Nur6051n Module1(week1-2) Informatics
22 hours ago
Respond 1 to Heidi in about half a page , cite 2 reference s.
RE: Discussion – Week 1
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Mental health disorders can range from mild depression to severe psychosis. Depending on how severe the mental health disorder is can sometimes determine treatment compliance. An important part of treatment is to be consistent and comply with the providers’ recommendations, which includes attending regular appointments for medication management. In most scenarios a behavioral health patient must attend regular provider visits in order to keep receiving medication. The provider will not prescribe for a patient who misses numerous appointments and therefore the patient may end up going without medication and declining in health. Behavioral health disorders have worsened as a result of poor compliance (Semahegn, Torpey, Manu, Assefa, Tesfaye, & Ankomah, 2018). It is critical that these patients see the provider in order to not decline in health. According to Gajwani (2014), poor medical adherence such as not seeing the provider, can lead to exacerbation of symptoms, relapse and hospitalization. With technology available today we are able to consult and keep appointments with providers via the computer, or Telehealth, to maintain patients’ health status and medication regimen without interruption. Non-adherence with appointment keeping has been reported as high as 50% and telepsychiatry could help alleviate that inconvenience with clinic attendance (Shulman, John, & Kane, 2017). For patients who frequently miss appointments they could still comply via a telepsychiatry visit. The data that could be collected would be if telepsychiatry helps with compliance by those patients who frequently cancel or no- show appointments to help with medication management and decrease risk of inpatient hospitalization. The first data we could gather is if telepsychiatry helps with missed appointments. The second data we could collect is if the patients’ health has stayed the same or improved due to having a virtual visit with the provider versus missing an appointment and declining in health. The information we collect could help us to determine which patients, in the future, may benefit from a virtual visit based on their ability and willingness to show up for face to face appointments. A nurse leader could use this information to plan and implement care based on each individual patients’ needs versus treating each patient uniformly for the best possible outcome. The behavioral health population is very unique in that they need care tailored to each specific individual and diagnoses.
Gajwani, P. (2014, September). Can what we learned about reducing no-shows in our clinic work for you? Retrieved from https://www.mdedge.com/psychiatry/article/86564/practice-management/can-what-we-learned-about-reducing-no-shows-our-clinic
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2018). Psychotropic medication non-adherence and associated factors among adult patients with major psychiatric disorders: a protocol for a systematic review. Systematic reviews, 7(1), 10. doi:10.1186/s13643-018-0676-yA
Shulman, M., John, M., & Kane, J. M. (2017, March 1). Home-Based Outpatient Telepsychiatry to Improve Adherence With Treatment Appointments: A Pilot Study. Retrieved from https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201600244
Response 2 to Kayla . same way
RE: Discussion – Week 1
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In the intensive care unit, (ICU), delirium is a major risk for patients, especially the elderly. To gauge the onset of diagnosis there are tools that nurses use such as the Richmond Agitation Sedation Scale and the Confusion Assessment method, (Sajjad, et.al, 2019). There are also data tools available that monitor the disparities involved with delirium such as the sub distribution hazard ratio, (Sajjaad, et.al., 2019). Although knowing the onset is helpful with gaining timeliness in interventions post delirium, there is not a data collection tool that monitors what preventative measures are used and if these measures are successful. The one exception is that ventilated patients receiving continuous sedation have documentation that provides when the sedative drips are paused for sedation vacation. Given the amount of preventative interventions that exist a tool used daily or every four hours that allots a check off system for preventative measures could be used and thus help determine whether preventative interventions decreased ICU delirium.
Suggestions that are non-pharmacologic included reorientation to time and place at least twice daily, daily screening of prescribed drugs, sleep hygiene, visible clocks in rooms, and invitation for family to aide in re-orientation, (Martinez, et.al., 2017). Although these interventions may take place in the hospital setting, there is no data tool to link the occurrence of intervention to the occurrence of delirium onset.
A study providing the feasibility and safety of providing both cognitive and physical intervention that would assist in preventing delirium was done in 2014. Brummel’s study proved that the ability for both set of interventions was safe and effective for critical patients within the first 72 hours of hospital admission. In my personal hospital we try to prevent ICU delirium every shift, however a tool that monitored the outcome of our interventions is not thorough. We can detect the onset of delirium but not the measures that were provided beforehand. With a checkoff tool for preventative interventions we could gather data and make a connection to whether there was a short coming of interventions being completed, or if the interventions that are being done are successful.
Brummel, N. E., Girard, T. D., Ely, E. W., Pandharipande, P. P., Morandi, A., Hughes, C. G., … Jackson, J. C. (n.d.). Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. INTENSIVE CARE MEDICINE, 40(3), 370–379. https://doi-org.ezp.waldenulibrary.org/10.1007/s00134-013-3136-0
Martinez, F., Maria Donoso, A., Marquez, C., & Labarca, E. (n.d.). Implementing a Multicomponent Intervention to Prevent Delirium Among Critically Ill Patients. CRITICAL CARE NURSE, 37(6), 36–46. https://doi-org.ezp.waldenulibrary.org/10.4037/ccn2017531
Sajjad, A., Wolters, A. E., Veldhuijzen, D. S., Peelen, L. M., Welling, M. C., Zaal, I. J., … Slooter, A. J. C. (2018). Psychopathology prior to critical illness and the risk of delirium onset during intensive care unit stay. Intensive Care Medicine, 44(8), 1355–1356. https://doi-org.ezp.waldenulibrary.org/10.1007/s00134-018-5195-8