Integration of Conceptual and Theoretical Frameworks.
PART A:
Discuss why it is important for advanced practice nurses to integrate conceptual and theoretical frameworks when working with families. Why do you think it is critical for the family and the advanced practice registered nurse to agree on what the health issue is for the family?Integration of Conceptual and Theoretical Frameworks.
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Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. This is required. In addition, you may also provide an example case, either from personal experience or from the media, which illustrates and supports your ideas. All sources must be referenced and cited using correct APA (including a link to the source).Integration of Conceptual and Theoretical Frameworks.
PART B:
A 52-year-old woman complains that she has been missing days of work almost every week, she states she is neglecting her family, and she is sleeping during the day but cannot sleep at night. She denies other health problems, medication, or environmental allergies.Integration of Conceptual and Theoretical Frameworks.
Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
In SOAP format, list:
Pertinent positive and negative information
Differential and working diagnosis
Treatment plan, including: Pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.Integration of Conceptual and Theoretical Frameworks.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
Part A: Integration of Conceptual and Theoretical Frameworks by Advanced Practice Registered Nurses (APRNs) in Working with Families.
It is indeed important for APRNs to integrate conceptual and theoretical frameworks when working with families of patients in the delivery of care. But just what are conceptual and theoretical frameworks? Two persons looking at the same scenario will see it from different standpoints, based on their backgrounds. What this means is that they will have different conceptual or theoretical frameworks from which their thinking operates (Imenda, 2014). To avoid this, a common defined conceptual or theoretical framework is required. In the case of healthcare, therefore, a common theoretical/ conceptual framework of care integrated by the APRN will underpin the patient’s care and act as a roadmap. Both the APRN and the family members of the patient will use it as a basis for reference and assessment of the achievement of set outcomes or treatment goals. Conceptual or theoretical frameworks help put care into perspective, clarifying and defining expected outcomes thereby eliminating ambiguity and misunderstanding between the APRN and the patient’s family (Wilson et al., 2015). The theoretical or conceptual framework confers significance to the patient care and helps the APRN share rationale for the care with the family. It also helps incorporate and put into perspective any external influences on care (Wilson et al., 2015).Integration of Conceptual and Theoretical Frameworks.
It is therefore crucial that the APRN and the family agree on what the diagnosis and plan of care for the patient are, and the way forward. This is because this practice has been associated with better outcomes (Cowling, 2018). This is where the plan of care will be guided by the conceptual framework. Both the national professional guidelines and individual past experience confirm that both the APRN and the patient’s family should agree on the care roadmap and expected outcomes for the patient’s illness. This is a fact supported by evidence from clinical practice. According to the American Association of Nurse Practitioners or AANP (2019), the APRN should come up with a treatment plan for the patient that is “cost-aware,” scientific, tried and tested, and “acceptable” in consultation and agreement with both the patient and their family. A practical case example of the importance of integrating family in the patient care comes from Cowling (2018). Cowling is an experienced board-certified APRN. He confesses that through his practice, he has found out that patient care is easier and patient outcomes are better when their families are made aware of care goals and implementation. He also opines that their contribution is immense when they are made partners in care, but that they also require the APRN’s attention as they come to terms with their patient’s illness (Cowling, 2018). In fact, education of family members about care at home after discharge is very crucial in eliciting positive responses from the patient. Cowling (2018) goes ahead to mention four pillars of family-focussed patient care as being respect and dignity, provision of information, participation, and collaboration.Integration of Conceptual and Theoretical Frameworks.
Part B: Major Depression: Diagnosis, Treatment, and Follow-up
The case patient is a 52-year-old lady who has been missing both work and sleep in the past few weeks. She says she has lost interest in her family and only dozes off during the day. According to her, she has no known medical condition, is not on any medication, and does not have any influencing environmental factors.
Questions the Patient Could be Asked, Physical Examination, and Further Tests
Based on the clinical suspicion of major depression, these are some of the questions the patient could be asked, as per the diagnostic criteria of the condition in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA, 2013):
In the past two weeks:
• Have you felt hopeless or had a feeling of sadness?
• Have you lost interest in pleasurable activities you normally enjoy?
• Have you felt overly tired;
• Have you felt valueless and not worthy, to the point of contemplating death?
Since there are other medical conditions that produce depression, the physical examination will focus on this, especially neurologic physical examination (Rouchell, 2000). Further testing in view of the same is as stated in the SOAP (subjective, objective, assessment, and plan) presentation below.Integration of Conceptual and Theoretical Frameworks.
SOAP Presentation of the Case Patient
Subjective
The patient says that she has lost interest in her own family, and is having insomnia. She only gets some sleep during the day. All this is happening in the abscence of any substance abuse, medication, or medical condition. This is the negative information. The positive information is that she is not having any suicidal thoughts so far (APA, 2013).
Objective
The patient has missed work on several occasions.
Assessment
From the symptoms and history, the patient is most likely suffering from a bout of major depression (Soleimani et al., 2011; APA, 2013; Steinberg, 2016). This is the working diagnosis, since she meets the diagnostic criteria A-C (APA, 2013). Given the symptoms and presentation, therefore, the differential diagnosis would be bipolar disorder (APA, 2013).
Plan
The patient would be put on an antidepressant at once. Selective serotonin reuptake inhibitors like citalopram are the first line Pharmacotherapeutic agents. This will be combined with cognitive behavior therapy (CBT) and/ or electroconvulsive therapy (ECT) as complementary treatment (Soleimani et al., 2011). Laboratory tests to be done will focus on eliminating a medical cause for the depression these include thyroid function tests, random blood sugar (RBS), and cardiac enzymes (Rouchell, 2000; Soleimani et al., 2011). Health education will focus on lifestyle changes, including regular exercise and eating a healthy balanced diet always (Krans, 2016). For preventive care, home-based depression care will be undertaken as per the Community Preventive Services Task Force recommendations (The Community Guide, n.d.). Follow-up of this patient should be within three weeks of start of therapy, to assess progress and compliance to therapy (Berthold, 2011).Integration of Conceptual and Theoretical Frameworks.