Evaluate the outcomes of therapeutic nursing interventions and plan further interventions accordingly.

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#6 Demonstrate an ability to reflect on interpersonal and interactional processes with individuals, families, and groups and critically analyze own role in relation to them.
#8 Evaluate the outcomes of therapeutic nursing interventions and plan further interventions accordingly.
JOURNAL 5
TOPIC Clinical expertise, patient values, optimum safe care
DIRECTIONS Complex and even “simple” nursing interventions may consist of several steps or components and may require various resources (additional personnel or equipment) to safely implement depending on individual patient characteristics. For example, bathing a patient who is morbidly obese with chest tubes, central lines, and is unconscious and intubated can make this seemingly simple task a multi-person undertaking to insure patient safety and wellbeing.
“Factors such as the strength . . . of an intervention and the resources required for delivering it (e.g., personnel, setting and equipment) are rarely described, nor are extraneous variables such as contextual or environmental features and patient characteristics, which can significantly influence the intervention process . . . (Sidani & Braden, 1998)” (Thompson and Clark, 2012, p. 277).
Think of a nursing intervention that you have performed on a specific (complex) patient. Consider these “factors” and carefully outline each step to illustrate the actual detail of this intervention, noting the influence of extraneous variables and clinical expertise. Note a “take away” from this eye opening exercise. This may be in an essay format or as a concept map to illustrate the intervention and intertwining elements.

Compare and contrast the inquiry processes of the DNP and the Doctor of Philosophy (PhD) in Nursing.

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In this discussion, reflect on the history and development of the doctorate of nursing practice (DNP). Also, refer to the Doctor of Nursing Practicetext reading and the AACN’s “The Essentials of Doctoral Education for Advanced Nursing Practice” to address the following:
Compare and contrast the inquiry processes of the DNP and the Doctor of Philosophy (PhD) in Nursing.
As you develop your post, consider these questions based on your readings this week:
What do you see as the major impetus for the DNP degree?
How does this degree differ from the PhD?
How will you apply the DNP degree in practice?
Who are the key stakeholders and how did they add credence and credibility to the DNP?
Remember to follow APA guidelines for citing and referencing your sources.

Explain the difference between an adjustment disorder and anxiety disorder.

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Anxiety Disorders, PTSD, and Related
Disorders
Anxiety disorders are common in both primary care and psychiatric practice. Clients with anxiety disorders including generalized anxiety disorders, agoraphobia, and other specific phobias will present to the PMHNP’s office with a significant level of distress. Successful recognition and treatment of anxiety disorders includes an accurate diagnostic assessment with a treatment plan that includes a combination of psychopharmacology and psychotherapy. Although psychoanalytic theories are based on the concept of anxiety, the more recent standard of care is with the cognitive-behavioral therapies.
Assignment
· Explain the difference between an adjustment disorder and anxiety disorder. Provide examples to illustrate your rationale.
· Explain the diagnostic criteria for your assigned anxiety disorder. Which is “Generalized Anxiety Disorder”
· Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned anxiety disorder. Which is “Generalized Anxiety Disorder”
· Compare differential diagnostic features of anxiety disorder
· Support your rationale with recent references (<5yrs) to the Learning Resources or other academic resource.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
· Chapter 9, “Anxiety Disorders” (pp. 387–417)
· Chapter 11, “Trauma- and Stressor-Related Disorders” (pp. 437–451)
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
· Chapter 16, “Panic Disorder”
· Chapter 18, “Social Anxiety Disorder (Social Phobia)”
· Chapter 19, “Generalized Anxiety Disorder”
· Chapter 20, “Specific Phobia”.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
· “Anxiety Disorders”
· “Trauma- and Stressor-Related Disorders”
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.
Anxiety
Generalized anxiety disorder
Panic disorder
alprazolam amitriptyline amoxapine buspirone chlordiazepoxide citalopram clomipramine clonazepam clonidine clorazepate cyamemazine desipramine diazepam dothiepin doxepin duloxetine escitalopram fluoxetine fluvoxamine gabapentin (adjunct) hydroxyzine imipramine isocarboxazid lofepramine
loflazepate lorazepam maprotiline mianserin mirtazapine moclobemide nefazodone nortriptyline oxazepam paroxetine phenelzine pregabalin reboxetine sertraline tiagabine tianeptine tranylcypromine trazodone trifluoperazine trimipramine venlafaxine vilazodone
alprazolam citalopram desvenlafaxine duloxetine escitalopram fluoxetine fluvoxamine mirtazapine paroxetine pregabalin sertraline tiagabine (adjunct) venlafaxine
alprazolam citalopram clonazepam desvenlafaxine escitalopram fluoxetine fluvoxamine isocarboxazid lorazepam mirtazapine nefazodone paroxetine phenelzine pregabalin reboxetine sertraline tranylcypromine venlafaxine
Posttraumatic stress disorder
Reversal of benzodiazepine effects
Social anxiety disorder
citalopram clonidine desvenlafaxine escitalopram fluoxetine fluvoxamine mirtazapine nefazodone paroxetine prazosin (nightmares) propranolol (prophylactic) sertraline venlafaxine
flumazenil
citalopram clonidine desvenlafaxine escitalopram fluoxetine fluvoxamine isocarboxazid moclobemide paroxetine phenelzine pregabalin sertraline tranylcypromine venlafaxine
Maples-Keller, J. L., Price, M., Rauch, S., Gerardi, M., & Rothbaum, B. O. (2017). Investigating relationships between PTSD symptom clusters within virtual reality exposure therapy for OEF/OIF veterans. Behavior Therapy, 48(2), 147–155. doi:10.1016/j.beth.2016.02.011
Hayes, J. P., Logue, M. W., Reagan, A., Salat, D., Wolf, E. J., Sadeh, N., & … Miller, M. W. (2017). COMT Val158Met polymorphism moderates the association between PTSD symptom severity and hippocampal volume. Journal of Psychiatry & Neuroscience: JPN, 42(2), 95–102. doi:10.1503/jpn.150339
Quinn, B. L., & Peters, A. (2017). Strategies to reduce nursing student test anxiety: A literature review. Journal of Nursing Education, 56(3), 145–151. doi:10.3928/01484834-20170222-05
Required Media
Wolpe, J. (Producer). (n.d.). Joseph Wolpe on systematic desensitization [Video file]. Mill Valley, CA: Psychotherapy.net
Optional Resources
Acosta, M. C., Possemato, K., Maisto, S. A., Marsch, L. A., Barrie, K., Lantinga, L., . . . Rosenblum, A. (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF veterans in primary care with symptomatic substance use and PTSD. Behavior Therapy, 48(2), 262-–276. doi:10.1016/j.beth.2016.09.001
Substance Abuse and Mental Health Services Association (SAMHSA). (2014). TIP 57: Trauma-informed care in behavioral health services. Retrieved from: http://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA14-4816
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s? •Are performance standards consistent with quality standards commonly used in the nursing profession?

