CAPÍTULO II MARCO TEÓRICO
EFECTOS TERAPÉUTICOS DE LA OHB
Scholarly project dissemination is one of the major components of the DNP project. Through dissemination, the project will be exposed to a larger audience. According to Carter-Templeton (2015), research dissemination has become extremely important in nursing’s era of evidence-based practice. DNP capstone projects have the potential to offer new findings or validate best practices and nursing interventions. Sharing this information with nurses who can use it in practice may help address the practice gap. Information that can be shared in the form of articles can provide evidence for nurses to use and offer a road map for study replication resulting in an extension of what is known about best practices and nursing interventions and their impact on patient outcomes. Capstone projects should represent and illustrate the result of knowledge and skills gained throughout DNP courses and activities. In section 5 I will discuss project dissemination plan and self-analysis.
Project Dissemination
I presented the implemented project to the chief medical officer, who is one of the key stakeholders of the field site, she was impressed with the project and will discuss with the information technology group the need for incorporation in the clinic’s EHR a section to record SMI patients’ baseline labs, weight, height, waist circumference and future recordings so that providers and other medical team members will be able to track the findings throughout duration of treatments with SGAs. The project will be
disseminated in the field site through in-service training of the medical staff and also during new staff orientation for medical staff. Another way my project will be
disseminated is through submission for publication in the Journal of the American Association of Nurse Practitioners (JAANP) and ProQuest.
Analysis of Self
My educational journey started while in my country Nigeria. I completed both my nursing and midwifery programs while in my country and was a nurse-midwife before migrating to the United States. I’m the middle child and the third of six children. Our mother died when I was 11 years old. After her death, my eldest sibling, my brother died at the age of 20 years from sickle cell disease. My youngest sibling and sister became very ill, and I was left to take care of her after my immediate older sister left home to live in the city for job training. Taking care of my little sister was a turning point in my life, from which I developed the passion to care for the sick. My sister later died after I left home to start my nursing education in the city. I completed my Bachelor of Science Nursing (BSN) degree after arriving in the United States. While pursing my BSN, I had a full-time job as a charge nurse in a nursing home. Many nurses were moved and
determined to go back to school to get their BSN, too, by following my footsteps. I was married with six children at the time I went back to school to get my master’s degree. My husband has moved back to my country and I was left to take care of six children alone. I started my master’s degree initially at Thomas Jefferson University in Philadelphia Pennsylvania and dropped out of the program in 2008. I picked up the courage to return to school in 2014 and was accepted to Walden University’s Adult-Geriatric MSN program. I was able to complete the program in 2015. I decided to go back to school to complete my DNP program; it was a very tough journey with six children, married, but
more of a single parent of six children with no support, and with full-time job. I told my children that with determination, you can achieve whatever you want to achieve in life.
My current practice is in a mental health outpatient clinic. More of the patients seen in this setting are low income persons from the African American community. The majority of the patients are unemployed. Patients with SMI have problems with trust and I want to make a big impact in their lives. There is a practice gap in the clinic related to monitoring the patients with SMIs for the development of MetS. It is important for the mental health providers to collaborate with the SMI patients primary care physicians to ensure that both their medical and mental health needs are managed adequately, which is in alignment with DNP Essential VI: Inter-Professional Collaboration for Improving Patient and Population Health Outcomes, enabling DNP nurses to take a leadership role in development and implementation of practice models, standards or care, and other scholarly projects (AACN, 2006).
The development of the education module on MetS relied on my experience from working at the mental health outpatient clinic for over 2 years. Through the experience I observed that most of the psychiatrists who work in the clinic isolate mental health from medical problems. Some of them also fail to ask the patients with SMI how often they visit with their PCP. Knowing if patients have a regular PCP is very important to ensure that their medical needs are not left out. PCPs of the patients with SMI are responsible to manage their medical problems including MetS, which is a major side effect of SGAs. It is imperative for the mental health providers to have patients’ PCP information in their
medical records to facilitate collaborations between both providers whenever the need arises.
