Tag: Clinical-Nursing

NURS 6630 Foundational Neuroscience Discussion

Foundational Neuroscience

Question 1

Agonists are drugs that imitate the endogenous molecule (hormone or neurotransmitter) molecule that causes the same neuronal response. Dopamine agonists are used to treat the motor systems of Parkinson’s disease (PD), such as Requip. The exogenous dopamine agonists have the same effect as the endogenous dopamine molecule itself and help correct the dopamine starved motor state of the patient with PD. There are other agonists that stimulate the serotonin system. Examples of serotonin agonists include 5-HT agonists like buspirone and sumatriptan (Kowalski et al., 2017) NURS 6630 Foundational Neuroscience Discussion.

Antagonists attach to a receptor so that an endogenous agonist like dopamine or serotonin cannot attach. This either blocks a biologic response or reduces the response of the neuron to the endogenous molecule. Medications that fall under this category include antipsychotics, anticholinergics, antihistaminergic, beta-blockers, calcium channel blockers, and neuromuscular blockers (Kowalski et al., 2017).

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Partial agonists elicit a response that is less than the response of an agonist. A partial agonist can increase endogenous activity in some areas of the brain and slow it down in another area. Aripiprazole increases neuronal activity in the underactive mesocortical dopaminergic tract while decreasing the neuronal activity in the overactive mesolimbic tract. Aripiprazole has a higher affinity for the dopamine receptor than dopamine itself (Kowalski et al., 2017).

Inverse agonists have an opposite effect to that of an agonist. An inverse agonist is dependent on the receptor having some level of basal activity. Many neurons continue to fire even in the absence of an agonist. If an agonist opens an ion channel, the inverse agonist will close the channel. Examples of some inverse agonists are naloxone and naltrexone (Kowalski et al., 2017).

Question 2

G protein-coupled receptors (GPCRs) are integral cell membrane proteins responsible for translating the molecular signals encoded in the chemical structure of hormones and neurotransmitters from outside to inside the cell. The binding of endogenous or synthetic agonists causes the activation of the receptor, which results in conformational changes that allow the allosteric coupling of accessory proteins such as G-protein at the intracellular part of the receptor. Activation of these accessory proteins triggers the series of steps that constitute the signal transduction mechanism which, eventually lead to the observed physiological responses (Cruz- Barbosa et al., 2018).

Ligand-gated ion channels are multimeric proteins constructed from large glycoprotein subunits. They are activated by a chemical (agonist) binding to a distinct site or sites within the channel complex. In most cases, neurotransmitters released from the presynaptic neurons serve as the primary agonists, acting as part of a complex integrated process required for rapid neuronal communication. Binding of the neurotransmitter to the protein induces a conformational change, resulting in the opening of the integral ion channel. The charge and the direction of ion flux through the activated channel determine its effect on cellular function (Weir, 2020).

In pharmacology, a receptor is a protein that recognizes an endogenous chemical mediator such as a neurotransmitter, hormone, or inflammatory mediator. When the mediator (agonist) binds to the receptor, a series of reactions takes place, ultimately leading to a change of function of the host cell (Weir, 2020). GPCRs are at the center of current drug discovery programs. As of November 2017, approximately 35% of approved drugs in the United States or European Union targets GPCRs (Cruz- Barbosa et al., 2018). There are different criteria for different drug designs. One is selectivity, as it seems appropriate that drugs act selectively through specific receptors. Another is the concept of receptor polypharmacology in which a drug exerts a combination of positive effects by binding to different receptors (Cruz- Barbosa et al., 2018).

The voltage-gated ion channel (VGIC) is a large number of membrane-bound proteins that are structurally similar. These proteins can be activated by a change in the transmembrane voltage. The proteins are divided into voltage-gated calcium, potassium, and sodium channels. VGICs can be opened according to the changes in the membrane potential, so the ion can flow down the electrochemical gradient across the cell membrane. Because of the importance of the VGICs, these proteins are the molecular targets for a variety of biological toxins from many organisms. These VGIC toxins provide valuable tools for exploring the function of ion channels. Moreover, these VGIC toxins can be used as pharmacological tools for exploring a variety of physiological processes and understanding potential therapeutic targets. Some VGIC toxins have been proved to have therapeutic value and are currently being investigated as drugs (Weir, 2020).

Question 3

Epigenetics studies heritable changes in gene expression that are not caused by alteration in DNA sequences. Epigenetic regulation may lead to relatively stable changes that are affected by other factors such as age, diet, lifestyle, disease, and environment. Some mechanisms of epigenetics that have been studied extensively include DNA methylation, histone modifications, and non-coding RNAs. Each of these can change gene expression without altering the underlying DNA sequences (Boks et al., n.d.). Evidence suggests that epigenetic regulation of brain functions is important in the etiology of psychiatric disorders. The recent interest in the role of epigenetics in the brain has led researchers to explore the possibility that drugs can modify epigenetic processes involved in psychiatric disorders. So far, several psychiatric drugs have been found to influence epigenetic mechanisms, suggesting that this may partially explain their mechanism of action (Boks et al., n.d.).

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With recent improvements in understanding of the actual function of the entire genome, there needs to be some modification in pharmacology to tackle disease not only in the drug-receptor sense but in a more global-response sense. Drugs may have to act broadly over a range of epigenetic events. The regulatory mechanisms of these events may regulate a large group of genes. The advantage of this approach is that epigenetic variations can often be the underlying cause of a particular disease, and simply targeting one protein of the multiple pathways involved may be futile (Stefanska & MacEwan, 2015).

Question 4

As providers, nurse practitioners (NPs) should be cautious about the epigenetic properties of drugs which may affect drug-metabolizing gene expression and drug disposition. Some clinically used drugs may also have the property to alter epigenetic signatures of drug-metabolizing genes, and lead to unexpected changes in drug metabolism and toxicity (Boks et al., n.d.). Evidence shows that valproic acid has been discovered as a histone deacetylase inhibitor with potent antitumor activity. When this kind of epigenetic drug is administered, the prescriber needs to consider potential changes in drug-metabolizing genes under epigenetic regulation (Boks et al., n.d.). Also, risperidone, an atypical antipsychotic antagonizes D2 receptors and binds to 5HT2 receptors. This induces global phosphor-acetylation of H3 in the striatum, mediated by the NMDA receptor, suggesting that dopamine, serotonin, and glutamate act in synchrony to influence chromatin regulation (Boks et al., n.d.).

References

Boks, M. P., de Jong, N. M., Kas, M. J. H., Vinkers, C. H., Fernandes, C., Kahn, R. S., Mill, J., & Ophoff, R. A. (n.d.). Current status and future prospects for epigenetic psychopharmacology.
EPIGENETICS
,
7
(1), 20–28. https://doi-org.ezp.waldenulibrary.org/10.4161/epi.7.1.18688

Cruz-Barbosa, R., Ramos-Pérez, E.-G., & Giraldo, J. (2018). Representation Learning for Class C G Protein-Coupled Receptors Classification.
Molecules
,
23
(3), 690. https://doi-org.ezp.waldenulibrary.org/10.3390/molecules23030690

Kowalski, P. C., Dowben, J. S., & Keltner, N. L. (2017). My Dad Can Beat Your Dad: Agonists, Antagonists, Partial Agonists, and Inverse Agonists.
Perspectives in Psychiatric Care
,
53
(2), 76–79. https://doi-org.ezp.waldenulibrary.org/10.1111/ppc.12208

Stefanska, B., & MacEwan, D. J. (2015) Epigenetics and pharmacology.
Br J Pharmacol,

172(11):2701-4. doi:10.1111/bph.13136. PMID: 25966315; PMCID: PMC4439868.

Weir, C. J. (2020). Ion channels, receptors, agonists and antagonists.
Anaesthesia & Intensive Care Medicine
,
21
(1), 62–68. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mpaic.2019.10.022

 

Week 2: Neurotransmitters and Receptor Theory

Receptors and neurotransmitters are like a lock-and-key system. Just as it takes the right key to open a specific lock, it takes the right neurotransmitter to bind to a specific receptor. Not surprisingly, as it concerns psychopharmacology, the pharmacotherapeutics that are prescribed must trigger the release of certain neurotransmitters that bind to the correct receptors in order to elicit a favorable response for the patient. The mechanism of this binding and the response that follows reflects receptor theory and lies at the foundation of pharmacology.

This week, you will continue your examination of neuroanatomy and neuroscience as you engage with you colleagues in a Discussion. You will also explore the potential impacts of foundational neuroscience on the prescription of pharmacotherapeutics.

Learning Objectives

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Students will:

Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Compare the actions of g couple proteins to ion gated channels

Analyze the role of epigenetics in pharmacologic action

Analyze the impact of foundational neuroscience on the prescription of medications

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Optional Resources
(click to expand/reduce)

Discussion: Foundational Neuroscience

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

Photo Credit: Getty Images/Cultura RF

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

By Day 3 of Week 2

Post
 a response to each of the following:

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

Compare and contrast the actions of g couple proteins and ion gated channels.

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

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

Read 
a selection of your colleagues’ responses.

By Day 6 of Week 2

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

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

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

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

 

NURS_6630_Week2_Discussion_Rubric

Grid View

List View

Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

Points Range:
40
(40%)
– 44
(44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

Points Range:
35
(35%)
– 39
(39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references. NURS 6630 Foundational Neuroscience Discussion

Points Range:
31
(31%)
– 34
(34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than two credible references.

Points Range:
0
(0%)
– 30
(30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

Points Range:
6
(6%)
– 6
(6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range:
5
(5%)
– 5
(5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range:
4
(4%)
– 4
(4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range:
0
(0%)
– 3
(3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

Points Range:
9
(9%)
– 10
(10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

Points Range:
8
(8%)
– 8
(8%)

Posts main Discussion by due date.

