Work Civility

After completing the Clark Healthy Workplace Inventory, my current workplace received a score of 72, which ranked as a mildly healthy workplace , which I agree with.  Although this organization truly wants to be its best for its employees and patients, there are too many issues that caused it to receive a lower score.  This organization’s nursing staff consists of a staggering 80-90% of travel RN´s.  I find this to be a huge issue because it leads to the questions; ¨How come your core staff doesn’t want to work here?¨ Also,  ¨What is the reason that other nurses are staffing this hospital, and not the local nurses you already have?¨  After speaking to the few core staff at this hospital many causes were brought to my attention.

lack of trust in the organization and  lack of appreciation

These causes included nurse burnout, inadequate leadership, lack of trust in the organization and  lack of appreciation.  I noticed the Clark Healthy Workplace Inventory had many questions regarding employee health and satisfaction.  Unfortunately these are the areas this company scored the worst, bringing down their overall score.  This is important to note because several studies conducted have proven that job attitude directly correlates to patient health and satisfaction (Chang et al., 2020).  In addition, the nurses who had higher job satisfaction, were more likely to have a higher job performance (Chang et al., 2020).

Another reason I found this workplace to be mildly civil is because of the lack of stability.  There are many nurses, RT´s PT´s that come in to work for a travel contract. And leave after a few short months.  This doesn’t allow a familiarity or a relationship to be built between the staff nor the patients.  Many people I work with have a mindset of  ¨I´m going to be here for a short while, let me do what I need and leave¨.  There is very little loyalty to the company, there are no trustworthy relationships, and there is frequent change.  All this leads to a decreased work satisfaction.  It is also important that patients be able to create a trusting relationship with their care providers, as it leads to reassurance and a sense of security (Leslie & Lonneman, 2016).

Experience with Incivility in the Workplace

A moment when I experienced incivility in my workplace, was a time before becoming a travel nurse.  It was right at the start of the COVID-19 pandemic.  I worked at a very small community hospital; and like the rest of the country this disease was so new to us and we were unsure of how to tackle the issue.  The issue of incivility came when nurses felt frustrated with management and executives.  Nurses at neighboring hospitals were receiving hazard. And incentive pay to care for COVID patients, however the nurses at our facility were not.

It was then discovered that many more hospitals in the area were increasing the pay of those caring for these patients,while ours stayed the same.  The issue was not about money necessarily.  It was the fact that nurses felt that they were literally putting their lives at risk taking care of these sicker patients with no recognition from their leaders, while other hospitals were at least trying to acknowledge the work of their nurses.  After some time enough nurses became frustrated that the issue was brought up to multiple managers, and in a matter of weeks, nurses working with COVID patients started receiving hazard pay.

Summary

After completing the workplace inventory, it became clear that areas that deal with nurse´s beliefs. And attitudes towards a workplace have a significant impact on how an organization runs.  I have also noticed that at times, when problems arise. Many nurses tend to complain about the issue amongst themselves before presenting it to leaders.  It’s important that problems and issues on the units get verbalized to the appropriate personnel so that effective change can take place.  Keeping quiet about an issue can decrease nursing satisfaction. Which can also decrease  patient satisfaction and ultimately patient care (Clark, 2015)

APA Scholarly Paper on the American Nurses Association

Topic	Comments	Points Assigned	Points Awarded
Document the name and website of the professional organization (ANA) American Nurses Association		15
What is the mission and vision of the organization? Document the membership fee and how to become a member. Document if the organization accepts students?		20
Document the benefits of the organization? What resources does it provide?		15
What legislative involvement does the organization have?		15
Proper APA format, must be peer reviewed articles within 5 years, citations, references, spelling, grammar.		15

*APA references must be PEER REVIEWED ARTICLES within 5 years*

Assignment: Evidence-Based Project, Part 3: Critical Appraisal of Research

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

· Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.

· Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3. Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.

The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

By Day 7 of Week 7

Submit Part 3A and 3B of your Evidence-Based Project.

Submission and Grading Information

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

· Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.

· Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.