Analysis of Self as a Practitioner
I have practiced as an APRN for a period of 3 years, with specialty as an Adult- Geriatric Nurse Practitioner (AGNP). Prior to becoming an APRN, I worked in many nursing homes as a supervisor and a charge nurse. Prior to my current job as a clinical registered nurse practitioner (CRNP) in an outpatient mental health clinic, my first job was with an agency to conduct home assessments for the elderly in their homes. I had no previous mental health knowledge, beyond 2 months of orientation in a mental health institution in Nigeria as a student nurse and working with elderly patients in the nursing homes with depression, anxiety, and dementia. Patients with SMI are very vulnerable and most of these patients have suffered from traumatic events in their lives, which make it very difficult for them to trust people. I want to help the SMI population by providing services that will help them maintain optimal health in collaboration with other clinicians such as psychotherapists and primary care providers. As a result of the passion I have for this vulnerable population, I have decided to go back to school after the completion of my DNP program to obtain my post master’s degree or certification as a Family Psychiatric Mental Health nurse practitioner.
One of my goals after completing the DNP program is to become an instructor for the new generation nurses, especially through online education. My long-term goal is to establish my own independent practice in collaboration with a family practice physician. My journey as a DNP student has sharpened my leadership skills, and I’m going to use
these skills to become involved in resolving ongoing care gaps that require energetic actions based on best practices, teamwork, care coordination, and clinical leadership competencies at the point of care. I want to be a transformational leader who uses evidence-based strategies and an inclusive style for working within the complexity of health care and interdisciplinary teams.
Summary
I created and implemented an educational module on MetS which is a common side effect of SGAs, psychotropic drugs commonly used and preferred by mental health providers in the field site in the treatment of patients with SMI. Increased knowledge of MetS among nurses and providers in the clinic will promote effective monitoring of SMI patients for the development of MetS at the initiation of treatment with SGAs and
throughout the duration of the treatment. I used Kurt Lewin’s change theory as a guide to implement this scholarly project. The creation and implementation of this scholarly project was made feasible through the collaboration of the clinic staff. Five expert panelists were given Likert-type questionnaires which they answered anonymously. No adjustment was made on the module; the five expert panelists liked the content of the module and would recommend that the module be incorporated into the in-service training for the new medical staff during new hire orientation and periodically for the old medical staff members. DNP projects need to be disseminated and I will have this work published through ProQuest after graduation from my institution.
References
American Association of Colleges of Nursing (AACN) (2006). The essentials of doctorate education for advanced nursing practice. Retrieved from https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf American Diabetes Association; American Psychiatric Association; American
Association of Clinical Endocrinologists; North American Association for the Study of Obesity (2004). Consensus development conference on
antipsychotic drugs and obesity and diabetes. Diabetes Care, 27(2), 596-601. doi.org/10.2337/diacare.27.2.596
Carter-Templeton, H. (2015). DNP project to manuscript, Converting a DNP scholarly project into a manuscript. Retrieved from http://naepub.com/student-
authorship/2015-25-1-2/
Chee, G., Wynaden, D., & Heslop, K. (2017). Improving metabolic monitoring rate for young people aged 35 and younger taking antipsychotic
medications to treat a psychosis: A literature review
Archives of Psychiatric Nursing, 31(6), 624-633. Cunningham, C., Riano, N. S., Mangurian, C., (2018). Screening for metabolic syndrome in people with severe mental illness. Journal of Clinical
Outcomes Management, 25(1).
Gin-Liang, C. (2017). Improving metabolic monitoring rate for young people aged 35 and younger taking antipsychotic medications to treat a psychosis:
A literature review. Archives of Psychiatric Nursing, 31 (6), 624-633. Happell, B., Platania-Phung, C., Gaskin, C. J., & Stanton, R. (2016). Use of an electronic metabolic monitoring form in a mental health service: A
retrospective file audit. BMC Psychiatry, 16, 109. doi: 10.1186/s12888- 016-0814-9
Hermes, E. D., Sernyak, M. J., & Rosenheck, R. A. (2013). Prescription of second- generation antipsychotics: Responding to treatment risk in real-world practice.
Psychiatric services, 64(3), 238-244. doi: 10.1176/appi.ps.201200183
Hodges, B. C., & Videto, D. M. (2011). Assessment and planning in health programs (2nd ed.). Sudbury, MA: Jones & Bartlett.
