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__________________________________________________________________________________
Part 1: Scientific and Theoretical Foundations for Advanced Nursing Practice
See Mrs. Mendez case (File attached)
1 Make a list of key concepts relevant to the case study.
a. Identify PHYSICAL key concepts relevant to Mrs. Mendez and 2 family members
2. Describe one nursing middle-range theory associated with the concepts of interest (PHYSICAL key concepts) and explain why
a. Give an example from the case for its selection (PHYSICAL key concepts).
3. Give deep information about the theory selected and defense your selection.
4. Discuss how the selected theory guides both your clinical assessments and interventions for Mrs. Mendez or her family.
a. How it influences your assessment questions
b. How it influences your selection of interventions for Mrs. Mendez and her family members.
5. Explain how knowledge from interprofessional health-related sciences informs advanced nursing practice.
a. provide an example
Part 2: Conceptual Frameworks or Theories Relevant to your Clinical Problem and Population of Interest
Clinical problem: hypertension
Target population: Hispanic elders
1. Provide an introduction to the clinical problem of interest in a specific patient population, include:
a. Describe your perceived need for change in practice and the rationale for such change
b. Discuss the incidence and prevalence of the clinical problem
c. Discuss the significance of the problem.
2. Identify two conceptual theories that may be applied to the study of the clinical problem within the context of the target population.
3. Summarize the major propositions of each theory separately
4. Discuss how the conceptual framework or theory is relevant to the clinical problem and target population.
Part 3: Concept Identification, Analysis, Middle Range Theory Development, and Clinical Application
Purpose: By defining, describing, and analyzing concepts, nurse scholars can develop a better understanding of how events and experiences, important to advanced practice nursing, are related to other concepts. This understanding can be used to develop middle-range theories which can focus on nursing assessments and can be tested through research to develop evidence-based interventions.
Watch the film “Breathing Lessons: The Life of Mark O’Brien” as a case study which you can find on the internet.
1. Make a list of all of the concepts that you identify as relevant to the nursing care of Mark.
2. Select from your list (Question 1) three concepts that you believe are related
a. Provide a conceptual definition for each of the three selected concepts based on a review of 1 literature article per each concept.
3. Create a middle-range theory for addressing the case
4. Identifies the propositions and relationships among the concepts in your middle range theory
5. Draw a conceptual map/diagram that illustrates how the concepts are related in your middle range theory
6. Apply knowledge of the characteristics of the three concepts (Question 2) in formulating at least two nursing assessment questions for each of the three selected concepts of your middle-range theory.
7. Compare and contrast your middle range theory with another middles range theory guiding advanced practice nursing in the care of Mark O’Brien nursing based on the literature.
8. Is your thinking consistent with another theorist’s theory? yes or not, and why
9. Explain why you are a nurse theorist.
The Impact Of Living
With A Long-Term Condition Exam (We Deliver Top Grades)
There is increasing
prevalence of people with long term conditions within the UK population
(Department of Health, 2012). Long term conditions are chronic diseases which
cannot be cured; however, they can be managed by medication and other
treatments (The King’s Fund, 2017). Treatments given to patients for long term
conditions seem to be more effective when their focus is on promoting overall
wellbeing and functional independence, instead of solely focusing on treating
medical symptoms (The King’s Fund, 2013). Therefore, this essay will discuss
the impact of living with a long-term condition. The chosen condition for this
essay is arthritis as approximately ten million people in the UK have this
condition (NHS, 2016). Specific reference will be given to the most common form
of arthritis, osteoarthritis (NHS, 2016). The physical, social and
psychological impact of arthritis will be discussed. Furthermore, the essay
will explore further complications of this condition.
The initial impact of
osteoarthritis on an affected joint is the degeneration of the cartilage
lining. As joint cartilage allows bones to glide over each other, degenerated
cartilage causes the joint to have difficulty in performing its usual movements
(NHS, 2016). Also, as the cartilage of the affected joint gradually thins out,
the tendons and ligaments of the joint have to work harder to create movement,
which results in joint inflammation and the formation of Osteophytes. This
eventually results in the bones of the affected joint rubbing against each
other (NIH, 2016): hence patients of osteoarthritis often report pain as a
major issue. However, the intensity of pain experienced by patients varies and
it is influenced by a variety of factors including medical conditions, age,
psychosocial factors and physical changes, including which joint is affected by
the condition (Arthritis Foundation, 2016; Backman, 2006). Knee osteoarthritis
patients often report intermittent weight-bearing pain which later changes into
a more persistent pain (Neogi, 2013).
Knee osteoarthritis
can severely impact the physical ability of patients. This includes difficulty
in walking and climbing stairs (Motiwala et al,
2016). As joint mobility is maintained by physical activity, limited movement
or maintaining the same position for prolonged periods of time can cause joint
stiffness (Kalunian, 2014; NIAMS, 2016). Joint
stiffness can cause the individual to take longer to perform their daily living
activities, such as getting out of bed in the morning. It can be difficult for
an osteoarthritis patient to manage the conflicting demands of staying mobile
whilst experiencing pain. The impact of limited movement significantly affects
all the dimensions of Health-Related Quality of Life, including a possible
impact on the emotional and mental health of the patient. Hence, improvements
in emotional and mental health were recognized in patients who had undergone a
successful total knee anthroplasty operation and no
longer faced the barriers of Knee osteoarthritis (Fernandez-Cuadros,
2016).
