Examine 
Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Case

BACKGROUND

Katie is an 8 year old Caucasian female who is brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katie’s teacher suggested that she may have ADHD. Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.

The parents give the PMHNP a copy of a form titled 
“Conner’s Teacher Rating Scale-Revised”. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their family primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in school work and is easily distracted. Katie is also noted to start things but never finish them, and seldom follows through on instructions and fails to finish her school work.

Katie’s parents actively deny that Katie has ADHD. “She would be running around like a wild person if she had ADHD” reports her mother. “She is never defiant or has temper outburst” adds her father.

SUBJECTIVE

Katie reports that she doesn’t know what the “big deal” is. She states that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds her other subjects boring, and sometimes hard because she feels “lost”. She admits that her mind does wander during class to things that she thinks of as more fun. “Sometimes” Katie reports “I will just be thinking about nothing and the teacher will call my name and I don’t know what they were talking about.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. Offers no other concerns at this time.

MENTAL STATUS EXAM

The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.

Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation

RESOURCES

§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners' Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.

Decision Point One

Begin Wellbutrin (bupropion) XL 150 mg orally daily

RESULTS OF DECISION POINT ONE

·  Client returns to clinic in four weeks

·  Katie’s parents inform you that they stopped giving Katie the medication because about 2 weeks into the prescription, Katie told her parents that she was thinking about hurting herself. This scared the parents, but they didn’t want to “bother you” by calling the office, so they felt that it would be best to just stop the medication as they would be seeing you in two weeks

Decision Point Two

Educate the parents that Bupropion sometimes causes suicidal ideation in children and that this is normal, and re-start the drug at the previous dose

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Katie's parents again report that after about a week of treatment with the Bupropion, Katie began telling her parents that she wanted to hurt herself and began having dreams about being dead. This scared her parents, and they stopped giving her the medication At this point, they are quite upset with the results of their daughter’s treatment and are convinced that medication is not the answer

Decision Point Three

Refer the parents to a pediatric psychologist who can use behavioral therapy to treat Katie’s ADHD.

Guidance to Student

Bupropion is used off-label for ADHD and is used more commonly in adults. It’s mechanism of action results in increasing the neurotransmitters norepinephrine/noradrenaline and dopamine. Since dopamine is inactivated by norepinephrine reuptake in frontal cortex, (which largely lacks dopamine transporters) bupropion can increase dopamine neurotransmission in this part of the brain, which may explain its effectiveness in ADHD. However, Bupropion as well as other antidepressants have been linked to suicidal ideation in children and adolescents- despite the fact that it was being used initially to treat ADHD, it is still an antidepressant.

At this point, the parents are probably quite frustrated as no parent wants to hear their child talking about hurting themselves or having dreams about being dead. If the parents are adamant about no more medications, referral to a pediatric psychologist or similar therapist skilled in the use of behavioral therapies to treat ADHD in children. However, it should be noted that behavioral therapies work best when combined with medication, however, if the parents are insistent, then behavioral therapy may be the only alternative left in the treatment of Katie.

In terms of the pathophysiology of ADHD, whereas it may be true that increasing age may demonstrate some improvement in symptoms (some people will actually experience complete resolution of symptoms by adulthood), it is not helping Katie in the here and now. Katie still needs help with her symptoms which are causing academic issues.

The PMHNP should attempt to repair the rupture in the therapeutic alliance (the parents now believe that medications are not the answer) by explaining rationale for the use of Bupropion (many people like to start with Bupropion because it has a low-risk for addiction). The family should be encouraged to allow the PMHNP to initiate Adderall as it has a very good track record in terms of its efficacy in treating ADHD.

Hospitals have noises that are buzzing day and night. Emergency Rooms, ICU’s and monitored patient floors to mention a few, have high rates of noise saturation. The most common attribution to the noise is alarms. Alarms are designed to alert staff of a change or potential change in patient status (Hebda et al., 2019). Often, the alarm going off is false or has no patient threat. This is due to parameters not being set, patches not sticking, or positioning of a sensor. This can cause alarm fatigue, “The desensitization of a clinician to an alarm stimulus that results from sensory overload causing the response of an alarm to be delayed or missed” (West et al., 2014).