Meets requirements for full participation.

Points Range:
7
(7%)
– 7
(7%)

Posts main Discussion by due date.

Points Range:
0
(0%)
– 6
(6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range:
9
(9%)
– 9
(9%)

Response 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.

Points Range:
8
(8%)
– 8
(8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range:
7
(7%)
– 7
(7%)

Response is on topic, may have some depth.

Points Range:
0
(0%)
– 6
(6%)

Response may not be on topic, lacks depth. NURS 6630 Foundational Neuroscience Discussion

First Response:

Writing

Points Range:
6
(6%)
– 6
(6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.

Points Range:
5
(5%)
– 5
(5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

Points Range:
4
(4%)
– 4
(4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range:
0
(0%)
– 3
(3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

Points Range:
5
(5%)
– 5
(5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range:
4
(4%)
– 4
(4%)

Meets requirements for full participation.

Posts by due date.

Points Range:
3
(3%)
– 3
(3%)

Posts by due date.

Points Range:
0
(0%)
– 2
(2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range:
9
(9%)
– 9
(9%)

Response 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.

Points Range:
8
(8%)
– 8
(8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range:
7
(7%)
– 7
(7%)

Response is on topic, may have some depth.

Points Range:
0
(0%)
– 6
(6%)

Response may not be on topic, lacks depth.

Second Response:

Writing

Points Range:
6
(6%)
– 6
(6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.

Points Range:
5
(5%)
– 5
(5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

Points Range:
4
(4%)
– 4
(4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range:
0
(0%)
– 3
(3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:

Timely and full participation

Points Range:
5
(5%)
– 5
(5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range:
4
(4%)
– 4
(4%)

Meets requirements for full participation.

Posts by due date.

Points Range:
3
(3%)
– 3
(3%)

Posts by due date. NURS 6630 Foundational Neuroscience Discussion

Points Range:
0
(0%)
– 2
(2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name: NURS_6630_Week2_Discussion_Rubric

 

An agonist generates a structural change in the G-protein-linked receptor that activates the synthesis of the second messenger to the fullest extent possible (Stahl, 2013). At times, the action of full agonists can cause too much stimulation of neurotransmitters; in this situation, impeding the activity of the natural neurotransmitter may be advantageous (Stahl, 2013). The antagonists’ role is to simply hinder the activity of the agonist, but produces no result itself (Stahl, 2013). Partial agonists are often referred to as “stabilizers” because they create stability between the conditions of extreme agonist action and the absence of agonist action (Stahl, 2013). Since partial agonists are considered “stabilizers”, if a patient is experiencing the extreme action of a full agonist, a partial agonist would be appropriate to downgrade, or stabilize, the signals. The role of the inverse agonist is to generate a structural change in the G-linked-protein receptor that changes it to a completely inactive state; they bind to the receptor and create an opposite effect from the agonist, decreasing the signal transmission level to below baseline (Stahl, 2013). NURS 6630 Foundational Neuroscience Discussion

G coupled protein receptors (GPCR) stimulate various pathways in the cell, and specific GCPR ligands have the ability to preferably activate specific pathways (Wingler & Lefkowitz, 2020). Ion-gated channels are trans membrane proteins that contain an opening to allow the flow of particular ions through the plasma membrane (Alexander et al., 2017). Once open, ions such as potassium and sodium can move through the channel, changing the electrical signal in the cell. GPCRs and ion channels are similar in that they conclusively result in alterations in neuronal activity, often linked to variations in gene expression (Stern et al., 2016). GPCRs and ion-gated channels are structurally different. GPCRs have seven helices and possess the ability to change shape after binding occurs to alter the protein (Latorraca et al., 2017). In contrast, ion-gated channels are direct trans membrane pathways. Additionally, the movement of ions through the ion channels rapidly transform the membrane potential and neuronal action; GPCRs operate slower in the second messenger systems (Stern et al., 2016).

Lockwood and Youssef (2017) describes epigenetics as the examination of any possibly stable and inborn changes in gene expression or cell phenotype that takes place without changes in DNA sequence. Epigenetic modifications are the primary mechanism underlying numerous diseases, particularly growth and developmental conditions (Furtado et al., 2019). Understanding the epigenetics of different diseases and conditions can aid healthcare providers in developing individualized pharmacologic treatment plans that will lead to improved responses to drug therapy (Wachman & Farrer, 2019).

Studies show there is an association between abnormal epigenetic mechanisms of gene expression and schizophrenia, bipolar disorder, and major depressive disorder (Peedicayil & Grayson, 2018). Furthermore, evidence suggests that abnormalities in the DNA methylation throughout the genomes are present in patients with schizophrenia (Peedicayil & Grayson, 2018).  A patient with this particular epigenetic abnormality may benefit from a DNA methyltransferase (DNMT) inhibitor that acts on DNA methylation, such as 5-azacytidine (Kular & Kular, 2018). Understanding what the abnormality is in the gene will help the provider chose the appropriate pharmacotherapy for the best patient outcomes.

References

Alexander, S., Peters, J. A., Kelly, E., Marrion, N. V., Faccenda, E., Harding, S. D., Pawson, A. J., Sharman, J. L., Southan, C., & Davies, J. A. (2017). The concise guide to pharmacology 2017/18: Ligand-gated ion channels.
British Journal of Pharmacology
,
174
, S130–S159.
https://doi.org/10.1111/bph.13879 NURS 6630 Foundational Neuroscience Discussion

Kular, L., & Kular, S. (2018). Epigenetics applied to psychiatry: Clinical opportunities and future challenges.
Psychiatry and Clinical Neurosciences
,
72
(4), 195–211.
https://doi.org/10.1111/pcn.12634

Latorraca, N. R., Venkatakrishnan, A. J., & Dror, R. O. (2016). Gpcr dynamics: Structures in motion.
Chemical Reviews
,
117
(1), 139–155.
https://doi.org/10.1021/acs.chemrev.6b00177

Lockwood, L., & Youssef, N. (2017). Systematic review of epigenetic effects of pharmacological agents for bipolar disorders.
Brain Sciences
,
7
(12), 154.
https://doi.org/10.3390/brainsci7110154

Miranda Furtado, C., Dos Santos Luciano, M., Silva Santos, R., Furtado, G., Moraes, M., & Pessoa, C. (2019). Epidrugs: Targeting epigenetic marks in cancer treatment.
Epigenetics
,
14
(12), 1164–1176.
https://doi.org/10.1080/15592294.2019.1640546

Stahl, S. M. (2013).
Stahl’s Essential Psychopharmacology
(4th ed.). Cambridge University Press.

Stern MD, Theodore A., Maurizio, F. M., Wilens MD, Timothy E., & Rosenbaum MD, Jerrold F. (2016).
Massachusetts General Hospital psychopharmacology and neurotherapeutics
(1st ed.). Elsevier.

Wachman, E. M., & Farrer, L. A. (2019). The genetics and epigenetics of neonatal abstinence syndrome.
Seminars in Fetal and Neonatal Medicine
,
24
(2), 105–110.
https://doi.org/10.1016/j.siny.2019.01.002

Wingler, L. M., & Lefkowitz, R. J. (2020). Conformational basis of g protein-coupled receptor signaling versatility.
Trends in Cell Biology
,
30
(9), 736–747.
https://doi.org/10.1016/j.tcb.2020.06.002 NURS 6630 Foundational Neuroscience Discussion

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology full course

Week 1: Introduction to Neuroanatomy

The human brain is organized into the cerebral cortex, brainstem, subcortical structures, and the cerebellum. These anatomical structures are made of inter-connected elements that create distributed and highly inter-connected circuits. It is in these circuits where cognition, behavior, and affect are processed.

—Camprodon, J. A., & Roffman, J. L. (2016, p. 6)

By using a combination of psychotherapy and medication therapy, psychiatric nurse practitioners (PNP) are positioned to provide a very unique type of care to patients with psychiatric disorders. To be successful in this role, you must have a strong theoretical foundation in pathophysiology, psychopharmacology, and neuroscience. This foundation will help you assess, diagnose, and treat patients as you relate presenting symptoms to theoretical neuronal functioning.

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This week, as you begin to study psychopharmacology, you will explore the basic functional unit of the nervous system, the neuron. You will review the structure of the neuron and you will examine the anatomy of the central nervous system and consider the functionality of the different structure and outward (phenotypic) expression of their activities. You will analyze these concepts as you complete your short answer assessment for this week.

Reference:

Camprodon, J. A., & Roffman, J. L. (2016). Psychiatric neuroscience: Incorporating pathophysiology into clinical case formulation. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.),
Massachusetts General Hospital psychopharmacology and neurotherapeutics
(pp. 1–19). Elsevier. NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology full course

Learning Objectives

Students will:

Describe the functions and structures of the central nervous system

Describe the different structures that make up the neuron

Explain the function of neurons in intracellular communication

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Optional Resources
(click to expand/reduce)

Assignment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

Optional Discussion Forum: PMHNP Study Support Lounge

The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.

As a peer, you are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like these is a statistically significant predictor of success.

To Participate in this Optional Discussion:

PMHNP Study Support Lounge

Assignment: Short Answer Assessment

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

To Prepare:

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

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

Reflect on the inter-connectedness between neurons and the central nervous system, including the pathway and distribution of electrical impulses.

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

To complete:

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

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

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

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

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

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

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

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

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

By Day 7

Submit
your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 1 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 1 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 1 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 1 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 1

To participate in this Assignment:

Week 1 Assignment

What’s Coming Up in Week 2?