· Click the Week 7 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 “WK7Assgn+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 7 Assignment Rubric

 

Check Your Assignment Draft for Authenticity

 

To check your Assignment Draft for Authenticity

Submit your Week 7 Assignment Draft and review the originality report

 

Week 7 Grand Rounds Discussion: Complex Case Study Presentation

Student name: KA

College of Nursing-PMHNP

PRAC 6675: PMHNP Care Across the Lifespan II Practicum

Dr

Assignment Due Date :7/14/2021

Objectives for the Presentation

After this presentation:

· Objective 1

The audience will be able to list the diagnostic criteria of Bipolar I as per the DSM 5 definition.

· Objective 2

The audience will be able to list one FDA approved pharmacological treatment modality for the management of bipolar disorders.

Objective 3

The audience will be able to list one evidence -based psychotherapeutic treatment for the management of bipolar disorder.

Subjective:

CC

(Chief complaint): ”I don’t know what’s going on with me. I hope you can help me feel better with my mood swings”.

HPI

CK is a 25-year-old African American female. She reports that she had a severe manic episode 1 month ago and was hospitalized at a local hospital. After this episode, she reports she was very depressed for a week. She has 2 small children and she said she called CPS and said she was overwhelmed and afraid she could not handle her kids anymore. She gave the kids to her aunt. The patient said her anxiety is 2/10 at this time and her depression is a 7/10. She was started on Lexapro 20 mg PO daily a month ago. she is also prescribed Vraylar 4.5 mg cap daily. She reports feeling better and denies mania currently. she denies SI/HI/AVH. she said she has good family support system. She is also willing to start therapy next week. The patient reported that she was diagnosed with depression, and bipolar disorder in the past.

Past Psychiatric History

The client has a history of bipolar disorder and Major Depressive Disorder(MDD). The patient recalls that when she was 15 and in high school, she had a period of time where she went as many as 5 days with very little to no sleep. She said during that time, she was very hyper and had racing thoughts and felt very irritable and “wired” with a lot more energy than usual. She said her mother recalled her changing boyfriends and having sexual indiscretions. She reports that her mother got worried and took her to the ER. \

medications

She said she was started on medications but not she did not continue taking the medications and does not remember what the names of the medications. She denies Suicide Ideation, homicide ideation at present. The client shared those 2 or 3 times a year she has episodes where her mood is very depressed most of the days and she has feeling of interested in anything. She even reports during those times, she barely can sleep and lacks energy to do anything and stays in bed all day. She also reported during these depressive periods, she feels worthless and have difficulty concentrating during that same time.

Current Medications: The patient reports that she was started on Lexapro 20 mg PO daily a month ago. she is also prescribed Vraylar 4.5 mg cap daily. She reports these two medications seem to help her.

Psychotherapy: The patient has never tried psychotherapy. Swartz & Frank (2001)noted that although pharmacotherapy is the mainstay of treatment for bipolar disorder, medication offers only partial relief for patients. Treatment with pharmacologic interventions alone is associated with disappointingly low rates of remission, high rates of recurrence, residual symptoms, and psychosocial impairment. Bipolar-specific therapy is increasingly recommended as an essential component of illness management. Patient is willing to start psychotherapy next week.

Substance Current Use:

CK denies any past or current substance abuse .

Medical History:

Two C sections birth of her children.

Family Substance Use and Psychiatric History

Reports maternal Grandmother had a history of depression. And her mother has Bipolar. Father has history of alcohol use disorder. Her brother smokes marijuana and was in jail for conduct disorder.

Social History

Single, patient has two children, but they have been taken away by CPS and given to her aunt. She lives alone in her apartment and works at a local Starbucks. She owns her car and has health insurance. Currently her aunt has her two small children. She is taking classes part time at a local college and had to withdraw her summer term due to her recent hospitalization. She intends on continuing college when her mood is more stable. She reports dating a new boyfriend.

Allergies: The client did not report any allergies.

Reproductive Hx: patient reports a history of two pregnancies and two births The patient’s last monthly periods were last week. She denies being pregnant and she reports being sexually active.