The result of alarm fatigue can lead to harmful patient situations. For example, if a nurse on a busy med-surg floor has several patients on beds with alarms, patients with IV pumps infusing and on telemetry monitoring, the alarm noise from all the devices could cause the nurse to tone out some of the sounds. If one of her patient’s bed alarms continues to go off repeatedly and every time she enters the patient’s room, finds the patient in bed, she determines the sensor is set to sensitive for the patient. But if the sensor is not reset, and the alarm continues to go off, the nurse may start to ignore the alarm. The last time the alarm sounds, the patient does get out of bed and falls, injuring his hip. This can turn into a legal issue as the safety measure was in place to protect the patient from harm, but due to a failure to change the bed setting, and the nurse’s desensitization of the alarm, the patient had a poor outcome. There is an ethical responsibility for the nurse to assess the injured patient, report the fall to appropriate change according to hospital policy and discuss the incident with the patient or family members. According to Kadivar et al., (2017), that despite measures put into place in the health care setting, there are still numerous threats posed to patient safety.

Evidence suggests that alarm fatigue is a patient safety and quality concern. As health care delivery becomes more digitalized, it is increasingly important to develop a safety culture to address alarm fatigue. The research suggests establishing safe alarm management and response processes. The use of multilevel sharing practices and prevention strategies is also a way to collaborate with multidisciplinary teams on strategies for reduction in alarm fatigue (Winter et al., 2021). By decreasing the number of false alarms with use of proper management, nurses can better care for patients needs without disruptions. Thus, reduce potential missed or ignored alarms resulting in poor patient outcomes.

 

References:

Kadivar, M., ManooKian, A., Asgharican., & Zarvani, A. (2017). Ethical and legal aspects of patient's safety: A clinical case report.
Journal of Medical Ethics and History of Medicine,
10, 15.

 

Winters, B., Slota, J., & Bilimoria, K. (2021). Safety Culture as a Patient Safety Practice for Alarm Fatigue.
Journal of the American Medical Association,
326(12), 1207-1208.

https://doi.org/chamberlainuniversity.idm.oclc.org/10.1001/jama.2021.8316

Links to an external site.

 

Hebda, T., Hunter, K., & Czar, P. (2018). Handbook of Informatics for Nurses & Healthcare Professionals (6th ed.). Pearson Learning Solutions.

https://ambassadored.vitalsource.com/books/9781323903148

Links to an external site.

 

West, P., Abbott, P., & Probst, P. (2014). Alarm fatigue: A concept analysis.
Online Journal of Nursing Informatics,
18(2), 1.

Reply

please see attachment

Assessment 2

Determining the Credibility of Evidence and Resources

Instructions-Develop a 2-4 page scholarly paper in which you describe a quality or safety issue, or a chosen diagnosis, and then identify and analyze credible evidence that could be used as the basis for applying EBP to the issue.

Introduction

The goal of using evidence-based research findings is to enhance safety and quality of patient care and ensure optimal outcomes are achieved. It is not uncommon to hear a nurse say, “why change it as we’ve always done it this way.” However, this is no longer acceptable in today's practice environment. The profession of nursing has evolved, and the expectation is that the professional nurse has a scientific foundation to support the care that is provided. As the profession of nursing continues to evolve and engage in health care transformation, baccalaureate-prepared nurses are expanding taking on leadership roles that include incorporating EBPs. To be able to do this, the nurse needs to understand the criteria and makes a resource credible, as this is crucial when deciding if the research is valid and reliable for implementation into health care settings. The nurse will need to incorporate the use of evidence-based practice models. EBP models are designed to assist the nurse in developing a plan to gather evidence to answer a practice problem or question. It is a systematic approach to direct the user to incorporate scholarly findings into current practice. These EBP models lead the nurse through the decision-making process of evaluating the literature to determine the best practice evidence for the practice issue or question.

It would be an excellent choice to complete the Vila Health Determining the Credibility of Evidence activity prior to developing the report. The activity is a media simulation that offers an opportunity to review a scenario and work on determining the credibility of presented evidence. These skills will be necessary to complete Assessment 2 successfully. This media simulation is one potential source of context on which to base your assessment submission. This will take just a few minutes of your time and is not graded.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

Scenario For this assessment, you may choose from the following options as the context for the quality or safety issue or chosen diagnosis/health issue for researching and completing this assessment:

· The specific diagnosis/health issue you identified in your previous assessment.