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

Next week,
 you will examine how neurotransmitters and receptor theory may impact the function of the central nervous system. You explore medication adherence and consider how it might impact a patient’s treatment goals.

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms,
you will need to submit your application via
Meditrek
 .

For information on the practicum application process and deadlines, please visit the
Field Experience: College of Nursing: Application Process – Graduate
 web page.

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

Next Week

To go to the next week:

Week 2: Neurotransmitters and Receptor Theory

Receptors and neurotransmitters are like a lock-and-key system. Just as it takes the right key to open a specific lock, it takes the right neurotransmitter to bind to a specific receptor. Not surprisingly, as it concerns psychopharmacology, the pharmacotherapeutics that are prescribed must trigger the release of certain neurotransmitters that bind to the correct receptors in order to elicit a favorable response for the patient. The mechanism of this binding and the response that follows reflects receptor theory and lies at the foundation of pharmacology. NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology full course

This week, you will continue your examination of neuroanatomy and neuroscience as you engage with you colleagues in a Discussion. You will also explore the potential impacts of foundational neuroscience on the prescription of pharmacotherapeutics.

Learning Objectives

Students will:

Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Compare the actions of g couple proteins to ion gated channels

Analyze the role of epigenetics in pharmacologic action

Analyze the impact of foundational neuroscience on the prescription of medications

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Optional Resources
(click to expand/reduce)

Discussion: Foundational Neuroscience

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

Photo Credit: Getty Images/Cultura RF

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

By Day 3 of Week 2

Post
 a response to each of the following:

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

Compare and contrast the actions of g couple proteins and ion gated channels.

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

Explain how this information may impact the way you prescribe medications to patients. Include a specific example of a situation or case with a patient in which the psychiatric mental health nurse practitioner must be aware of the medication’s action. NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology full course

Read 
a selection of your colleagues’ responses.

By Day 6 of Week 2

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

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

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

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

What’s Coming Up in Week 3?

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

Next week,
 you will explore medication adherence and strategies to help overcome non-adherence to pharmacotherapeutics. You will also complete a Quiz that addresses the content covered throughout this module.

Next Week

To go to the next week:

Module 2: Disorders With Affective Components

As a psychiatric nurse practitioner (PNP), does that research finding surprise you? How do PNPs ensure that effective psychopharmacologic treatments are prescribed to address the prevalence of affective disorders?

Consider for example that current treatments are sub-optimal, resulting in poor patient responses and uncertain modes-of-action (Plant, 2017). While it is no surprise that mental health medicine and clinical approaches are constantly evolving, novel insights into the underlying mechanisms of how affective disorders arise, remain. Additionally, the use of psychopharmacologic treatments may not always be consistent with a patient’s preferred treatment plan. Thus, your skills and understanding of how to assess and treat patients with affective disorders are important in ensuring positive patient outcomes and may also contribute to the research needed to connect clinical observations to the neuroscience, physiology, and pharmacologic processes needed to treat these disorders. NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology full course

Reference:

Plant, N. (2017). Can a systems approach produce a better understanding of mood disorders?
Biochimica et Biophysica Acta, 1861
(1), 3335-3344. https://doi.org/10.1016/J.BBAGEN.2016.08.016

What’s Happening This Module?

Module 2, Disorders With Affective Components,
 
is a 6-week module. During Week 4, you will begin applying your assessment and therapy skills as you engage in your first Assignment assessing and treating pediatric patients with mood disorders. In Week 5, you will continue to apply your assessment and therapy skills as you assess and treat patients presenting with bipolar disorders. As you engage with the decision tree exercises, reflect on the critical decision-making skills that you, as a psychiatric nurse practitioner, are making, as these skills are essential to your current and future practice. In Week 6, you will assess and treat patients presenting with anxiety and posttraumatic stress disorder (PTSD). You will also complete your Midterm Exam. During Week 7, you will assess and treat patients presenting with schizophrenia. In Week 8, you will complete a Short Answer Assessment in which you will synthesize your understanding of sleep/wake disorders. You will also continue to apply your assessment and therapy skills as you assess and treat patients presenting with sleep/wake disorders. During Week 9, you will examine psychopharmacologic therapies for patients with ADHD/ODD and you will complete a Quiz to test your understanding of the content explored in this module

What do I have to do?

When do I have to do it?

Review your Learning Resources.

Days 1–7, Weeks 4–9

Assignment: Assessing and Treating Pediatric Patients With Mood Disorders

Submit your Assignment by
Day 7
 of
Week 4
.

Assignment: Assessing and Treating Patients With Bipolar Disorder

Submit your Assignment by
Day 7
 of
Week 5
.

Assignment: Assessing and Treating Patients With Anxiety Disorders

Submit your Assignment by
Day 7
 of
Week 6
.

Midterm Exam

Complete Midterm Exam by
Day 7
 of
Week 6
.

Discussion: Treatment for a Patient With Insomnia

Post by
Day 3
of
 Week 7
 and respond to your colleagues by
Day 6
of
 Week 7
.

Assignment: Assessing and Treating Patients With Psychosis and Schizophrenia

Submit your Assignment by
Day 7
 of
Week 7
.

Assignment 1: Short Answer Assessment

Submit your Assignment by
Day 7
 of
Week 8
.

Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

Submit your Assignment by
Day 7
 of
Week 8
.

Assignment: Assessing and Treating Patients With ADHD/ODD

Submit your Assignment by
Day 7
 of
Week 9
.

Quiz: Assessing and Treating Patients With Psychopharmacology

Complete Quiz by
Day 7
 of
Week 9
.

Go to the Weekly Content

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology full course

Week 1: Competencies of Advanced Nursing Practice

Advanced nursing practice competencies focus on the unique practice knowledge, skills, and attitudes a nurse practitioner must demonstrate as they work with adults across the lifespan in clinical settings. They are developed by experts in the field and provide clarity about what is needed to be successful in your career. Competencies need to be practiced so they can be used to effectively address a wide range of situations. In addition to real-world settings, there are virtual opportunities that can facilitate the development of competencies. For example, throughout this course, you will complete case study simulation assignments with virtual i-Human patients presenting a variety of medical conditions. These types of virtual simulations provide you with the formative practice needed to help guide and prepare you for the real-world clinical experience.

For this week, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives.

Learning Objectives

Students will:

Analyze strengths and challenges related to nursing practice competencies

Describe professional career goals or objectives

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Class Café: Introductions

Photo Credit: nakophotography / Adobe Stock

This Class Café is a place for discussions that do not necessarily relate to the formal content of this course and will not be assessed. However, we encourage you to get to know your colleagues and familiarize yourselves with everyone’s background and personal history.
Note
: If your posting is of a personal nature or involves issues that are of concern only to you and require an individual response from the Instructor, please email the Instructor directly.

By Day 2

Post
and introduce yourself to your colleagues and ask any questions you might have about the course or questions in general.

Respond
to your colleagues and answer any questions or ask any questions that you might have.

Note
: This Class Café is not required and will not be assessed; however, you are encouraged to get to know your colleagues.

Submission and Grading Information

Post by Day 2

To Participate in this Discussion:

Class Café: Introductions

Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

An advanced practice nurse collaborates and communicates with patients, families, doctors, nurses, and specialists to ensure patients receive the care they need. As they diagnose, treat, manage, and educate patients, they are responsible for ensuring patient safety and maintaining ethical behavior. Competencies have been developed to help the advanced practice nurse to understand the practice knowledge, skills, and attitudes they need to be successful.

Photo Credit: michaeljung / Adobe Stock

For this Discussion, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives.

To prepare:

Review the Learning Resources for this week, specifically the advanced nursing practice competencies. As you review the competencies, reflect on your own strengths and challenges when working with adults across the lifespan.

By Day 3

Post
a summary of your expectations of this course. Also, include a brief explanation of your strengths and challenges as they relate to nursing practice competencies when working with adults. Describe any career goals or objectives this course may help you accomplish in the Family Nurse Practitioner (FNP) or
Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
role and explain why. Use your research to support your explanations by providing credible and scholarly sources.

Read
a selection of your colleagues’ responses.

By Day 6

Respond
to
at least two
of your colleagues on
two different days
by offering a suggestion or resources to help your colleagues in addressing their personal strengths or challenges, or their career goals. Use your research to support your suggestions. Provide at least 3 credible and current scholarly sources.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 1 Discussion

Assignment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

What’s Coming Up in Week 2?

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms,
you will need to submit your application via
Meditrek
 .

For information on the practicum application process and deadlines, please visit the
Field Experience: College of Nursing: Application Process – Graduate
 web page.

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

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

Next week, you will analyze an i-Human simulation case study about an adult patient with an integumentary condition and formulate a differential diagnosis, based on the patient’s information. Using the findings of your analysis, you will evaluate treatment options and then create an appropriate treatment plan for the patient.

Looking Ahead:

In this course and beginning in Week 2, you will be required to complete case study assignments using the web-based software i-Human. You should have received an email with your i-Human Patients login and password information. If you have not received this information, please contact the Course Instructor.

Ensure that you are able to log in to the software and review the
i-Human Patients Case Player Student Manual
as needed to familiarize yourself about how to navigate i-Human.

NRNP_6531_Week1_Discussion_Rubric

Grid View

List View

Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

Main Posting:

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

Points Range:
40
(40%)
– 44
(44%)

Thoroughly responds to the discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least 3 current credible sources.

Points Range:
35
(35%)
– 39
(39%)

Responds to most of the discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 current credible references.

Points Range:
31
(31%)
– 34
(34%)

Responds to some of the discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than 2 credible references.

Points Range:
0
(0%)
– 30
(30%)

Does not respond to the discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only 1 or no credible references.

