This assignment is designed for the student to examine the antecedents, attributes, and consequences of a selected concept. The student will explore a concept, and then analyze the concept using Steps from Wilson’s Concept Analysis Walker & Avant, 2019, p.170.

Assessment 3

Applying Ethical Principles

Competency 3

Apply ethical principles and academic standards to the study of health care.

Criterion

Summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.

Your Result: NON_PERFORMANCE

Does not summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Criterion

Discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.

Your Result: NON_PERFORMANCE

Does not discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Criterion

Apply ethical principles to a possible solution to the proposed problem or issue from a case study.

Your Result: NON_PERFORMANCE

Does not identify ethical principles related to the possible solution to the proposed problem or issue from the case study.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Competency 4

Write for a specific audience, in appropriate tone and style, in accordance with Capella's writing standards.

Criterion

Discuss the effectiveness of the communication approaches present in a case study.

Your Result: NON_PERFORMANCE

Does not discuss the effectiveness of the communication approaches present in a case study.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Criterion

Produce text with minimal grammatical, usage, spelling, and mechanical errors.

Your Result: BASIC

Produces text with some grammatical, usage, spelling, and mechanical errors, making text difficult to follow at times.

Faculty Comments:

Again, as mentioned in your previous assessment – your focus gets lost in your extravigant vocabulary. Please take a look at the example paper for ideas as to how your paper should look and sound.

Criterion

Integrate into text appropriate use of scholarly sources, evidence, and citation style.

Your Result: NON_PERFORMANCE

Does not integrate into text appropriate use of scholarly sources, evidence, and citation style.

Faculty Comments:

Your paper does not appear to be in APA format as discussed in the scoring guide of your previous assessment. Please utilize the resources provided to assist you with APA formatting. Additionally, you need to use literature that is recent and peer-reviewed. Resources should be 5 years old or less.

You should check two places for feedback from faculty: in the comments for each criterion above, and within the document itself, either as attached comments or within tracked changes.

Assessment 3 instructions

Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

Access the Ethical Case Studies media piece to review the case studies you will be using for this assessment.

Select the case most closely related to your area of interest and use it to complete the assessment.

Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.

Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APA section of the Writing Center for guidance.

Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.

Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.

Identify who is involved or affected by the ethical problem or issue.

Access the Ethical Decision-Making Model media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.

Apply the three components outlined in the Ethical Decision-Making Model media.

Analyze the factors that contributed to the ethical problem or issue identified in the case study.

Describe the factors that contributed to the problem or issue and explain how they contributed.

Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.

In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The NHS-FPX4000: Developing a Health Care Perspective Library Guide will help you locate appropriate references.

Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.

Review the Think Critically About Source Quality resource.

Assess the credibility of the information source.

Assess the relevance of the information source.

Discuss the effectiveness of the communication approaches present in a case study.

Describe how the health care professional in the case study communicated with others.

Assess instances where the professional communicated effectively or ineffectively.

Explain which communication approaches should be used and which ones should be avoided.

Describe the consequences of using effective and non-effective communication approaches.

Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

Describe the actions taken in response to the ethical dilemma or issue presented in the case study.

Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.

Discuss the key lessons this case provides for health care professionals.

Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.

Describe the proposed solution.

Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.

Discuss how likely it is the proposed solution will foster professional collaboration.

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

Apply the principles of effective composition.

Determine the proper application of the rules of grammar and mechanics.

Write using APA style for in-text citations, quotes, and references.

Determine the proper application of APA formatting requirements and scholarly writing standards.

Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Ethical Case Studies to use for this assignment

Consider the ethical dilemma the health care professional is faced with in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).

Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.

Case Study topic is the missing needle protector.

E. L. Straight is director of clinical services at Hopewell Hospital. As in many hospitals, a few physicians provide care that is acceptable, but not of very high quality; they tend to make more mistakes than the others and have a higher incidence of patients going “sour.” Since Straight took the position 2 years ago, new programs have been developed and things seem to be getting better in terms of quality.

Dr. Cutrite has practiced at Hopewell for longer than anyone can remember. Although once a brilliant general surgeon, he has slipped physically and mentally over the years, and Straight is contemplating taking steps to recommend a reduction in his privileges. However, the process is not complete, and Cutrite continues to perform a full range of procedures.

The operating room supervisor appeared at Straight's office one Monday afternoon. “We've got a problem,” she said, somewhat nonchalantly, but with a hint of disgust. “ I'm almost sure we left a plastic needle protector from a disposable syringe in a patient's belly, a Mrs. Jameson. You know, the protectors with the red–pink color. They'd be almost impossible to see if they were in a wound.”

“Where did it come from?” asked Straight.

“I'm not absolutely sure,” answered the supervisor. “All I know is that the syringe was among items in a used surgical pack when we did the count.” She went on to describe the safeguards of counts and records. The discrepancy was noted when records were reconciled at the end of the week. A surgical pack was shown as having a syringe, that was not supposed to be there. When the scrub nurse working with Cutrite was questioned, she remembered that he had used a syringe, but, when it was included in the count at the conclusion of surgery, she didn't think about the protective sheath, which must have been on it.

“Let's get Mrs. Jameson back into surgery.” said Straight. “We'll tell her it's necessary to check her incision and deep sutures. She'll never know we're really looking for the needle cover.”

“Too late,” responded the supervisor, “she went home day before yesterday.”

Oh, oh, thought Straight. Now what to do? “Have you talked to Dr. Cutrite?”

