Theoretical and Scientific Foundations of Nursing

Roshni Patel

PEER Response

 

          The initial post effectively outlines the practice problem, the evidence from the literature review, and the need for a practice change initiative related to bipolar disorder. However, there are a few suggestions to help sharpen the explanation of the problem-evidence-change initiative linkage.

            While the post mentions the practice problem as bipolar disorder and its associated relapse rates, it would be beneficial to provide a brief yet clear definition or description of the problem. This will help readers, especially those who may not be familiar with the subject, to understand the issue more comprehensively. To emphasize the seriousness of the practice problem, consider including relevant statistics or data on the prevalence of relapse rates in individuals with bipolar disorder (McCombes, 2023). This quantitative information can make the problem more tangible.

          In addition to discussing the adverse effects of relapse, such as increased suicide risk, the post could elaborate on the broader consequences of high relapse rates in terms of healthcare costs, patient quality of life, and the burden on healthcare systems. This helps underscore the significance of addressing the problem. Also, to strengthen the linkage between the evidence and the practice problem, explicitly connect each piece of evidence to the problem it addresses (Henning, 2011). For example, when discussing cognitive-behavioral therapy (CBT), specify how CBT directly relates to reducing relapse rates in bipolar disorder. This clarity will reinforce the relevance of the evidence.

          While the need for a practice change initiative is mentioned, consider discussing the limitations or gaps in current practice related to managing bipolar disorder. This can further illustrate why change is necessary. Although the need for a practice change initiative is acknowledged, providing more details about the proposed changes and interventions can enhance the post. Specify what nurses can do differently to reduce relapse rates, whether it involves specific programs, protocols, or guidelines.

 

References

Henning, T. B. (2011). Literature Review: Synthesizing Multiple Sources. LSU - Louisiana State University.

          https://www.lsu.edu/hss/english/files/university_writing_files/item35404.pdf

McCombes, S. (2023). How To Synthesize Written Information From Multiple Sources. Simply Psychology.

          https://www.simplypsychology.org/synthesising.html

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.

5

Title of the Paper in Full Goes Here

Student Name Here

Program Name or Degree Name, Walden University

Course Number, Section, and Title

(Example: NURS 0000 Section 01, Title of Course)

Instructor Name

Month, Day, Year

(enter the date submitted to instructor)

Title of the Paper

This is your introductory paragraph designed to inform the reader of what you will cover in the paper. ( BSN Students - Carefully follow your course-specific Grading Rubric concerning the content that is required for your assignment and the Academic Writing Expectations [AWE] level of your course.) This template’s formatting—Times New Roman 12-point font (other options include Calibri 11, Arial 11, Lucida Sans Unicode 10, and Georgia 11), double spacing, 1” margins, 1/2” indentations beginning of each paragraph, page numbers, and page breaks—is set for you, and you do not need to change it. Do not add any extra spaces between the heading and the text (you may want to check Spacing under Paragraph, and make sure settings are all set to “0”). The ideas in this paper should be in your own words and supported by credible outside evidence. Cite the author, year of publication, and page number, if necessary, per APA. The introductory paragraph should receive no specific heading because the first section functions as your paper’s introduction. Build this paragraph with the following elements:

1. Briefly detail what has been said or done regarding the topic.

2. Explain the problem with what has been said or done.

3. Create a purpose statement (also commonly referred to as a thesis statement) as the last sentence of this paragraph: “The purpose of this paper is to describe…”.

Level 1 Heading (Name According to the Grading Rubric Required Content)

This text will be the beginning of the body of the paper. Even though this section has a new heading, make sure to connect this section to the previous one so the reader can follow along with the ideas and research presented. The first sentence, or topic sentence, in each paragraph should transition from the previous paragraph and summarize the main point in the paragraph. Make sure each paragraph addresses only one topic. When you see yourself drifting to another idea, make sure you break into a new paragraph. Avoid long paragraphs that are more than three-fourths of a page. Per our program recommendations, each paragraph should be at least 3-4 sentences in length and contain a topic sentence, evidence, analysis, and a conclusion or lead out sentence. See the MEAL plan (Main idea, Evidence, Analysis, and Lead out) in the Writing Center. In your paragraphs, synthesize your resources/readings into your own words and avoid using direct quotations. In the rare instances you do use a direct quotation of a historical nature from a source, the page or paragraph numbers are also included in the citation. For example, Leplante and Nolin (2014) described burnout as "a negative affective response occurring as result of chronic work stress" (p. 2). When you transition to a new idea, you should begin a new paragraph.

Another Level 1 Heading (Name According to the Grading Rubric Required Content)

Here is another Level 1 heading. Again, the topic sentence of this section should explain how this paragraph is related to or a result of what you discussed in the previous section. Consider using transitions between sentences to help readers see the connections between ideas.