Main Posting:

Writing

Points Range:
6
(6%)
– 6
(6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Further adheres to current APA manual writing rules and style.

Points Range:
5
(5%)
– 5
(5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range:
4
(4%)
– 4
(4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range:
0
(0%)
– 3
(3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

Points Range:
9
(9%)
– 10
(10%)

Meets requirements for timely, full, and active participation.

Posts main discussion by due date.

Points Range:
8
(8%)
– 8
(8%)

Posts main discussion by due date.

Meets requirements for full participation.

Points Range:
7
(7%)
– 7
(7%)

Posts main discussion by due date.

Points Range:
0
(0%)
– 6
(6%)

Does not meet requirements for full participation.

Does not post main discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range:
9
(9%)
– 9
(9%)

Response 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.

Points Range:
8
(8%)
– 8
(8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range:
7
(7%)
– 7
(7%)

Response is on topic, may have some depth.

Points Range:
0
(0%)
– 6
(6%)

Response may not be on topic, lacks depth.

First Response:

Writing

Points Range:
6
(6%)
– 6
(6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.

Points Range:
5
(5%)
– 5
(5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

Points Range:
4
(4%)
– 4
(4%)

Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range:
0
(0%)
– 3
(3%)

Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

Points Range:
5
(5%)
– 5
(5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range:
4
(4%)
– 4
(4%)

Meets requirements for full participation.

Posts by due date.

Points Range:
3
(3%)
– 3
(3%)

Posts by due date.

Points Range:
0
(0%)
– 2
(2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range:
9
(9%)
– 9
(9%)

Response 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.

Points Range:
8
(8%)
– 8
(8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range:
7
(7%)
– 7
(7%)

Response is on topic, may have some depth.

Points Range:
0
(0%)
– 6
(6%)

Response may not be on topic, lacks depth.

Second Response:

Writing

Points Range:
6
(6%)
– 6
(6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range:
5
(5%)
– 5
(5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

Points Range:
4
(4%)
– 4
(4%)

Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range:
0
(0%)
– 3
(3%)

Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:

Timely and full participation

Points Range:
5
(5%)
– 5
(5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range:
4
(4%)
– 4
(4%)

Meets requirements for full participation.

Posts by due date.

Points Range:
3
(3%)
– 3
(3%)

Posts by due date.

Points Range:
0
(0%)
– 2
(2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name: NRNP_6531_Week1_Discussion_Rubric

Week 3: Evaluation and Management of HEENT Conditions

Last week, observing external characteristics of a patient was introduced as an important initial component of a physical examination. In addition to those observations, additional patient information can be learned by examining the head, eyes, ears, nose and throat, referred to as the HEENT system. Abnormal or disease manifestations may cause changes to one or more parts of the HEENT system, and understanding those manifestations is a critical skill for the advanced practice nurse.

For this week, you will not have a simulation case study however, it will be important for you to recognize that your continued observations and additional patient information are critical to your advanced nursing skills. This Week 3 concludes Module 1, and you will complete a Knowledge Check assessment covering the Module 1 topics examined in Weeks 1–3.

Learning Objectives

Students will:

Identify key terms, concepts, and principles related to the primary care of adults across the lifespan

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

In this exercise, you will complete a 10- question Knowledge Check to gauge your understanding of this module’s content.  Please note that this is a formative practice to help you better prepare for your Midterm and Final Exam as well as your Nurse Practitioner (NP) certification exam. The questions in this Knowledge Check are related to the topics from Weeks 1, 2, and 3 Topics include:

Nursing competencies

Billing and coding

Integumentary conditions

HEENT conditions

It is in your best interest to take your time, do your best, and answer each question to the best of your ability.

Photo Credit: [DirtyDog_Creative]/[Vetta]/Getty Images

By Day 7

Complete
and
submit
your Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 3 Knowledge Check

What’s Coming Up in Module 2?

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

In Module 2, you will examine the evaluation and management of cardiovascular conditions in Week 4 and respiratory conditions in Week 5. You will consider how to assess, diagnose, and treat two i-Human patients—one presenting a cardiovascular condition and one presenting a respiratory condition.

Week 5 Knowledge Check

In Week 5, you will experience your next Knowledge Check which covers the Module 2 topics from Weeks 4 and 5. Refer to the Week 5 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly.

Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

What’s Happening in This Module?

This course is composed of four separate modules. Each module consists of an overarching topic and each week within the module consists of specific subtopics for learning. As you work through each module, you will have an opportunity to draw upon the knowledge you gain in various case study assignments and knowledge checks, which will be due throughout each of the modules.

Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

is a three-week module consisting of

Weeks 1–3 of the course. In Week 1, you will begin by examining competencies of advanced nursing practice. You will also reflect on your own strengths and challenges in relation to the competencies and when working with adult patients across the lifespan. Then, in Weeks 2 and 3, you will examine the evaluation and management of integumentary conditions as well as those conditions impacting HEENT in Weeks 2 and 3.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1–7 in Weeks 1, 2, and 3

Week 1 Class Café: Introductions

Post by Day 2 of Week 1

Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

Post by Day 3 of Week 1 and respond to your colleagues by Day 6 of Week 1

Week 2 Assignment: i-Human Case Study: Evaluating and Managing Integumentary Conditions

By Day 7 of Week 2:

Complete and submit your i-Human Case Study Assignment

Week 3 Assignment: i-Human Case Study: Evaluating and Managing HEENT Conditions

By Day 7 of Week 3:

Complete and submit your i-Human Case Study Assignment

Week 3: Knowledge Check: Module 1

By Day 7 of Week 3:

Complete and submit your Module 1 Knowledge Check

Go to the Week’s Content

Week 1

Week 2

Week 3

Week 1: Competencies of Advanced Nursing Practice

Advanced nursing practice competencies focus on the unique practice knowledge, skills, and attitudes a nurse practitioner must demonstrate as they work with adults across the lifespan in clinical settings. They are developed by experts in the field and provide clarity about what is needed to be successful in your career. Competencies need to be practiced so they can be used to effectively address a wide range of situations. In addition to real-world settings, there are virtual opportunities that can facilitate the development of competencies. For example, throughout this course, you will complete case study simulation assignments with virtual i-Human patients presenting a variety of medical conditions. These types of virtual simulations provide you with the formative practice needed to help guide and prepare you for the real-world clinical experience.

For this week, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives.

Learning Objectives

Students will:

Analyze strengths and challenges related to nursing practice competencies

Describe professional career goals or objectives

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Class Café: Introductions

Photo Credit: nakophotography / Adobe Stock

This Class Café is a place for discussions that do not necessarily relate to the formal content of this course and will not be assessed. However, we encourage you to get to know your colleagues and familiarize yourselves with everyone’s background and personal history.
Note
: If your posting is of a personal nature or involves issues that are of concern only to you and require an individual response from the Instructor, please email the Instructor directly.

By Day 2

Post
and introduce yourself to your colleagues and ask any questions you might have about the course or questions in general.

Respond
to your colleagues and answer any questions or ask any questions that you might have.

Note
: This Class Café is not required and will not be assessed; however, you are encouraged to get to know your colleagues.

Submission and Grading Information

Post by Day 2

To Participate in this Discussion:

Class Café: Introductions

Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

An advanced practice nurse collaborates and communicates with patients, families, doctors, nurses, and specialists to ensure patients receive the care they need. As they diagnose, treat, manage, and educate patients, they are responsible for ensuring patient safety and maintaining ethical behavior. Competencies have been developed to help the advanced practice nurse to understand the practice knowledge, skills, and attitudes they need to be successful.

Photo Credit: michaeljung / Adobe Stock

For this Discussion, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives.

To prepare:

Review the Learning Resources for this week, specifically the advanced nursing practice competencies. As you review the competencies, reflect on your own strengths and challenges when working with adults across the lifespan.

By Day 3

Post
a summary of your expectations of this course. Also, include a brief explanation of your strengths and challenges as they relate to nursing practice competencies when working with adults. Describe any career goals or objectives this course may help you accomplish in the Family Nurse Practitioner (FNP) or
Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
role and explain why. Use your research to support your explanations by providing credible and scholarly sources.

Read
a selection of your colleagues’ responses.

By Day 6

Respond
to
at least two
of your colleagues on
two different days
by offering a suggestion or resources to help your colleagues in addressing their personal strengths or challenges, or their career goals. Use your research to support your suggestions. Provide at least 3 credible and current scholarly sources.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 1 Discussion

Assignment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.

What’s Coming Up in Week 2?

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms,
you will need to submit your application via
Meditrek
 .

For information on the practicum application process and deadlines, please visit the
Field Experience: College of Nursing: Application Process – Graduate
 web page.

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

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

Next week, you will analyze an i-Human simulation case study about an adult patient with an integumentary condition and formulate a differential diagnosis, based on the patient’s information. Using the findings of your analysis, you will evaluate treatment options and then create an appropriate treatment plan for the patient.

Looking Ahead:

In this course and beginning in Week 2, you will be required to complete case study assignments using the web-based software i-Human. You should have received an email with your i-Human Patients login and password information. If you have not received this information, please contact the Course Instructor.

Ensure that you are able to log in to the software and review the
i-Human Patients Case Player Student Manual
as needed to familiarize yourself about how to navigate i-Human.

Week 2: Evaluation and Management of Integumentary Conditions

A key skill for an advanced practice nurse is gathering patient information that can be used to inform diagnosis and treatment of conditions. Physical examination of a patient is often initiated by simple visual observations of external characteristics, including body language, demeanor, and cognitive ability, as well as the skin, hair, and nails (integumentary system). This information can contribute to the overall evaluation of a patient and guide assessment and diagnosis.

