Theoretical and Scientific Foundations of Nursing

4

Addressing High Relapse Rates in Bipolar Patients as a Quality Improvement Initiative

Synthesis of Articles Selected

Although effective drugs for the condition are available, bipolar disorder remains one of the significant causes of disability, mortality, and functional decline, significantly reducing patients' quality of life. Rantala et al. (2021) highlight Cognitive-Behavioral Therapy (CBT) as an effective evidence-based strategy for reducing relapse rates in bipolar patients. CBT can help patients recognize and manage symptoms and triggers, enhancing coping skills and reducing the risk of relapse. If individuals with bipolar disorder are not given proper treatment and follow-up, the disorder usually relapses during their lives (McIntyre et al., 2020). For individuals with bipolar disorder, discontinuing medication against the recommendations of mental health specialists may cause a recurrence of mood episodes, delayed remission, and residual symptoms (O'Donovan & Alda, 2020). These outcomes commonly result in hospitalization, heightened risk of suicide, and hindered psychosocial recovery (Rantala et al., 2021). On the other hand, adhering to recommended treatment plans reduces patients' chances of recurrence by spacing out episodes and giving them more time in the euthymic, stable state (O'Donovan & Alda, 2020). Relapse worsens the symptoms of bipolar disorder. Manic and depressive episodes affect patients significantly, disrupting their daily lives. These patients often struggle to function effectively in various life aspects, including work and relationships. Integrated care can ensure comprehensive disorder management (Davarinejad et al., 2021).

Language to Use With Stakeholders

When addressing stakeholders of bipolar disorder EBP QI, including patients, their families, health care professionals, hospital administration, and the broader community, it is essential to communicate in a respectful and empathetic language. An empathetic and supportive tone shows that one understands the problem, acknowledges the challenges individuals and families face, and is determined to bring practical solutions to the problem. Using a language that educates stakeholders about the condition is also essential. Furthermore, it is important to use clear and simple language so that patients unfamiliar with complex medical terms can understand the intended message.

References

Davarinejad, O., Majd, T. M., Golmohammadi, F., Mohamadi, P., Radmehr, F., Nazari, S., & Moradinazar, M. (2021). Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder.  Shiraz E-Medical Journal,  22(8).

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders.  The Lancet,  396(10265), 1841-1856.

O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder.  Frontiers in psychiatry,  11, 500.

Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2021). Bipolar disorder: An evolutionary psychoneuroimmunological approach.  Neuroscience & Biobehavioral Reviews,  122, 28-37.

2

Practice Problem as a Critical Question With Measurable Outcome

Student’s Name

Institution

Course number and name

Assignment due date

Practice Problem as a Critical Question With Measurable Outcome

Critical Question

Evidence-based practice quality improvement (EBP QI) is essential in nursing since it helps nurses identify and implement best practices that have been proven to improve patient outcomes. Integrating evidence-based interventions into practice reduces complications, enhances recovery times, and improves overall patient well-being. My practice issue is bipolar disorder. A critical question about bipolar disorder that calls for EBP QI is how nurses can reduce relapse rates in individuals with bipolar disorder.

Bipolar disorder is a mood disorder and a terminal, severe, and recurrent mental issue. People with the disorder experience serious changes in their mood. Although effective drugs for the condition are available, bipolar remains one of the significant causes of disability, mortality, and functional decline, significantly reducing patients' quality of life (Rantala et al., 2021). If bipolar patients are not given proper treatment and follow-up, the disorder usually relapses during their lives. Relapse is a significant therapeutic challenge for individuals with mental illnesses, particularly those with bipolar disorder. It imposes significant economic and societal costs. Relapse is a term used frequently in the mental health delivery system to describe the deterioration of psychiatric patients' conditions and the return of illness following an apparent period of recovery. Bipolar patients who choose to discontinue their medication against the recommendations of mental health specialists may have a recurrence of mood episodes, delayed remission, and residual symptoms. These outcomes commonly result in hospitalization, heightened risk of suicide, and hindered psychosocial recovery (Rantala et al., 2021).

The Value of Addressing High Relapse Rates in Bipolar Patients as a Quality Improvement Initiative.

Focusing on the reduction or relapse rates should be a focus of a quality improvement initiative since relapse undermines outcomes for patients with bipolar disorder. According to research, over 90% of patients with the condition experience relapse during their lifetime, usually within the first two years of an initial episode (Davarinejad et al., 2021). Relapses in bipolar disorder are reasonably common. Numerous studies have been conducted to determine the precise relapse rate but have shown varying results. In summary, the longer one has bipolar disorder, the greater the likelihood of relapse (Davarinejad et al., 2021). On the other hand, sticking to medicine and treatment plans reduces patients' chances of recurrence by spacing out episodes and giving them more time in the euthymic, stable state. One of the significant goals of an evidence-based treatment plan is to keep bipolar disorder from relapsing.

The specific subtype of bipolar disorder influences the frequency of relapse that an individual has. Individuals diagnosed with bipolar II disorder experience a higher frequency of depressive episodes and a comparatively reduced length of euthymic periods in comparison to individuals diagnosed with bipolar I disorder (McIntyre et al., 2020). While Bipolar I and II may appear to be similar, there is a key difference between the two subtypes of the disorder. Individuals with bipolar I experience at least one manic episode in their lifetime. However, those with bipolar II also experience at least one manic episode but the mania is less severe hypomania. When experiencing manic episodes, patients with bipolar I typically experience more severe symptoms that interfere with their daily lives (McIntyre et al., 2020).

