Respond to your colleagues suggesting an additional biomedical theory or model that may be utilized in their specific practice area. Also provide additional insights on how the theory helps improve health care practices and thus health outcomes.
Note what you learned and/or any insights you gained as a result of the comments made by your colleague
DISCUSSION
A biomedical model used frequently in healthcare to improve patient outcomes is the web of causation (McEwen & Wills, 2019). This theory stems from the idea that health problems have many contributions that are rarely simple to solve (McEwen & Wills, 2019). The web of causation theory helps healthcare workers understand how social determinants, social factors, and biomedical etiological factors influence one disease process (Ventriglio et al., 2016). Healthcare providers must understand how various factors influence most disease processes so that patients are appropriately screened and given sufficient education to avoid and treat disease processes. For example, childhood obesity is a problem that has a variety of factors influencing it. Childhood obesity can be caused by genetic influence, behavioral factors, socioeconomic status, and environmental factors (Lacrimioara et al., 2018). Understanding the web of causation in childhood obesity allows healthcare providers to screen for risk factors before obesity starts and consider which specific factors need to be treated when working with a child who is obese. The web of causation is a fundamental theory that can be used throughout healthcare to improve patient outcomes.
Genetic principles and theories are utilized daily in my practice area. Genomic and environmental influences should be considered when looking at risk-factors for cancer (Mahon, 2009). The same is true when considering assessing psychiatric risk factors. As a psychiatric mental health nurse practitioner (PMHNP), genetics play a large role in diagnosing and treating my patients. Nurses who “think genetically” can ask appropriate questions to assess for genetic risk factors, educate patients on inherited risks, and make referrals for genetic counseling (McEwen & Wills, 2019). Nurses can use genetic knowledge by obtaining a family history, updating a family pedigree, evaluating factors that influence gene expression, and assessing lab results (Pestka et al., 2010). An example of how this helps me provide care is when evaluating a person who is seeking care for depression. Since I understand that treating someone who is bipolar with an antidepressant could put the patient into a psychiatric crisis by causing a manic episode, I ask several questions to screen for the possibility of bipolar disorder. This screening includes asking if there is a family history of bipolar disorder, asking about any known psychotropic medication trials and results within the family, and asking about current substances that could influence gene expression. Another example of how genetic principles and theories are utilized in my practice is pharmacogenetic testing. Our practice is utilizing pharmacogenetic testing fairly regularly when medication-resistant patients have failed multiple medication trials. Pharmacogenetic testing helps address the issue of the ‘trial-and-error’ prescribing of medications in psychiatry, and it is a promising treatment that can provide substantial benefit to patients (Yoshida et al., 2019). This testing allows us to determine what medications that patient metabolizes slower than usual and faster than expected to help us understand whether or not they need lower or higher doses of medications to be effective.
References
Lacrimioara, S. C., Mihai, S. D., Ioana, B. S., & Diana, L. (2018). Web of causation between dietary patterns and childhood
obesity: Applying Hill’s criteria. Romanian Journal of Diabetes Nutrition and Metabolic Diseases, 25(4), 431-438.
https://doaj.org/article/f18e6e1bc1f746a5b3d901dd027fd37b
Mahom, S. M. (2009). Cancer genomics: Advocating for competent care for families. Clinical Journal of Oncology Nursing,
13(4), 373-376. doi:10.1188/09.CJON.373-376
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.) Philadelphia, PA: Wolters Kluwer Health
Pestka, E. L., Burbank, K. F., & Junglen, L. M. (2010). Improving nursing practice with genomics. Nursing Management,
41(3), 40-44. doi:10.1097/NUMA.0000369499.99852.c3
Ventriglio, A., Bellomo, A., & Bhugra, D. (2016). Web of causation and its implications for epidemiological research.
International Journal of Social Psychiatry, 62(1), 3-4. doi:10.1177/0020764015587629
Yoshida, K., Muller, D. J., & Kennedy, J. L. (2019). The coming-of-age of pharmacogenetic testing in clinical psychiatry.
Psychiatry and clinical neurosciences, 73(5), p. 203. doi:10.1111/pcn.12832
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