· The simulation Vila Health: Determining the Credibility of Evidence.

· A personal practice experience in which a sentinel event occurred.

Instructions- The purpose of this analysis is to better understand what constitutes credibility of journal articles as well as websites. The role of the baccalaureate-prepared nurse in incorporating evidence-based research continues to growth in clinical practice. As quality improvement (QI) measures to reduce safety risks continue to be emphasized, the need for evidence-based models and evidence-based templates is growing. This type of systematic approach to incorporating evidence-based findings allows nurses to make clinical and operational decisions based upon the best available evidence. When the most up-to-date evidence-based findings are utilized, patient-centered care improves outcomes and enhances the patient experience.

Below is a quick review table of several well-known Evidence-Based Practice Models used to guide exploration:

Evidence-Based Practice Models

Iowa Model of Evidence-Based Practice

Stetler Model

Ottawa Model

PARiHS (Promoting Action on Research Implementation in Health Services) Model

ACE (Academic Center for Evidence-Based Practice) Star Model

ARCC (Advancing Research and Clinical Practice Through Close Collaboration) Mode

John Hopkins Model

KTA (Knowledge-to-Action) Model

For this assessment:

· Explain the criteria that should be used when determining the credibility of journal articles as well as websites.

· Support your explanations with references to the literature or research articles that describe criteria that should be used to determine credibility.

· Your identification and determination of credibility should be done within the context of your chosen scenario for this assessment. For example, if you choose to use the provided Vila Health scenario, your initial identification of resources should be of resources that will best help address the presented issue. However, if you are locating resources to help provide evidence-based care for the diagnosis/health care issue you identified in the first assessment, you may want to begin your literature and evidence search from the databases that were identified. Any of the three scenario options are acceptable. So, pick the one that most interests you.

Be sure to address the following in this assessment, which correspond to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you will know what is needed for a distinguished score.

· Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based approach.

· Explain criteria that should be considered when determining credibility of resources such as journal articles and websites.

· Analyze the credibility and relevance of evidence and resources within the context of a quality or safety issue, or a chosen diagnosis.

· This is where you are selecting the specific resources to help address the issue in your chosen scenario.

· Identify the Evidence-Based Practice model and explain the importance of incorporating credible evidence into the EBP model used to address a quality or safety issue, or a chosen diagnosis/health care issue. Review the literature below and choose the appropriate model for your diagnosis/health care issue.

·

Selecting a model for evidence-based practice changes. [PDF]
 and 

Evidence-Based Practice Models
 help explain the various evidence-based nursing models.

· Communicate using writing that is clear, logical, and professional with correct grammar and spelling using current APA style.

Additional Requirements

Your assessment should meet the following requirements:

·
Length of submission:
 2-4-page scholarly paper, this does not include the APA-formatted title page and reference list.

·
Number of references:
 Cite 3-5 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than five years old.

·
APA formatting:
 References and citations are formatted according to current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

· Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

· Explain criteria that should be considered when determining credibility of resources such as journal articles and websites.

· Analyze the credibility and relevance of evidence and resources within the context of a quality or safety issue, or a chosen diagnosis.

· Competency 3: Apply an evidence-based practice model to address a practice issue.

· Identify an evidence-based practice model (such as Iowa, Stetler, John Hopkins, etc.) and explain the importance of incorporating credible evidence into an EBP model used to address a quality or safety issue, or a chosen diagnosis/health care issue.

· Competency 4: Plan care based on the best available evidence.

· Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based approach.

· Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

· Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

· Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

Scoring Guide

Use the scoring guide to understand how your assessment will be evaluated

Determining the Credibility of Evidence and Resources Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Describe a quality or safety issue, or a chosen diagnosis, that could benefit from an evidence-based approach.

Explain criteria that should be considered when determining credibility of resources such as journal articles and websites.

Analyze the credibility and relevance of evidence and resources within the context of a quality or safety issue, or a chosen diagnosis.

Identify an evidence-based practice model (such as John Hopkins, Stetler, Iowa, etc.) and explain the importance of incorporating credible evidence into an EBP model used to address a quality or safety issue, or a chosen diagnosis/health care issue.

Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.

Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

see file attached