Be sure to credit your source(s) in your paper using APA style. The APA Manual 7th edition and the Walden Writing Center are your best citation resources. Writing Center resources are available at https://academicguides.waldenu.edu/writingcenter/apa/citations. You must appropriately and correctly cite all works used in your document.

The following paragraph provides examples of in-text citation examples. According to Leplante (2019), employers cause burnout when employees are stressed by too much work. Or you might write and cite in this manner: Employers cause burnout when employees are stressed by too much work (Leplante, 2019). When paraphrasing, the author name and year of publication in citations is required by APA to direct the reader to a specific source in the reference list. Personal communications are not listed in the reference page but are noted in text as (S. Wall, personal communication, May 24, 2019). This should immediately follow the content of the interview. Also, go to

Another Level 1 Heading (Name According to the Grading Rubric Required Content)

APA can seem difficult to master, but following the general rules becomes easier with use. The Writing Center also offers numerous APA resources on its website and can answer your questions via email. Prior to submitting your paper for grading, submit your draft to SafeAssign Drafts found in the left column of your course.

And so forth until the conclusion….

Conclusion

The conclusion section should recap the major points of your paper. Do not introduce new ideas in this paragraph; the conclusion should interpret what you have written and what it means in the bigger picture.

References

Please note that the following references are intended as examples only. List your own references in alphabetical order. Also, these illustrate different types of references; you are responsible for any citations not included in this list. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list.

Journal Article; Two Authors; DOI

Leplante, J. P. & Nolin, C. (2014). Consultas and socially responsible investing in Guatemala: A case study examining Maya perspectives on the Indigenous right to free, prior, and informed consent. Society & Natural Resources, 27(4), 231–248. https://doi.org/10.1080/08941920.2013.861554  

Journal Article, Two Authors; URL

Eaton, T. V., & Akers, M. D. (20007). Whistleblowing and good governance. CPA Journal, 77(6), 66–71. http://archives.cpajournal.com/2007/607/essentials/p58.htm

Journal Article, More Than Twenty Authors; DOI

Wiskunde, B., Arslan, M., Fischer, P., Nowak, L., Van den Berg, O., Coetzee, L., Juárez, U., Riyaziyyat, E., Wang, C., Zhang, I., Li, P., Yang, R., Kumar, B., Xu, A., Martinez, R., McIntosh, V., Ibáñez, L. M., Mäkinen, G., Virtanen, E., . . . Kovács, A. (2019). Indie pop rocks mathematics: Twenty One Pilots, Nicolas Bourbaki, and the empty set.  Journal of Improbable Mathematics,  27(1), 1935–1968. https://doi.org/xxx/xxxxxx

Book; One Author

Weinstein, J. A. (2019). Social change (3rd ed.). Rowman & Littlefield.

Book; Chapter in an Edited Book

Christensen, L. (2020). For my people: Celebrating community through poetry. In B. Bigelow, B. Harvey, S. Karp, & L. Miller (Eds.), Rethinking our classrooms: Teaching for equity and justice (Vol. 2; pp. 16–17). Rethinking Schools.

Professional Organization Web page

Centers for Disease Control and Prevention. (2018). Back to school. https://www.cdc.gov/features/teens-back-to-school/index.html

Professional Organization Book

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.).

Two or more works by same author in the same year

Wall, S. (2018a). Effects of friendship on children’s behavior. Journal of Social Psychology, 4(1), 101–105.

Wall, S. (2018b). Trials of parenting adolescents with deviant behaviors. Journal of Child Psychology, 4(12), 161–167.

Government Article

National Institute of Mental Health. (1990). Clinical training in serious mental illness (DHHS Publication No. ADM 90-1679). U.S. Government Printing Office.

Lecture Notes

Health effects of exposure to forest fires [Lecture notes]. (2019). Walden University Blackboard. https://class.waldenu.edu

Personal Communication (Only Goes in Body of Paper and not in References)

Video

Walden University. (2009). Title of video here [Video]. Walden University Blackboard. https://class.waldenu.edu

Television (Audio)

Important, I. M. (Producer). (1990, November 1). The nightly news hour [TV series episode]. Central Broadcasting Service.

APA Resources

You have other several options to assist you in the formulation of your reference page.

· Your American Psychological Association (APA) Manual is your best reference resource. Use the current edition with a copyright date of 2020.

· The Walden Writing Center also a great place for referencing advice at https://academicguides.waldenu.edu/writingcenter/apa/references .

· Citation and reference examples are provided in the ‘BSN TOP Ten References and Citations” handout found in the Writing Resources tab of the course. This document covers the 10 most commonly used reference and citation formats. You are responsible for looking up any that are not included on this list.