Review of Systems (ROS)

• General: Denies weight loss or gain, fever, or chills. Denies fatigue.

• HEENT: Head: Denies headaches, head injury/trauma. Eyes: Denies visual loss, double vision, or yellow sclera. Ears: Denies hearing loss, ringing in the ears, or drainage. Nose: Denies sneezing, congestion, runny nose. Throat Denies itching, swelling, redness, or sore throat.

• Skin: Denies lesions, rash, itching, or easy bruising.

• Cardiovascular: Denies chest pain, chest pressure, or discomfort. No edema or palpitations.

• RESPIRATORY: Denies shortness of breath, cough, or sputum.

• GASTROINTESTINAL: Denies anorexia, denies nausea, vomiting, or diarrhea. No abdominal pain or blood.

• GENITOURINARY: Denies burning on urination. Pregnancy. The last menstrual period was last week.

• NEUROLOGICAL: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. Denies seizures activities

• MUSCULOSKELETAL: Denies any trauma, injury, or pain.

• HEMATOLOGIC: Denies any history of anemia, bleeding, or bruising.

• LYMPHATICS: Denies any enlarged nodes. Denies history of splenectomy.

PSYCHIATRIC: Reports Major Depressive Disorder (MDD) . Reports Bipolar Disorder. Reports being hospitalized last month for a severe manic episode. Stated had another manic episode in her teens.

• ENDOCRINOLOGIC: denies hypothyroidism. Denies hyperthyroidism Denies any history of sweating, cold, or heat intolerance. No polyuria or polydipsia or thyroid disorder. Denies any diabetes.

• ALLERGIES: NKDA

• Food: No food allergies.

• No Environmental and Seasonal Allergies and Latex Allergy.

Objective:

Physical Assessment:

• Vital Signs: not assessed

• General: She is alert and oriented and appears stated age. No weight loss or fever reported.

• Appearance: Normal appearance. She is well-developed. She is not diaphoretic.

HENT

• Head: Normocephalic and atraumatic.

Eyes: General: No scleral icterus. Right eye: No discharge. Left eye: No discharge.

Conjunctiva sclera: Conjunctivae normal. Nose: reports no drainage.

Neck: Normal range of motion.

Trachea: No tracheal deviation.

Cardiovascular: Rate and Rhythm: Normal rate.

Pulmonary: Pulmonary effort is normal. No respiratory distress.

Musculoskeletal: Normal range of motion.

Skin: General: Skin is warm and dry

Neurological: she is alert and oriented to person, place, and time.

Psychiatric: Attention and Perception: She appears attentive and alert and oriented.

Mood and Affect: Affect is flat and depressed.

Speech: Speech is clear.

Behavior: Behavior is calm.

Diagnostic results: There were no laboratory tests specific to diagnose BD. To diagnose BP. The PMHNP will conduct a thorough psychiatric history of the patient including family history as well as ask about current medical conditions that can affect the patient’s mood, I will order a urine drug screen because of my patient strong family history of use of alcohol and drugs. First, I will order CBC, chemistry profile , thyroid function tests, and B12 level to rule out metabolic causes or unidentified conditions . Johnson, Vanderhoef, & Johnson (2016). I will also order baseline EKG to make sure our patient does not have underling cardiac abnormalities before I order psychotropic medications. .

There are diagnostic tools to assist in assessing for BD. Second, I will use the Mood Disorder Questionnaire to assess for bipolar disorder. Hirschfeld et al (2010) noted that The MDQ is a self-report inventory that screens for a lifetime history of a manic or hypomanic syndrome by including 13 yes ⁄no items (Question 1). In addition to achieving the threshold number of symptom items, the subject must also have indicated that the symptoms clustered in the same period (Question 2) and caused moderate or serious problems (Question 3) (16, 21, 22). An MDQ screening score of ‡ 7, plus concurrence of symptoms and at least moderate problems reported, was found to have a sensitivity of 29–91% and a specificity of 67–94% for the diagnosis of bipolar disorder. I will also use the DSM-5 to help me in diagnostic inclusions and exclusions for this client. (APA,2013).