For this week, you will analyze a simulated case study about an adult i-Human patient with an integumentary condition and formulate a differential diagnosis, based on the patient’s information. Using the findings of your analysis, you will evaluate treatment options and then create an appropriate treatment plan for the patient.

Learning Objectives

Students will:

Formulate differential diagnoses for adult patients with integumentary conditions

Analyze pattern recognition in adult patient diagnoses

Analyze the role of patient information in differential diagnosis

Evaluate pharmacologic and non-pharmacologic treatment options for adult patients

Create an appropriate treatment plan that includes health education and follow-up care

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Assignment: i-Human Case Study: Evaluating and Managing Integumentary Conditions

This course will require you to complete a series of case studies using the i-Human software application. The i-Human Patients (IHP) Case Player enables you to interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual patients and receive expert feedback on your performance.

Photo Credit: RFBSIP – stock.adobe.com

The integumentary system is susceptible to a variety of diseases, conditions, and injuries, ranging from the bothersome but relatively innocuous bacterial or fungal infections that are categorized as disorders to skin cancer and severe burns, which can be life-threatening.

For this Case Study Assignment, you will examine your first case study and work with a patient with an integumentary condition. You will formulate a differential diagnosis, evaluate treatment options, and then create an appropriate treatment plan for the patient.

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with integumentary conditions.

Review the
i-Human Patients Case Player Student Manual
found in this week’s Learning Resources to familiarize yourself with how to use the i-Human software.

Access i-Human from this week’s Learning Resources and review this week’s i-Human case study Krista Hampton V5.1 PC PL. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.

Reflect on how the results would be used to make a diagnosis.

Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with integumentary conditions.

Assignment

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the
 i-Human Patients Case Player Student Manual
 in the Week 1 Learning Resources.

By Day 7

Complete your Assignment in i-Human.

Submission and Grading Information

To access your rubric:

Week 2 Assignment Rubric

What’s Coming Up in Week 3?

Week 3 Knowledge Check

Week 3 concludes Module 1, and you will complete a Knowledge Check assessment covering the Module 1 topics examined in Weeks 1–3. Plan your time to review accordingly.

Week 3: Evaluation and Management of HEENT Conditions

Last week, observing external characteristics of a patient was introduced as an important initial component of a physical examination. In addition to those observations, additional patient information can be learned by examining the head, eyes, ears, nose and throat, referred to as the HEENT system. Abnormal or disease manifestations may cause changes to one or more parts of the HEENT system, and understanding those manifestations is a critical skill for the advanced practice nurse.

For this week, you will not have a simulation case study however, it will be important for you to recognize that your continued observations and additional patient information are critical to your advanced nursing skills. This Week 3 concludes Module 1, and you will complete a Knowledge Check assessment covering the Module 1 topics examined in Weeks 1–3.

Learning Objectives

Students will:

Identify key terms, concepts, and principles related to the primary care of adults across the lifespan

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

In this exercise, you will complete a 10- question Knowledge Check to gauge your understanding of this module’s content.  Please note that this is a formative practice to help you better prepare for your Midterm and Final Exam as well as your Nurse Practitioner (NP) certification exam. The questions in this Knowledge Check are related to the topics from Weeks 1, 2, and 3 Topics include:

Nursing competencies

Billing and coding

Integumentary conditions

HEENT conditions

It is in your best interest to take your time, do your best, and answer each question to the best of your ability.

Photo Credit: [DirtyDog_Creative]/[Vetta]/Getty Images

By Day 7

Complete
and
submit
your Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 3 Knowledge Check

What’s Coming Up in Module 2?

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

In Module 2, you will examine the evaluation and management of cardiovascular conditions in Week 4 and respiratory conditions in Week 5. You will consider how to assess, diagnose, and treat two i-Human patients—one presenting a cardiovascular condition and one presenting a respiratory condition.

Week 5 Knowledge Check

In Week 5, you will experience your next Knowledge Check which covers the Module 2 topics from Weeks 4 and 5. Refer to the Week 5 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly.

NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem

Main Post Week 1

The Problem

The facility at which I am employed is located on a Native American Reservation in North Central Montana. There is a high rate of enrolled members who are diagnosed with diabetes, many of which are further classified as uncontrolled and have multiple complications. I work in the Diabetes Management Department as the Diabetes Educator, Diabetes Nurse, and the Diabetic Foot Care Specialist. The patient safety problem that I have identified involves an increase in the number of patients diagnosed with diabetes who were presenting to the clinic with different types of chief complaints related to their feet. Some of those diagnoses included in-growing toenails, onychomycosis, macerations, ulcerations, fissures, corns, and callosities. Many of those patients also had musculoskeletal diagnoses such as hammertoe, claw toe, early-stage Charcot Foot, prominent metatarsal heads, and Taylor’s bunions. NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem.

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The Research and The Potential Cause

Indian Health Services (IHS) (2020) state as many as 10 – 20% of native American patients diagnosed with diabetes who attend a scheduled diabetes exam will have an acute problem related to foot care such as infection, toenail overgrowth, and callosities that needs immediate treatment. The authors continue to state that it is essential to inspect the feet of the diabetic patient at each exam visit because there may also be other factors that increase the risk of injuries such as peripheral arterial disease and sensory neuropathy (IHS, 2020).

Using the Electronic Health Record system, a report was generated to determine which patients diagnosed with any form of diabetes were due for an annual foot exam (had not had a documented foot exam in the past eleven months) and which of those patients also had a full diabetes examination scheduled. In 2018, 35% of the diabetic population of the reservation had a complex foot examination completed. In 2019, only 19% of the diabetic population had a diabetic foot exam documented. After careful review and comparison, it was noted that the patients who attended the scheduled full diabetes examinations were not always receiving the annual foot examination from the nurses or the providers. The nurses should have been removing the shoes of those patients with diabetes and performing a foot exam with 10-g monofilament plus one other sensory test, such as vibratory perception with a tuning fork. This exam was not being completed and was leading to poor outcomes.

More Research

Realizing that this facility cannot be the first facility to experience this challenge, further research was conducted to determine what evidence-based practice guidelines might have been established recently through studies that proved effective in increasing the number of diabetic foot exams. Vanderbilt University Medical Center conducted a study to improve foot exam completions by implementing posters for rooms and developing a template for charting that proved successful (Agency for Healthcare and Research Quality, 2014). The Centers for Disease Control and Prevention (CDC) (2017) reports that in 2016 over 82% of adults who are also diagnosed with diabetes in Montana have had an annual foot exam completed.

Change in Practice

The importance of annual foot exams for patients diagnosed with diabetes and the gathered data was shared with the appropriate leaders at the facility. After two weeks of collaboration, a few steps were implemented to help ensure the patients were educated, the nurses were trained and supported, and the patient outcomes were improved. Some of the critical elements of change included the following: NURS 3150 3151 week 1 Discussion: Choosing the Type of Research for a Research Problem

A Diabetic Foot Exam Template was developed to help facilitate accurate and efficient documenting

Each of the nurses in the clinic participated in education related to foot exams and are provided additional education quarterly to help them learn about what may be abnormal and interventions to take.

Each exam room is stocked with 10-g monofilament (sensory testing) and a tuning fork (for vibratory perception testing)

Each exam room and every nursing station has a graphic hanging that shows how to perform the sensory testing.

Each of the 22 exam rooms has a sign hung that states, “Do You Have Diabetes? We would LOVE to see your feet” Please make sure your nurse takes off your shoes!”

The Foot Care Nurse reviews upcoming appointments and orchestrates daily huddles with providers and nurses

Impact on Patient Outcomes

To date, the changes implemented have been positive, not only for the patient outcomes but also for nurse-provider communications. At this point, I have not run updated reports to get exact numbers but have noticed differences in patient care as well as responses from patients during patient interactions. The impacts on patients and processes are as follows:

Fewer patients are presenting to Urgent Care for chief complaint related to their feet, i.e., “sore on the toe,” “infected in-grown.”

Increased number of patients scheduling appointments for routine foot care

Increased number of patients receiving Annual foot exam from nurse or provider during an office visit.

Nurses and providers are calling Foot Care Nurse more often with questions, for specific patient education, to schedule appointments for patients while they are with the patient.

The Research Question and Why

How often do nurses perform foot exams on patients diagnosed with diabetes at Rocky Boy Health Center?

To answer this question and to increase the number of foot exams performed, a quantitative methodology will be used. There is a distinct correlation in the variables; the nurse and the patient diagnosed with diabetes and foot exams. The information is easily gathered from the facility’s database. The data has been collected and compared to state and national indicators. Research has been conducted and evidence-based guidelines reviewed concerning improving nurse compliance with conducting foot exams. New processes have been established at the facility, and patient outcomes are improving. Continued monitoring and measuring are needed before I can say with certainty that these new implementations have been a real success.

 

References

Agency for Healthcare and Research Quality (2014). Toolkit for implementing the chronic care

model in an academic environment: Diabetes foot exam. Retrieved July 13, 2020 from

DNP vs PhD in nursing

Topic 3 DQ 2

NRS-440VN Trends and Issues in Today’s Healthcare

Discuss the difference between a DNP and a PhD in nursing. Discuss which of these you would choose to pursue if you decide to continue your education to the doctoral level and explain why.

Topic 3 DQ 2

According to Gaines,DNP graduates are leaders in advanced nursing practice that bring evidence-based knowledge into the clinical setting to help improve healthcare outcomes and strengthen the leadership role of nurses in both the clinical and academic setting. An individual with a DNP can function in a provider capacity but most also work to generate new scientific and clinical knowledge in nursing and healthcare. A nurse practitioner with a doctorate does not change the scope of practice. (Gaines, 2019).

