Assignment: 

Respond to at least two of your colleagues who argued the opposite side as you by countering their argument with evidence. Identify at least two consequences to support your position.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Response Post #1

Against Diagnosing Pediatric Patients with Bipolar Disorder

           Bipolar disorder is genetic, and 60 to 90 percent of studies on twins indicates that it is passed down from generation to generation. Studies indicate that changes in the prefrontal cortex and subcortical area of the brain are associated with bipolar disorder (Sadock & Ruiz 2014).   Bipolar Disorder is a persistent mental health disorder that occurs with severe and single mood swings, either high with a lot of energy or low with a feeling of depression, according to the National Institute of Mental Health (2018).   The genetic aspect of Bipolar Disorder causes signs to be seen in pediatric patients and in the DSM-5 manual without meeting the diagnostic criteria.

           According to the DSM-5 manual, hypomanic or manic episodes (talkative, a flight of thoughts, diminished need for sleep, distractibility, high-energy agitation, and outburst) are the diagnostic criteria for Bipolar Disorder (APA, 2013).  This diagnosis criterion is close to the Attention-Deficit / Hyperactive Disorder criteria. ADHD requirements include (flight of thoughts, concentration difficulty, non-stop conversation, higher energy, etc.) (APA, 2013).  Therefore, an ADHD child with Bipolar Disorder is extremely likely to be misdiagnosed.

           The American Association of Psychology recognized children’s irritability, rage, and mood swings and agreed to add another diagnosis; Destructive Mood Dysregulation Disorder  (APA, 2013). Chronic irritability in between periods of rage or temper tantrums seen in the Bipolar Disorder criteria is the main characteristic of DMDD.  Diagnosis of DMDD is a child-specific symptom that aids in the proper care and removes the controversies in children around Bipolar Disorder.  There is a need to be particular when diagnosing children.  Developmental and hormonal changes in children have their psychological effects and may be temporary.  Therefore, other treatment options should be explored before rushing to diagnose a child with Bipolar Disorder. 

Response Post #2

Against

Pediatric Bipolar Depression Disorder Debate

           Pediatric Bipolar Depression Disorder (PBDD) has been a controversial subject for decades. The concept of PBDD came about by United States researchers in the middle of the 1990s (Duffy, Carlson, Dubicka, & Hillegers, 2020). The following will provide information that supports that PBDD is not an appropriate diagnosis for children.

Against the Diagnosis

According to the diagnostic criteria form the DSM-5, pediatric diagnosis of Bipolar Depression Disorder can be made with irritability rather than depression, sleep disturbances, psychomotor agitation, inappropriate guilt, problems concentrating, fatigue, and/or thoughts of death. The question I present is: How does a provider determine if those symptoms are due to trauma, ADHD, or other mental health concerns? Another question is: Why is the United States the one country who embraces the diagnosis of PBDD?

A case review highlighted by the NCTSN showed that a 12 year old child who had been subjected to extreme neglect, sexual abuse, domestic violence, and parental substance use was diagnosed with Oppositional Defiant Disorder and Pediatric Bipolar Disorder (2019). Further screening and assessment by a trauma-informed clinician found that the symptoms she was presenting was linked to complex trauma. Perry and Levin (2012) highlighted that not only trauma, but ADHD, can lead to the presentation of symptoms that are congruent with the diagnosis of PBDD.

In the facility I work, we provide trauma-informed care. Many of the children we care for are diagnosed with ADHD, anxiety, ODD, and Bipolar Disorder. We are finding that once we have switched to trauma informed care, children are leaving our care with LESS diagnoses. Duffy et al. (2020) highlights that the determination of PBDD does not take into account the environmental factors, social factors, and adverse childhood factors that may be contributing to the presenting symptoms.

Conclusion

           The controversy of over medicating children and causing significant long-term harm has been an issue that all providers need to be aware of. What if a child is diagnosed with PBDD and treated with medications that are not warranted? What if a trauma-informed approach could decrease or even eliminate the symptoms? Are you willing to make a lifelong diagnosis, treat the child with medications that may be unnecessary and harmful, and not take into account the possibility of a childhood disorder or trauma?  I know I am not.

PLEASE ANSWER THE QUESTIONS BELOW IN APA FORMAT

USE 2 CITATIONS AND 2 REFERENCES MINIMUM

THERE IS NO MINIMUM # OF WORDS FOR THIS ONE BUT PLEASE GIVE A SUBSTANTIAL ANSWER TO EACH QUESTION.

THANK YOU!

1. Why is the subject of workplace health and safety of concern to nurses? 

How are these concepts related to patient safety and patient outcomes? 

2. What action is suggested when you are faced with an angry or hostile coworker?

3. Why is substance misuse among nurses a serious concern? What is the most appropriate way to handle a suspicion that a coworker may be involved in serious substance misuse?

4. What is the most common physical injury experienced by LPNs and nursing assistants? How can a nurse manager help staff avoid physical injury at work? 

5. Describe several examples of sexual harassment in the workplace. Discuss methods of dealing with these instances.

6. Review the policies and procedures on the following safety issues in your current clinical rotation. Compare with other students in the class. What are the similarities and differences? What might this mean in terms of workplace safety? 

• Latex allergies

• Needlestick injuries

• Violence 

3. Go to the ANA website and explore the sections on workplace and patient safety under the heading “Professional Nursing Practice.” 

Which concepts discussed in these sections are particularly important to the beginning RN? Why? 

4. Interview one of the staff nurses on your unit. Explore his or her feelings and concerns related to the following topics. Based on the comments, develop strategies to address the concerns.

• Substance abuse among nurses

• Emergency preparation 

• Quality of work life within the organization 

  This is a discussion….please make sure it is understandable when it is read

One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the components of HEDIS comprehensive diabetes care; then consider the following scenario.

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes. 

Take on the role of the staff nurse in the scenario, and post an explanation of how you would go about finding out how many diabetics are in your practice and how many meet all components of HEDIS comprehensive diabetes care.

https://www.ncqa.org/hedis/measures/

I also attached another resource from this week

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist).

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. 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. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old). (Refer to AWE Checklist, Capstone)

TASK

Post your initial response to the topic below.

Simulation technology has been transformative in nursing education. Through the use of simulation, nurses can repeatedly practice skills and gain clinical confidence in a risk-free environment. Simulation, however, is not just for health care professionals.

How can nurses leverage simulation technology for patient and family education? (Include your rationale.)
Share your experiences and ideas for leveraging simulation technology for patient education.

On a separate reference page, cite all sources using APA format. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.