The length of an episode subsequent to relapse in individuals with bipolar disorder shows significant variability. The duration of symptoms associated with mania or depression can range from a period of one to two weeks to an extended duration of many months. Several variables influence the duration of symptom manifestation, including the specific subtype of bipolar disorder that an individual has and whether they are undergoing treatment.

Patients with bipolar I disorder who are not undergoing any treatment can have manic episodes lasting for a week to many months in some cases. These patients experience depressive episodes with irregular attacks of hypomania (O'Donovan & Alda, 2020). Hypomania is a less severe type of mania. Episodes of hypomania last at least four days, but depressive episodes typically last longer than that.

The impacts of relapse are significant for bipolar patients. Relapse worsens the symptoms of bipolar. Manic and depressive episodes affect patients significantly, disrupting their daily lives. These patients often struggle to function effectively in various life aspects, including work and relationships (Davarinejad et al., 2021). Individuals with bipolar disorder may also turn to substance abuse as a way of coping with severe mood swings and distress brought on by relapse. Substance abuse significantly affects patient outcomes. It is also important to note that after relapse, some patients may become less compliant with treatment plans, worsening their condition (Davarinejad et al., 2021). Given the adverse effects of bipolar disorder relapse, there is a need for EBP QI aiming to reduce relapse rates.

References

Davarinejad, O., Majd, T. M., Golmohammadi, F., Mohamadi, P., Radmehr, F., Nazari, S., & Moradinazar, M. (2021). Factors Influencing the Number of Relapse in Patients with Bipolar I Disorder.  Shiraz E-Medical Journal,  22(8).

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., ... & Mansur, R. B. (2020). Bipolar disorders.  The Lancet,  396(10265), 1841-1856.

O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder.  Frontiers in psychiatry,  11, 500.

Rantala, M. J., Luoto, S., Borráz-León, J. I., & Krams, I. (2021). Bipolar disorder: An evolutionary psychoneuroimmunological approach.  Neuroscience & Biobehavioral Reviews,  122, 28-37.

Synthesizing Your Sources

To demonstrate your knowledge on a field through a review of literature, the key component is synthesis. To synthesize is to combine independent elements and form a cohesive whole; in essence, your literature review should integrate your sources and

· Identify patterns

· Critically discuss strengths and weaknesses of sources or the field

· Compare and contrast methods, approaches, and findings of authors

· Evaluate and interpret what is known in your field and what, if anything, is missing

A Metaphor for Synthesis

Imagine you are at a dinner party with other researchers and theorists from your field. Everyone is sitting around the table and discussing the state of your field of research. The beginning portion of your literature review would be similar to those dinner party guests who started the conversation by discussing foundational research and theories. The body of your literature review could take many forms: What guests are agreeing, and which are arguing? What are the debatable issues, and are there any subtopics of those key topics? Does one particular guest keep interrupting the table's conversation? The final portion of your literature review would be similar to the host of the dinner party ending the debate with a comprehensive speech that touches on all opinions yet provides closure for the conversation.

Local and Global Synthesis

When writers synthesize successfully, they present new ideas based on interpretations of other evidence or arguments. In a literature review, it can helpful to think about synthesis occurring at both the local (or paragraph) level and the global (or section/paper) level.

Local Synthesis

Local synthesis occurs at the paragraph level when writers  connect individual pieces of evidence from multiple sources  to support a paragraph’s main idea and advance a paper’s thesis statement. A common example in academic writing is a scholarly paragraph that includes a main idea, evidence from multiple sources, and analysis of those multiple sources together.

Example: Based on the metaphor above, local synthesis would occur during each individual conversation item. So, if you brought up a single issue within your topic, and several prominent scholars agree, while others disagree, you would represent this debate of a singular issue in that paragraph.

Global Synthesis

Global synthesis occurs at the paper (or, sometimes, section) level when writers connect ideas across paragraphs or sections to create a new narrative whole. In a literature review, which can either stand alone or be a section/chapter within a capstone, global synthesis in integral for cohesion and flow.

Example: Using the same dinner party metaphor, global synthesis occurs when a writer take a birds-eye view of the entire dinner party. What major topics were discussed and how were they linked to other ideas or conversations? What dinner party guests contributed to what ideas? And, finally, where did the guests leave the conversation at the end of the night? A summary of your dinner party, with its multiple guests and discussions, is what ultimately will bring order to major themes within your larger topic.

Tips for creating global synthesis within a literature review:

· Use thematic headings to create an intentional narrative order.

· Quick Tip: Create a heading outline to think through which headings should be placed where.

· Use  topic sentences  for each paragraph that clearly link ideas between paragraphs.

· Incorporate appropriate  transitions  throughout your draft to clearly connect ideas.

Related Resources

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Incorporating Analysis and Synthesis (webinar)

·

Literature Review and Annotated Bibliography Basics (webinar)

·

Writing Literature Reviews in Your Graduate Coursework (webinar)

Writing Center webinar (master's and doctoral coursework students)

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