On the other hand, The scope of practice for a nurse with a Ph.D. is tricky. Individuals can work as a bedside nurse, but unless they are a CRNP, they do not have any advanced responsibilities or roles beyond a normal bedside nurse. Nurses who earn a PhD typically fall into two employment categories: nurse researcher and nurse educator. (Gaines, 2019).

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If I were to make a choice. I would most likely choose DNPas opposed to Ph.D. simply because they work closely withpatients and I’ve always liked meeting new people and gettingto know to a more personal level. Although research study isinteresting,I find working at bedside and being able to helppatients more than I normally do as a nurse makes myreasoning why I wanted to become a nurse to begin with–fulfilling.

Gaines, K. (2019). Dnp vs ph.d. – in nursing- what is the difference? Nurse.org. Retrieved from https://nurse.org/education/dnp-or-phd-in-nursing-difference/ DNP vs PhD in nursing

Topic 3 DQ 2

Since the rise in patient population resulting from the Affordable Care Act, nurse scientists are entering the field of research at an earlier period in their career than before. Both DNP and PhD nurses participate in the forefront of cutting edge research. A simple overview of the difference is the two is that a DNP is more practice based and PhD is more suited toward nursing research. My personal interests are more in the area of nursing practice. I enjoy working with patients and family members in a more holistic manner. A PhD would give me the ability to take a more behind the scenes look at the statistics behind everything but I don’t think I would enjoy it is much because I like the interactions with other caregivers and people. “Overall, the number of schools with a DNP program has grown tenfold in the past seven years. The AACN Annual Survey of Baccalaureate and Graduate Nursing Programs revealed that, of 400 schools offering some level of APRN education in 2013, 98 (25 percent) had active BSN-to-DNP programs and 229 (57 percent) had MSN-to-DNP programs.”

 

Auerbach, D. I., Martsolf, G. R., Pearson, M. L., Taylor, E. A., Zaydman, M., Muchow, A. N., Spetz, J., & Lee, Y. (2015). The DNP by 2015: A Study of the Institutional, Political, and Professional Issues that Facilitate or Impede Establishing a Post-Baccalaureate Doctor of Nursing Practice Program. Rand health quarterly, 5(1), 3.

 Topic 3 DQ 2

Doctorate of Nursing Practice (DNP) curriculum leans more toward improving health care through transformational leadership, evidence-based practice, quantitative methods, and data-driven quality improvement (Duke University School of Nursing, 2020). It does not include student stipends, nor does it require a dissertation. A student can attend on a part-time basis, unlike a PhD in Nursing, which requires full-time status. PhD curriculum is focused on preparing the student for research and includes, philosophy, science, statistics, analysis of data and qualitative research. Tuition is usually paid for by the university and PhD students are paid a stipend.

I would have to choose the DNP path because I could attend part time, and many universities offer online programs that are designed for working nurses. Having had a 36 year career already, I would love to be instrumental in helping to transform healthcare. I believe we need stronger leaders in nursing to advocate for the profession, and to be a part of decision-making.

Duke University School of Nursing. (2020). DNP-PhD comparison. Retrieved from 
https://nursing.duke.edu/academic-programs/dnp-program-nursing/dnp-phd-comparison

 

Topic 3 DQ 2

Both DNP and Ph.D. in nursing are essential in pursuing a doctorate in nursing. The most significant difference between the two is that DNP is practice-focused, and a Ph.D. is a research-focused program. The DNP, also known as the Doctor of Nursing Practice, is a degree that focuses on clinical practice at the highest level of a nursing license. Nurses who go for DNP degree programs want to practice nursing. The DNP programs equip them with scientific, evidence-based research and translate it into patient care to improve healthcare outcomes (Canady, 2020). Additionally, DNP programs frequently require the accomplishment of clinical hours because of the clinical practice element. Lastly, a DNP graduate will be self-assured of leading an interdisciplinary care team and estimate the outcome among a specific patient population.

On the other hand, a Ph.D., also known as a Doctor of Philosophy in Nursing, focuses on research and students’ research to advance nursing practice and science. At one time, Ph.D. was seen as the only doctorate option. The Doctor of Nursing Science (DNS) has similar traits to that of a Ph.D. Students who enroll in Ph.D. focuses on learning theories and policies of research so they may pinpoint the information that is appropriate to patient care (Neal-Boylan, 2020). Ph.D. students have a broader understanding of nursing practice that will aid them in providing good research. A Ph.D. program runs for a minimum of three years for full-time students. The type of nursing that I am more interested in is having more contact with the patient and their families. With a better understanding between Ph.D. and DNP, I will go for DNP. I feel that my strongest desire lies in the DNP since it is more practical. DNP vs PhD in nursing

Reference

Canady, K. (2020). Practical and philosophical considerations in choosing the DNP or PhD in nursing. 
Journal of Professional Nursing
.

Neal-Boylan, L. (2020). PhD or DNP? That Is the Question. 
The Journal for Nurse Practitioners
, 
16
(2), A5-A6.

 

 

 Topic 3 DQ 2

The DNP is an advanced nursing practice degree, often with a focus on clinical practice, and the PH.D. in nursing is a research and academic degree. The Doctor of Nursing Practice is a doctoral degree that is pursued by an experienced nurse practitioner who wants to advance in their clinical practice and sometimes move into a leadership position. Experience however is no longer a prerequisite however, as many nurse practitioner programs are integrating the DNP into their curriculum making them RN-DNP programs. Also, most nurse practitioner programs are requiring faculty to have an advanced degree (DNP or PH.D.) to teach. Again, the DNP focuses a lot on nursing practice. Curriculums are built on creating nursing leaders who have the skills and tools needed to take evidence they obtain through research and implement it in clinical practice to ultimately improve patient outcomes. It focuses also on advancing the understanding of the nursing practice. DNP vs PhD in nursing Ultimately these skills will allow DNP-prepared nurses to lead interdisciplinary teams, improve patient care, and evaluate outcomes to hopefully eventually change healthcare standards. Because of the clinical practice component, DNP programs often require the completion of clinical hours. This is usually not required in a PH.D. program(Moskowitz.K,2019)

The focus of most Ph.D. in nursing programs is on research. The purpose of this program is to prepare nursing scientists to develop new nursing knowledge to advance the actual science of how we do our jobs. Graduates often lead research teams and are often involved in clinical trials. PH.D. graduates are also often found in academic settings. Not only do they teach, but they also often help to design, develop, and research educational programs. Because of this, many Ph. D. programs often require a mentored teaching experience (Moskowitz. K,2019).

For those who want to continue to work as a clinician, possibly in a leadership role, the DNP may be a better choice. For those who want to work in research, education, and academia primarily, a Ph.D. may be the better choice. Personally, if I decide to continue my education to the doctoral level, I will pursue DNP because I would continue to work as a clinician rather than to work in research or education. DNP vs PhD in nursing

Reference:

Moskowitz. K(2019) 
The Difference Between a DNP and a Ph.D. in Nursing?
 Retrieved from: 
https://www.nursingce.com/blog/the-difference-between-a-dnp-and-a-phd-in-nursing/

 

 Topic 3 DQ 2

While researching the differences between DNP and PhD in nursing, most agree that they are both terminal degrees qualifying an individual expertise in the field of nursing, however the DNP is viewed as a clinical approach while the PhD is a research-based approach. These degrees are chosen based on the career goals of the nurse pursuing them. For example, individuals aiming to obtain positions in leadership or nursing education would be more appropriate to follow the PhD path. Finishing a BSN degree has always been the first step for me as a nursing professional, and I have always known I would take it further beyond this. Deciding where I see myself in the future is the most challenging part of deciding which path is right for me, though. My nursing career stemmed from a passion for birth work, and midwifery, so nurse-midwife always seemed like the end goal that was meant for me. As I have recently taken on a position in a busy women’s hospital on the labor floor, I am still unsure if this is still the right path for me. In the event that I do pursue midwifery, then the DNP route will be most appropriate for me after I’ve obtained my MSN. “MSN-prepared nurses practicing in an advanced role (i.e., nurse practitioner, nurse midwife, CRNA) who wish to expand their knowledge base and achieve a terminal degree to enhance their practice would benefit from choosing the DNP path” (Registerednursing.org, 2020).References:Registerednursing.org . (2020). What’s the Difference Between a PhD and DNP in Nursing? DNP vs PhD in nursingRetrieved from https://www.registerednursing.org/answers/difference-phd-dnp-nursing/

 

 Topic 3 DQ 2

A Doctor of Nursing Practice (DNP) an advanced degree in nursing, focuses on implementing research and advancement of nursing practice through application of new principles/theories in nursing practice. This prepare the nurse to be expert clinicians that apply advanced theories to nursing care that will improve patient outcomes, (Thomas, 2018). The Doctor of Philosophy (PhD) in nursing focuses on the discovery of new practices in nursing through testing of new researched principles and theories to advance/impact nursing as a profession, Thomas, (2018). The need for  advanced nursing education and by extension, advanced knowledge, contributed to availability of faculty at the university level to teach nursing courses. The 2010 report of the Institute of Medicine (IOM) recommended the need for these advanced levels in nursing education, Whitney, (2018) to move nursing forward as a profession and impacting healthcare reform.

In my future studies at this point in my thought process I would be interested in a DNP program that would improve my functioning as a clinician and still would enable be to precept confidently, new nurses that would assist with current evidenced-based practices being administered to patients impacting patient outcomes and healthcare by extension.

