining knowledge. In other words, this professional contact may never lead to an actual job, but instead serve as an invaluable resource for knowledge that can be instrumental in advancing the nurse’s career (Schmidt, n.d.).” I can relate to this because this is how I found my current job here in North Carolina. I network on LinkedIn and came across a job posting for oncology at Duke. It wasn’t the department I wanted, but I developed a relationship with this person and she became such a great resource for me and then eventually a year and a half later I was able to land the job I was initially looking for.
Walden University. (n.d.). Nurse Practitioner Programs Practicum Manual for the Master of Science in Nursing (MSN) and Post-Master’s Certificate: Section 1: Introduction.
https://academicguides.waldenu.edu/msn/practicum-manual/introduction#s-lg-box-27713490
Links to an external site.
Schmidt, K. (n.d.).
5 reasons nurses should engage in professional networkingLinks to an external site.
Links to an external site.
[Blog post]. Retrieved November 14, 2018, from
Links to an external site.
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Angalisa Rose Brittlebank
Aug 25 10:21am
| Last reply Aug 28 3pm
Reply from Angalisa Rose Brittlebank
The Foundation of my Academic and Professional Success
Success to me means being able to achieve a goal or desired outcome. It is being a better version of yourself.
I have been a nurse for 6 years now with experience in many different areas, but child/adolescent mental health is a passion of mine. While currently working as a school nurse, I have had the opportunity of working with school counselors and psychologists with whom have assisted me with accomplishing my goal of becoming a Psychiatric Mental Health Nurse Practitioner.
How does Walden/College of Nursing Mission/Vision apply to my Professional/Academic goal
As mentioned in my introduction, mental health my passion, while choosing a program that would be beneficial to my academic success, Walden’s mission statement for the PMHNP program states to”Provide holistic care for patients with psychiatric disorders and emotional challenges. Be a lifeline to those who are struggling.”(walden university,2025). Holistic Care in Nursing is key and I truly believe in this.
Networking
In my opinion, networking is important, because it can open doors to endless possibilities. When deciding which university to choose to further my degree, I utilized many different resources in making my decision. For example, talking with friends and social media sites.
References
Walden University.(2025)
Psychiatric Mental Health Nurse Practitioner Program.
https://waldenu.edu
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Amanda Jean Rawlinson
Aug 23 10:56pm
| Last reply Aug 27 7:09pm
Reply from Amanda Jean Rawlinson
Hello, my name is Amanda, but I go by Mandie. I have been working as a Pediatric Psych Nurse for the past 3 years and absolutely love this field. I see the growing need for more providers and more people in general when it comes to this area of health care. I have also done a few travel assignments as well. I got married last year in November to my best friend, Eli. We have 2 crazy cats and live in Jacksonville, FL. I moved here to FL from IL (freezing cold).
Walden’s vision, goals, mission, and social change initiatives relate to my professional and academic goals by being all about the students. One of their core values is student centeredness. That just goes to show how important our success is to this program; they want to see us do well and succeed. Their goals are very similar in that aspect. They also provide students with so many different options when it comes to fields of study.
This program relates to my academic goals because they are dedicated to making us reliable, dependable, and competent in our field of study. We have ample resources available to use that we can utilize to better our education. They truly seem to care about their students and really want us to succeed.
Networking is important because you never know who you might meet and what they may have to offer. It also allows us to be more open and available to knowledge and things we might have not learned. We may also find mentorship in networking. It’s all about being open and making yourself available to opportunities. You want to make yourself known so they can also seek you out. Networking Opportunities NURS-6003 Module 1: Discussion