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Discussion: Performance Standards and Appraisals Performance appraisals should be timely, thoughtful, consistent, thorough, and free from bias. How can performance appraisal systems be structured to facilitate this type of environment? Effective performance standards and appraisals can promote an open and continuous relationship among the nurse manager, HR professionals, and employees. How might you, as a nurse manager, use performance appraisals and other performance management strategies, such as positive discipline, in your leadership approach? In this Discussion, you reflect on questions that commonly arise when assessing performance appraisal processes. •Performance Standards: •Who creates performance standards, and how are they communicated to employees? •Are performance standards consistent with quality standards commonly used in the nursing profession? •Do performance standards align with legal and ethical nursing practice? •Performance Appraisals: •How is employee performance (i.e., behaviors, attitudes, abilities, and skills) documented? •What measures, if any, protect employees from subjectivity? •Are employees asked to engage in any form of self-evaluation? •Do colleagues participate in peer evaluations such as 360-degree appraisals? •Does the performance appraisal process encourage employee development? •Aside from the written performance measures, what aspects contribute to success or failure in achieving performance improvement? To prepare •Review this week’s media, “Performance Management,” and consider the best practices highlighted by this week’s presenters. •Reflect on the performance standards and appraisal systems used in your current organization or one with which you are familiar. With the above questions in mind, identify this organization’s strengths and areas for improvement. •Drawing from ideas presented in this week’s Learning Resources, think of specific ways you might improve your organization’s use of performance standards and/or the performance appraisal process. •Review the article, “Positive Discipline Reaps Retention.” As a nurse manager, how might you incorporate positive discipline into your performance management approach? What effect–good, bad, or indifferent–do you think it would have on your nursing staff? By Day 3 Post a description of the performance appraisal system used in your workplace, including how performance standards are created and communicated to employees. Describe the effectiveness of the performance appraisal system by sharing at least two strengths and two areas for improvement. Conclude your posting by explaining how you might incorporate positive discipline into your performance management approach and what impact you think it will have.
Required Readings Lussier, R. N., & Hendon, J. R. (2016). Human resource management: Functions, applications, & skill development (2nd ed.). Thousand Oaks, CA: Sage Publications. •Chapter 8, “Performance Management and Appraisal” (pp. 274–314) This chapter introduces the performance appraisal process. The authors explain how to effectively carry out performance appraisals, the methods of assessment one can use, and who should be responsible for assessing employees. •Chapter 9, “Rights and Employee Development&rdquo (pp. 316–355) Chapter 9 provides an overview of employee rights and privileges. It also explains the processes of developing or terminating an employee, providing counseling for problem employees, and effectively using discipline and termination. Dupee, J. M., Ernst, N. P., & Caslin, K. E. (2011). Does multisource feedback influence performance appraisal satisfaction? Nursing Management, 42(3), 12–16. Retrieved from the Walden Library databases. The article focuses on the effects of multisource feedback (MSF) in a nursing environment. Murray, B. (2003). Positive discipline reaps retention. Nursing Management, 34(6), 19–22. Retrieved from the Walden Library databases. Positive discipline can transform communication and relationships between nurse managers and nursing staff. This article examines how nurse managers at a medical center in Boise, Idaho shifted their feedback process to an Alternative Correction Action model based on positive discipline philosophies.