References

Thomas, J. (2018). Professional Development in Nursing. In 
Trends in Health Care: A Nursing Perspective
 [1] (1st ed.). Retrieved from 
https://lc.gcumedia.com/nrs440vn/trends-in-health-care-a-nursing-perspective/v1.1/#/chapter/3

Whitney, S. (2018). The Future of Nursing in an Evolving Health Care System. In 
Trends in Health Care: A Nursing Perspective
 [1] (1st ed.). Retrieved from 
https://lc.gcumedia.com/nrs440vn/trends-in-health-care-a-nursing-perspective/v1.1/#/chapter/1 
DNP vs PhD in nursing

NURS 3100 Discussion: The Essence of Nursing

Discussion – Week 4

Option 1

According to Ma, Shang, & Bott (2015), it is critical that contemporary nurses have strong leadership and collaboration skills to improve health care. Reflect on the expertise that you expect to acquire with your education at Walden.  Envision yourself taking the lead to improve patient care in your practice setting. Describe the knowledge and skills needed to achieve your professional goals.

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In today’s world of healthcare, it is imperative that providers and nurses demonstrate high levels of communication among them.  In the study by Ma, Shang, and Bott, nurses were administered two scales, both adapted from the Index of Work Satisfaction, which measures nurses’ attitudes toward distinct aspects of their jobs (Ma, et al, 2015).  Nurses noted higher levels of job satisfaction, less intent to leave, and better quality of heath care on units with better teamwork and communication.

I wholeheartedly agree with the results of this study.  As I work in the emergency department, I find that communication between providers and nurses is key to providing the best quality of healthcare for our patients.   It helps to ensure that everyone on the treatment team is on the same page with the patient’s plan of care and lessens the chance of miscommunication and/or mistakes being made. NURS 3100 Discussion: The Essence of Nursing.  When the patient sees that his/her provider communicates with his/her nurse, it reinforces the confidence the patient has in the treatment team.

I expect to use my 15 years working in clinical psychology and my 13 years as a nurse when I finish my program and become a psychiatric nurse practitioner.  I certainly realize that the nurse is the one to spend the most time with the patient and, therefore, is often the one who has earned the patient’s trust.  Currently, my providers depend on me to gather very personal information about our psychiatric patients and make suggestions about the level of care needed.  I plan to use my experience as a nurse when I become a psychiatric nurse practitioner as I will remember to keep the lines of communication open and two-way. NURS 3100 Discussion: The Essence of Nursing. I think having been a nurse communicating with providers will only help to strengthen my own communication skills when I myself become a provider.

References:

Ma, C. , Shang, J. & Bott, M. J. (2015). Linking Unit Collaboration and Nursing Leadership to Nurse Outcomes and Quality of Care. JONA: The Journal of Nursing Administration, 45(9), 435–442. doi: 10.1097/NNA.0000000000000229.

Discussion: The Essence of Nursing

Jean Watson states that “caring is the essence of nursing.” Compassion, wisdom, loving kindness, caring, and 
knowledge
, all concepts of Watson’s Caring Theory, are what nurses are all about. Watson’s Caring Theory incorporates arts and humanities as well as science.

Delivering the kind of care Watson describes hinges on nurses practicing to the fullest extent of their education and training and on their 
taking the lead to improve health care safety and quality and patient outcomes
(2010). Think about how you incorporate science into your everyday practice. Right now, for example, you may use your understanding of pharmacotherapy when safely administering medications. In the future, do you see yourself applying your research expertise by collecting or using clinical data to improve patient outcomes at your place of work or in the larger community? NURS 3100 Discussion: The Essence of Nursing.

To prepare

Review the following resources from this week’s Learning Resources:

Week 4 Discussion Rubric, provided in the Course Information area or accessible through the link below

This week’s Writing Resources and Program Success Tools

This week’s articles and media

By Day 3

Post
 a 3-paragraph response (of at least 350 words) to 
one
 of the following options. Be sure to use 
evidence
 from the readings and include 
in-text citations
. Utilize 
essay-level
 writing practice and skills, including the use of 
transitional material
 and 
organizational frames
. Use the writing resources and the Week 4 Discussion Rubric to develop your post.

Reflect on your readings from this week, and then address one of the following options:

Option 1

According to Ma, Shang, & Bott (2015), it is critical that contemporary nurses have strong leadership and collaboration skills to improve health care. Reflect on the expertise that you expect to acquire with your education at Walden. Envision yourself taking the lead to improve patient care in your practice setting. Describe the 
knowledge and skills
 needed to achieve your professional goals.

OR

Option 2

Use the website, 
http://www.qualityindicators.ahrq.gov/
 , found in the Learning Resources to do the following:

Provide a brief definition of 
quality indicators
.

Choose a particular indicator that either is being addressed or you would like to see addressed at your place of employment (or previous place of employment), and explain your reasons. Describe both the issue and your involvement in it. Alternatively, discuss your leadership’s role and your role in utilizing the indicator to improve health care. NURS 3100 Discussion: The Essence of Nursing.

By Day 7

Read two or more
 of your colleagues’ postings from the Discussion question.

Respond
 with a comment that asks for clarification, provides support for, or contributes additional information to 
two or more
 of your colleagues.

Return to this Discussion
 in a few days to read the responses to your initial posting. Note what you have learned and/or any insights you have gained as a result of the comments your classmates made.

Post a discussion entry on 
3 different days of the week
.

Discussion – Week 4

Quality indicators are evidence-based measures used within the inpatient hospital setting. Hospitals used quality indicators to track patient outcomes and unit performance. Quality indicators can also highlight areas that may need improvement (“Agency for Healthcare,” n.d.).

           A patient safety indicator that is currently being addressed and will continue to be discussed in the hospital setting are pressure ulcer rates (“Agency for Healthcare,” n.d.). Pressure ulcer injuries can happen to patients of all ages. Too often, we see patients who have either had a stroke or became paralyzed to the point that it limits the individual’s mobility. These patients cannot redistribute their weight correctly, which can ultimately lead to a pressure injury and many other complications later on. Pressure injuries can lead to unforeseen costs in inpatient care, as well. As nurses, our job is to prevent our patients from harm and oversee all aspects of their care. Although repositioning a patient may seem simple and easily delegated, it is still the nurse’s job to make sure it is done. For me, it is crucial to help my patients progress and prevent any complication in their care that may set them back. Unless I am busy with other tasks, I make a point to reposition my patient so that I can assess them and their current skin condition better. NURS 3100 Discussion: The Essence of Nursing.

Being in the leadership role as a registered nurse (RN) on the floor, I can collaborate with a team of healthcare workers to prevent harm to my patients. Currently, where I work now, we use team nursing. Team nursing may include one RN, one licensed practical nurse, and one personal care assistant. Working in this setting allows me to collaborate with my team and other specialties in my patient’s care. The hospital setting can be hectic, and it takes a group of individuals to ensure patient safety. As an RN, I make sure all patients that need assistance in repositioning are getting repositioned a minimum of every two hours. It seems like a simple task, but this small intervention can help our patients continue their road to recovery.

References:

Agency for Healthcare Research and Quality. (n.d.). AHRQuality indicators. Retrieved from http://www.qualityindicators.ahrq.gov/ NURS 3100 Discussion: The Essence of Nursing

NURS 3100 3101 Discussion: Nurses Make the Difference

Discussion – Week 3

Option 1- Provide an overview of a Magnet facility. Include explanation of how Magnet drives health care change in the institution.

 
Magnet status of a healthcare facility means for an overall improvement in quality of care. Having a Magnet status isn’t just a reward given to an institution, but a credential (Laureate Education, 2009). When I think of a hospital having magnet status, I automatically think of nurses with a BSN degree, however, there is much more meaning than that. Magnet does have an increased % of BSN’s, as well as an increased % of certifications, notably in specialty areas. Hospitals of Magnet status are known to offer tuition reimbursement to nurses interested in advancing their education, and most often that comes with an increase in pay. Nurses in a Magnet facility are included in decision making, data collection, and research at every level. Nurses who are part of a Magnet institution are frequently active in community programs and community education programs, as well as any nursing organizations that may be present in their area (Tinkham, 2013). Magnet facilities want their nurses to be well known around their communities.

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Having a Magnet status heavily revolves around the nursing profession, but that has been shown to lead to better outcomes for the patient (Laureate Education, 2009). A study also showed that Magnet hospitals have a significantly lower mortality rate. Magnet status has led to increased employee satisfaction, as well as, increased patient satisfaction. When patient satisfaction goes up, so does reimbursement for the facility. Clinical measures also play a role in Magnet status. These measures are normally key metrics that the hospital analyzes on a monthly/quarterly/yearly basis. These measures also play a part in reimbursements from insurance companies. Magnet hospitals are known to have better scores within these clinical measures. Leaders who advocate for their nurses and their patients, will be more successful in continuing to have satisfied employees. Accountability and teamwork are also crucial pieces of a Magnet facility. A hospital, in reality, is a business, but when you have satisfied nurses and satisfied patients, the hospital is always going to gain. NURS 3100 3101 Discussion: Nurses Make the Difference

 

Laureate Education (Producer). (2009b). Issues and trends in nursing: Professional practice models [Video file]. Baltimore, MD: Author.

Tinkham.M. R. (2013). Pursuing magnet designation: The role of structural empowerment. AORN Journal, 97(2), 253-256.

 

Week 3 Discussion 

I choose question 1;  “Provide an overview of a Magnet facility, include an explanation of how Magnet status drives health care change.