Joseph, M. L., & Huber, D. L. (2015). Clinical leadership development and education for nurses: Prospects and opportunities. Journal of Healthcare Leadership, 7, 55–64. doi:10.2147/JHL.S68071
Kagal, U. A.Torgal, S. S., &Malleshappa, A. (2012).Prevalence of the metabolic syndrome in schizophrenic patients receiving second-generation
antipsychotic agents: A cross-sectional study. Journal of Pharmacy Practice, 25(3), 368-373. doi: 10.1177/0897190012442220.
Kioko, E., Williams, K., & Newhouse, B., (2016). Improving metabolic syndrome on patients on second generation antipsychotic medications. Psychiatric
Nursing, 30 (6), 671-677.
Laugharne, J., Waterreus, A. J., Castle, D. J. & Dragovic, M (2016). Screening for the metabolic syndrome in Australia: A national survey of psychiatrists’ attitudes and
reported practice in patients prescribed antipsychotic drugs. Australasian
Psychiatry, 24(1), 62-66. doi: 10.1177/1039856215618521
Lee, Y., Altschuld, J., & White, J. (2007). Effects of multiple stakeholders in identifying and interpreting perceived needs. Retrieved from,
https://www.researchgate.net/publication/6150911_Effects_of_Multiple_Stakehol ders_in_Identifying_and_Interpreting_Perceived_Needs
Lopuszanska, U. J., Skorzynska-Dziduszko K., Lupa-Zatwarnicka, K., Makara- Studzinska, M. (2014). Mental illness and metabolic syndrome: A literature review. Annals of Agricultural and Environmental Medicine, 21(4), 815– 821.
McDaid, T. M. & Smyth, S. (2015). Metabolic abnormalities among people diagnosed with schizophrenia: A literature review and implications for mental health nurses.
Journal of Psychiatricand Mental Health Nursing, 22, 157–170.
Misiak, B., Frydecka, D., Laczmanski, L., Slezak, R., & Kiejna, A. (2014). Effects of second-generation antipsychotics on selected markers of one-carbon metabolism and metabolic syndrome components in first-episode schizophrenia patients.
European Journal of Clinical Pharmacoogy, 70, 1433–1441. doi:
10.1007/s00228-014-1762-2
Padmavati, R. (2016). Metabolic syndrome, serious mental illnesses & lifestyle. The
Indian journal of medical research, 143(4), 395-7.
Papanastasiou E. (2013). The prevalence and mechanisms of metabolic syndrome in schizophrenia: A review. Therapeutic advances in psychopharmacology, 3(1), 33-
51.
Sabella, D. (2017). CE: Antipsychotic Medications. AJN, American Journal of
Nursing, 117(6), 36-43. doi: 10.1097/01.NAJ.0000520229.04987.46
Seow, L. S., Chong, S. A., Wang, P., Shafie, S., Ong, H. L. & Subramaniam, M. (2017). Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care. Comprehensive Psychiatry, 74, 196-203. doi: 10.1016/j.comppsych.2017.01.017
Ward, T., Wynaden, D., & Heslop, K. (2018). Who is responsible for metabolic screening for mental health clients taking antipsychotic medications? International Journal of Mental Health Nursing, 27(1), 196-203.
doi: 10.1111/inm.12309
Wojciechowski, E., Murphy, P., Pearsall, T., French, E.(2016) A Case Review: Integrating Lewin’s theory with Lean’s system approach for change. OJIN: The
Online Journal of Issues in Nursing, 21(2), Manuscript 4.
Yang, C., Lo, S., & Peng, Y. (2016). Prevalence & Predictors of Metabolic Syndrome in People with schizophrenia in inpatient rehabilitation wards. Biological Research for Nursing, 18(5), 558-566. doi :
Appendix A: Survey Questions Dear member of the educational program review committee,
I want to use this opportunity to thank you for participating in the evaluation of the educational program. Your comment and feedback will be very helpful in making adjustment for this educational program for the staff in the mental health clinic. Please try and map out time to answer the question listed below. Please feel free to provide your valuable feedback by adding a comment at the end of the survey. Thanks very much for been part of this scholarly project.
