Theoretical and scientific foundations of nursing

PracticeProblemAsaCriticalQuestionwithMeasurableOutcomes.edited1.docx

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Practice Problem as a Critical Question With Measurable Outcome

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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.

DISCUSSIO1.docx

DISCUSSION

TRANSLATION OF EVIDENCE AND APPLICATION

Based on your work in previous modules, you will wrap up the course with a Discussion on challenges in translating and applying evidence to implement a quality improvement initiative. Draw on your experience in your current or previous health care settings to consider specific barriers to address and opportunities to leverage in advocating for evidence-based practice quality improvement.

TO PREPARE:

· Review the readings in the White, Dudley-Brown, and Terhaar text. With your current health care organization, or an organization you are targeting for your DNP Project, in mind, consider the area(s) of greatest challenge with regard to translating and applying evidence for a practice change initiative, e.g., leadership, technology, collaboration, stakeholder buy-in. Focus on the relevant text chapter(s) in your Discussion preparation.

· Consider theories and best practice recommendations for addressing your identified challenges and barriers to translating and applying evidence that would support practice change initiatives.

· Reflect on the philosophy of nursing practice that you developed in Modules 1–2. Consider your role as a DNP in creating an organizational culture that embraces evidence-based practice and quality improvement.

With these thoughts in mind …

Post an explanation of the challenges and barriers to translating and applying evidence for practice change in your target health care organization. Briefly explain your issue(s) of concern and describe specific approaches for addressing these challenges. Explain how you view your role as a DNP in creating a health care culture that promotes translation of evidence for quality improvement and explain why. Then, recommend actions and activities you could model and lead, including through an EBP QI project, to advocate for quality improvement and social change in nursing. Be specific and provide examples.