Similarly, limited
movement can influence the individual’s involvement in society, such as not
being able to physically attend or perform leisure and social activities
(Vaughan, 2016). Limitations may include events which are important to their
happiness and wellbeing such as participating in religious programs (Aghdam et al, 2013). This can influence the individual’s
self-esteem and self-image (Sheehy et al, 2006) and possibly cause the
individual to experience negative emotional states of depression and anxiety
(Murphy et al, 2012). Despite a lack of research having been conducted on the
psycho-social consequences of osteoarthritis, it seems like ageing adults may
be at higher risk of developing depression, and they may also be more likely to
experience a higher intensity of pain in comparison to those who are not
depressed (Dziechciaż et al, 2013). A patient
suffering from co-morbidities such as chronic depression and a form of
arthritis is more likely to have worse health outcomes than their counterparts
who suffer from only one condition (Margaretten et
al, 2011). If the individual is diagnosed with chronic depression, they are
also likely to be subject to more pharmacological interventions such as
anti-depressants as well as pain management medication. This puts the
individual at increased risk of adverse effects of medication (EUMUSC, 2013).
Employed individuals with osteoarthritis need to ensure that
their abilities balance the external environmental factors of their workplace.
This will more likely allow the individual to work and manage their symptoms in
comparison to an unfavorable situation which may cause an individual’s symptoms
to further deteriorate (Hubertsson, 2015). Most
individuals with osteoarthritis continue to suffer with pain throughout their
life, and over time their function decreases (Saulescu,
2016). This can result in them being unable to work due to very poor mobility.
Hence, unemployment can cause financial distress and complications for the
individual. Also, they may require support and care from others. Often, care is
provided informally by relations and a formal care plan is usually not in place
(Barker et al, 2016). Despite this care being beneficial to the individual with
osteoarthritis, it can negatively create stress and impact upon the lives of carers.
Current research still has not successfully identified why the
pain experienced by osteoarthritis patients is extensively varied (University
of Manchester, 2014). Therefore, the impact of living with osteoarthritis can
differ incredibly amongst sufferers. This is reflected in a study which
analyzed pain experienced by depressed and non-depressed women with
fibromyalgia and/or osteoarthritis. The study suggested that depression did not
change the pain experienced; however depressed women recovered only when they
experienced positive moods in comparison to their counterparts who recovered in
both positive and negative moods (Davis et al, 2014). Hence, exploring the
impact of osteoarthritis on the psychological wellbeing of a patient can be
extremely important in managing the condition. This can encourage the
individual to form truer attitudes towards their functional capability and gain
a better understanding of the disease (Purdy et al, 2014). osteoarthritis
patients may choose to access psychological therapies such as talking therapies
to support them with managing depression (NHS, 2015b; Arthritis Research UK,
2016a). Symptoms of anxiety and sleep disturbances have also been reported by
patients’ (Harris et al, 2012; Busija et al, 2013).
Sleep disturbances have been associated with pain and depression
amongst patients with knee osteoarthritis (Parmelee, 2015). Patients
experiencing high levels of pain are more likely to have sleep disturbances,
hence putting them at higher risk of developing depression. Long term sleep
deprivation can also impact bodily immunity, hence putting individuals at
higher risk of developing infections (Ibarra-Coronado et al, 2015).
Furthermore, recent research suggests that sleep deprivation can trigger immune
system abnormalities, hence possibly causing autoimmune disease (Sangle et al, 2015). Therefore, the impact of
osteoarthritis can lead to further complications on the health and wellbeing of
the individual.
Possible complications of osteoarthritis include developing gout
(Arthritis Research UK, 2016b). gout can be an extremely painful disease due to
the sudden pain attacks the individual experiences (NHS, 2015a). The management
of gout includes lifestyle changes e.g. dietary changes to prevent further
attacks from the condition. Hence, an individual suffering from osteoarthritis
and gout has the difficulty of managing their pain as well as making specific
lifestyle changes. Maintaining a healthy weight is important for the management
of both conditions and beneficial to the overall health and wellbeing of the
patient. arthritis generally seems to be more prevalent in individuals with
limited physical activity or who are obese (Furner et al, 2011). Hence,
overweight patients with osteoarthritis need to lose weight to reduce the
stress on weight-bearing joints to promote mobility and reduce the risk of
developing further health problems (NIAMS, 2016). However, maintaining a
healthy weight can be extremely difficult for an individual who is suffering from
pain, depression, anxiety and sleep disturbances as their physical limitations
and emotional state may act as a barrier. osteoarthritis is also a leading
cause of disability worldwide. Patients of osteoarthritis are at an increased
risk of mortality due to the risk of developing comorbidities (EUMUSC, 2013).
To summarize, the impact of living with
osteoarthritis varies amongst sufferers. Due to osteoarthritis being a
progressive disease all individuals suffer from the degeneration of the
cartilage lining, which can cause physical changes such as the rubbing of bones
and osteophytes. The impacts of these physical changes are joint inflammation
and stiffness, which predominantly determine the severity of pain experienced
by the individual and their ability to function. Individuals often face
limitations in the daily living activities they can perform. The pain
experienced by individuals varies and it is dependent on a variety of factors
including age. However, further research is needed on why some individuals
experience greater pain than others. osteoarthritis can also have psycho-social
impact on the individual through sleep disturbances, depression and anxiety.
Sleep disturbances can negatively impact the immune system, making the
individual more vulnerable to developing infections. There is a strong
association between depression and arthritis: hence individuals suffering from
both are more likely have worse health outcomes.