Panel of Experts Questionnaire for Metabolic Syndrome Educational Program
1. Do you perceive the education program to meet the objectives outlined by the
author at the beginning of the education?
a) Strongly Agree
b) Agree
c) Neither agree nor Disagree
d) Disagree
e) Strongly Disagree
2. Do you perceive the educational program to be beneficial for new staff to receive
during orientation?
a) Strongly Agree
b) Agree
c) Neither agree nor Disagree
e) Strongly Disagree
3. Does the content of the educational program provide knowledge of Metabolic
Syndrome for the clinic staff?
a) Strongly Agree
b) Agree
c) Neither Agree or Disagree
d) Disagree
e) Strongly Disagree
4. Will the educational module improve clinic staff monitoring of mentally ill
patients taking second generation antipsychotic drugs?
a) Strongly Agree
b) Agree
c) Neither Agree or Disagree
d) Disagree
e) Strongly Disagree
5. Is the content presented in the educational program easy for staff to understand?
a) Strongly Agree
b) Agree
c) Neither agree nor Disagree
d) Disagree
6. Do you perceive post test questions as the measure of understanding of the contents presented on the education program?
a) Strongly Agree
b) Agree
c) Neither Agree or Disagree
d) Disagree
e) Strongly Disagree
7. Please feel free to give your recommendations or feedbacks below the lines.
_____________________________________________________________ ______________________________________________________________ _____________________________________________________________ ______________________________________________________________
Appendix B : Staff Education on Metabolic Syndrome in Patients Taking Antipsychotic Drugs.
Appendix C: Pre and Posttests on staff education on Metabolic Syndrome (MetS) Please circle the specialty that most identifies you professionally
Psychiatrist Clinical Registered Nurse Practitioner (CRNP) Registered Nurse (RN) Licensed Practical Nurse (LPN) Medical Assistance (MA)
Please circle the correct answer from the following questions
1. Metabolic syndrome is defined as a combination of symptoms of:
A. Elevated body temperature, blood glucose, heart rate and blood pressure
B. Elevated blood pressure, cholesterol, blood glucose, and truncal obesity
C. Elevated blood plasma, cholesterol, increased weight gain, and blood glucose
D. Elevated blood glucose, blood pressure, respiratory rate, and cholesterol
2. Major side effect of Second-Generation Antipsychotic (SGAS) is:
A. Extrapyramidal symptoms (EPS)
B. Tardive Dyskinesia (TD)
C. Metabolic Syndrome (MetS)
D. Bradykinesia
3. Major complications of Metabolic syndrome are:
A. Congestive heart failure
B. Lung disease
C. Gastrointestinal disease
4. The prevalence of Metabolic syndrome in patients with mental illness is:
A. 1-2 times higher than general population
B. 2-3 times higher than the general population
C. 3-4 times higher than general population
D. 4-5 times higher than general population
5. Baseline measurement for metabolic syndrome include the following except:
A. Weight, height, and blood pressure
B. Fasting glucose level and lipid level
C. Comprehensive metabolic panel
D. Waist circumference
6. Early detection of metabolic syndrome will help to prevent:
A. Increased mortality and morbidity
B. Hospitalization
C. Side effects of antipsychotic drugs
D. Increase or decrease in psychotropic dosing
7. It is important to monitor severe mental ill patients (SMI) for metabolic syndrome
by using the practice guideline as recommended by:
A. American Psychiatric Association (APA) and Diabetic Association (ADA)
B. American College of Obstetricians and Gynecologists (ACOG)
D. American college of cardiology (ACC)
8. Why is it important to refer severe mental ill patient with metabolic syndrome to
their primary care physicians (PCP)?
A. Prevention of complications
B. Early treatment and management
C. Routine office visit
D. Delay of treatment
9. The most important labs to order at the initiation of treatment with antipsychotic
drugs are:
A. Basic metabolic profile and comprehensive metabolic profile
B. Thyroid profile and lipid profile
C. Complete blood count with differential
D. Fasting blood glucose and Lipid profile
10. Why is important for mental health providers to collaborate with severe mental ill
patients’ primary care providers?
A. Promote optimum health among SMI patients
B. Decrease hospitalization among SMI patients
C. Decreased preventive health care among SMI patients