This feels like a loaded question when I take in to consideration that I was reared and raised in Cleveland, Ohio very close to the infamous Cleveland Clinic.  Noting that the Clinic has cared for Queens, Kings and Millionaires forces many a person to think very close and very hard about care and how and who its provided by even though as nurses we all know that most nurses learn the same skills.  From my own personal work experiences I would have to agree  with the some of the sentiments that are associated with Magnet facilities in that many of the programs and trainings are very different in that tend to have a more developed process/procedure when it comes down to training and continuing education in my perspective.  Job security is particularly sought throughout Magnet facilities and adorn a much higher percentage of satisfied Registered Nurses, immense decreases in employee turnover moreover the HCAP scores revealed both improvement and patient satisfaction. NURS 3100 3101 Discussion: Nurses Make the Difference

Although some critics hold the belief that  Magnet Hospitals don’t necessarily offer better working conditions though ultimately, the mass majority of nurses gravitate towards hospitals and facilities with Magnet status for the notoriety and prestige that it brings about although I found that they don’t typically pay anymore than any other well defined institution however, their benefits packages are typically very outstanding and commensurable.  If you are a nurse looking to further your education a Magnet facility would definitely be worth looking into as they invest in their employees immensely as it relates to education and continuing education and training.    Keeping in mind that most Magnet institutions are also on the cutting edge of technology and open up a vast world in advancements.

Discussion: Nurses Make the Difference

Health care organizations that adhere to or seek Magnet designation (Magnet hospitals) are exemplars in serving patients. They are recognized as organizations that have high nurse satisfaction and lower rates of nurse shortages. These organizations tend to have higher degrees of nurse involvement at all levels of decision making. Magnet hospitals also have improved patient outcomes.

For this Discussion, you explore how Magnet status contributes to health care change within an institution and the personal contribution nurses make to this process. NURS 3100 3101 Discussion: Nurses Make the Difference

To prepare

Review the Discussion Rubric for Week 3, provided in the Course Information area or accessible through the link below.

Review the Academic Writing Expectations (AWE) Checklist, Weeks 1–3, listed in this week’s Learning Resources.

Review the video 
Issues and Trends in Nursing: Professional Practice Models
 (Laureate Education, 2009b).

Review the following articles from this week’s Resources:

ANCC Magnet Recognition Program
 (American Nurses Credentialing Center, n.d.)

The Future of Nursing: Leading Change, Advancing Health
 (Institute of Medicine, 2010)

Pursuing Magnet Designation: The Role of Structural Empowerment
 (AORN Journal, 2013)

By Day 3

Post
 a 2-paragraph response (of at least 350 words) to either Option 1 or Option 2.

Use the writing resources, writing samples, and Discussion Rubric to develop your post. Reflect on your reading from this week, and then address one of the following:

Option 1

Provide an overview of a Magnet facility. Include an explanation of how Magnet status drives health care change in the institution. Develop and post 
cohesive paragraphs
 and 
use evidence
to support your ideas. The practice of writing cohesive paragraphs is essential to good writing. Focus each paragraph on one main idea or goal. NURS 3100 3101 Discussion: Nurses Make the Difference

OR

Option 2

Describe the personal contribution a nurse might make in the process of seeking or maintaining Magnet designation. Develop and post 
cohesive paragraphs
 and 
use evidence
 to support your ideas. The practice of writing cohesive paragraphs is essential to good writing. Focus each paragraph on one main idea or goal.

By Day 7

Read two or more
 of your colleagues’ postings from the Discussion question.

Respond
 with a comment that asks for clarification from, provides support for, or contributes additional information to 
two or more
 of your colleagues.

Return to this Discussion
 in a few days to read the responses to your initial posting. Note what you have learned and/or any insights you have gained as a result of the comments your classmates made.

Post a discussion entry on 
3 different days of the week
.

Submission and Grading Information

Discussion – Week 3

COLLAPSE

Option 2

Describe the personal contribution a nurse might make in the process of seeking or maintaining Magnet designation. Develop and post 
cohesive paragraphs
 and 
use evidence
 to support your ideas. The practice of writing cohesive paragraphs is essential to good writing. Focus each paragraph on one main idea or goal.

In the nursing profession, “Magnet Recognition means education and development through every career stage, which leads to greater autonomy at the bedside.  To patients, it means the very best care, delivered by nurses who are supported to be the very best that they can be (ANCC, 2015).  Individual nurses can greatly contribute to seeking and maintaining Magnet designation in their hospitals.

During my eight years as an Emergency Room nurse at The Johns Hopkins Hospital, I had firsthand experience of working on Magnet re-designation as I was an active member of the Magnet committee.  In my role, I worked on encouraging new nurses with Associate degrees to enroll in RN to BSN programs within their first three years of nursing.  I inspired seasoned nurses to continue their education by obtaining their CEN (Certified Emergency Nurse) certification.  This entailed assembling a team to meet with the nurse manager of the emergency department, the Director of Nursing, and the Chief Nursing Officer.  In these meetings, the team discussed the importance of obtaining these degrees and certifications.  The team worked with administration to find funding to help defray the costs of attaining these goals.  Our team successfully lobbied for a CEN review class made available for any nurse who wished to take the exam.  Additionally, the nursing administration agreed to reimburse any nurse who successfully passed the CEN exam.  Our team also persuaded nursing administration to increase tuition reimbursement for nurses who enrolled in RN to BSN programs. NURS 3100 3101 Discussion: Nurses Make the Difference

Along with encouraging nurses to obtain these degrees and certifications, I worked with the Magnet committee to offer incentives of climbing the clinical ladder.  Truly, our committee was made up of leaders who believed in the clinical ladder.  Such a clinical ladder has demonstrated to “provide staff members with a framework for receiving professional recognition and financial benefits for for attaining advanced degrees, continuing education credit, and certifications (Tinkham, 2013).  At Johns Hopkins, nurses who obtained their Baccalaureate degree were eligible for advancement from Nurse Clinician I to Nurse Clinician II.  This advancement brought the Baccalaureate-trained nurse eligible for an added increase in pay that was in addition to their annual increase.  It also allowed the nurse to advance to more responsible roles, such as that as nursing preceptor to novice nurses, triage nurse, and charge nurse. NURS 3100 3101 Discussion: Nurses Make the Difference

References:

American Nurses Credentialing Center (n.d.). 
ANCC Magnet Recognition Program.  
Retrieved September 22, 2015, from https://nursingworld.org/organizational-programs/magnet/

Tinkham, M. R. (2013). Pursuing magnet designation: The role of structural empowerment. 
 AORN Journal
, 97(2), 253-256. NURS 3100 3101 Discussion: Nurses Make the Difference

NURS 3100 Academic Writing Expectations (AWE) -1000 AWE Level Assignment Template

Name of Assignment

 

Student’s Full Name

 

Walden University

 

Course Number, Section, and Title

(Example: NURS 3100 Section 01, Issues and Trends)

 

Month, Day, Year

(enter the date submitted to instructor)

 

Write Title of Assignment Here

Begin your paper with an
introductory paragraph
. Double-space the paper with 1″ margins on all sides and type in Times New Roman 12 point font.  End this paragraph with, “The purpose of this paper is to describe . . .”

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Body

When making reference to a source, at a minimum, include the author name/s, year of publication, title of the article, and name of the journal as applicable in the paper.  Citations are
not
required at the 1000 AWE Level using APA formatting requirements. However, you are free to practice crediting your source(s) in your paper using APA Style. The Walden Writing Center is YOUR citation resource place at
http://academicguides.waldenu.edu/writingcenter/apa/citations
  Also see the citation and reference examples provided in the Academic Writing Expectations tab of this course. NURS 3100 Academic Writing Expectations (AWE) -1000 AWE Level Assignment Template

.The Walden Writing Center has a paper review service! For appointments and reviews go to
http://academicguides.waldenu.edu/writingcenter/paperreviews

 

Conclusion

 

Summarize the key points in your paper.

 

References

 

Although a Reference List is
not
required at the 1000 AWE Level, you may practice referencing your source/s using APA formatting requirements. The Walden Writing Center is YOUR reference resource place at
http://academicguides.waldenu.edu/writingcenter/apa/references
Also see the citation and reference examples provided in the Academic Writing Expectations tab of this course.

 

 

NURS 3100 Academic Writing Expectations (AWE) Checklist, Weeks 1–3

Academic Writing Expectations for First-Term/1000 Level Courses

http://academicguides.waldenu.edu/writingcenter/undergraduate/awe/2000-3000

 

Students: Prior to submission please review your assignment for sentence-level, paragraph level, and use of evidence to make sure you meet the AWE expectations.  Check the boxes as you complete your review and click the links to access Writing Center for additional resources if you need them.

 

DO NOT SUBMIT THIS FORM WITH YOUR ASSIGNMENT.  It is for you to check your compliance to Academic Writing Expectations

 

Sentence-level skills

 

Constructing complete and correct sentences. See an explanation of
sentence components
and how to avoid
sentence fragments and run-ons
. Work through an
interactive module on sentence basics
.

Using and spelling words correctly. See a list of
commonly misused words
and information on
MS Word’s spell check
.

Punctuating appropriately. See the different types of
punctuation
and their uses.

Using Grammarly to catch further errors. See a
Grammarly tutorial
.

 

Paragraph-level skills

 

Using paragraph breaks. Each paragraph acts as a concrete unit of the 
central argument
. See a description of
paragraph basics
.

Focusing each paragraph on one central idea (rather than multiple ideas). See an explanation of how
topic sentences
work. Use of evidence NURS 3100 Academic Writing Expectations (AWE) -1000 AWE Level Assignment Template

 

Using course learning resources. See examples of
integrating evidence
in a paper.

Enclosing direct quotes in quotation marks. Read about the purpose of
quotation marks
.

  Paraphrasing (explaining in one’s own words) to avoid plagiarizing the source. Using

quotes appropriately (no more than one short, unique quote.)  See
paraphrasing strategies
.  See
Ineffective Paraphrasing Strategies
.

 

NURS 3100 Academic Writing Expectations (AWE) -1000 AWE Level Assignment Template