The supervisor nodded affirmatively. “He won't consider telling Mrs. Jameson there might be a problem and calling her back to the hospital,” she said. “And he warned us not to do anything either,” she added. “Dr. Cutrite claims it cannot possibly hurt her. Except for a little discomfort, she'll never know it's there.”

Straight called the chief of surgery and asked s hypothetical question about the consequences of leaving a small plastic cap in a patient's belly. The chief knew something was amiss but didn't pursue it. He simply replied there would likely be occasional discomfort, but probably no life–threatening consequences from leaving it in. “Although,” he added, “one never knows.”

Straight liked working at Hopewell Hospital and didn't relish crossing swords with Cutrite, who, although declining clinically, was politically very powerful. Straight had refrained from fingernail biting for years, but that old habit was suddenly overwhelming.

Answer these 2 questions.

1. What other therapy approaches can be easily applied to this patient? (different therapy than the one she developed here)

2. How can we help the patient stick to the treatment plan?( based on what it says here, how I can help the patient.)

At least 2 references

Complex Case Study Presentation

CC (chief complaint): “I need medication. I don't feel good.”

HPI: C is a 15-year-old African American female who came for a psychiatric evaluation with her case manager. She states, ” I need medication. I don't feel good.” The client noted that the other day, she had a breakdown where she was crying and laughing. Also, she mentioned that she started thinking about bad things. Most of the time she feels sad, that is why she feels “better when I’m with my friends.” She also noted that she can be agitated very easily. Her concentration is poor, and she said “everything” stresses her out. The client denies any symptoms of suicidal ideations, but she said, “I don't want to kill anybody, but when I'm upset, I make threats to kill people.” She said she suddenly has difficulty meeting new people, has problems with crowds in the grocery store or big box stores, and feels judged when out in person. The client reports verbal, physical, and sexual abuse that started in childhood. She experiences painful flashbacks and nightmares in the past. She reports abuse and misuse of ADHD medications and no complaints with medications. Also, she mentioned to be on probation, and she would like to be out of prison.

Diagnostic Impression:

Major depressive disorder

Approximately 12.8% of people between 12-17 years have been diagnosed with Major depression in the United States. (Mullen, 2018) The client presents most of the diagnosis criteria for this disease. She is showing a depressed mood irritation that is typical for adolescents. She has a poor interest in activities, low energy, and poor appetite. Also, she mentioned that she has trouble falling asleep and staying asleep. These symptoms caused social impairment, evidenced by the frequent fights. It is essential to mention that her family is dysfunctional, and her mom and brother are diagnosed with major depression.

Generalized anxiety disorder F41.1

Generalized anxiety disorder is a common mental health disorder affecting more females. Anxiety leads to restlessness, feeling keyed up or on edge, fear, and difficulty concentrating. (APA,2022 ) The client presents excessive anxiety and difficulty controlling worry and concern that something will happen. She has problems being around crowds, feels anxious, and feels judged. Also, she is always irritable, losing her temper, involving her in multiple fights. This client's diagnosis criteria are restlessness, difficulty concentrating, irritability, sleep disturbance, and muscle tension.

Post-Traumatic Stress Disorder F43.10

This disorder results from exposure to one or more traumatic events. Usually, the symptoms start showing up within three months of the traumatic events. The symptoms interfere with the daily tasks. The client reports verbal, physical, and sexual abuse that started in childhood, and she experiences painful flashbacks and nightmares from the event. This situation met the first criterion for this diagnosis because she was exposed to a traumatic event. Also, she mentioned recurrent and intrusive thoughts about something terrible that would happen. She avoids speaking about the incident and has persistent negative feelings. The client said to be hypervigilance.

Reflection:

The client comes for the first-time evaluation, saying she needs medications because she doesn't feel good. This client is presenting almost all the symptoms of major depression. She lacks energy, and most of the time, she is irritated, evidenced by getting involved in many fights. Also, she stated being sad almost every day and having breakdowns. She was sexually, mentally, and physically abused, which is most likely why she presents all those symptoms. Women victims of child sexual assault are twice as likely to have more depression and anxiety than no female victims. Also, major depressive episodes among those with PTSD have a higher risk of suicide than those with PTSD. (Alix,2020) She mentioned the sexual abuse and said that she was thinking about crazy stuff. We suspect she was thinking about suicide, which is why the primary diagnosis is Major depression. Alix (2020) states that self-blame is an internal attribution, a cognitive process by which some individuals with traumas can attribute the event of an unfavorable event to themselves. She also said that she feels guilty about what happened to her.

The second diagnosis is Generalized anxiety disorder because the client finds it difficult to control her concern about something wrong will happen. She stated feeling restless, having problems concentrating, muscle tension, and sleep disturbance. Also, she is presenting poor concentration. This affects her daily tasks even though she mentioned that she couldn't be around people anymore. De Beru (2020) states that the only two disorders significantly associated with suicide ideation were MDD and GAD. For this reason, this will be my secondary diagnosis and the one I will pay more attention to.

The third differential diagnosis will be post-traumatic stress disorder. As mentioned above, this client came from a household where she suffered a lot of violence, including physical, sexual, and emotional damage. She has problems falling asleep due to the trauma and avoided discussing the incident by changing the topic. The US Department of Veteran Affairs (2018) states that survivors of child sexual abuse show symptoms of PTSD that include agitated behavior, and they may exhibit anxiety. Also, another behavior that they may exhibit is inappropriate sexual behavior or seductiveness. The school sent her to a psychiatry evaluation in the 6th grade because of her aggressiveness and promiscuity. That was one of the indicators that she was suffering from sexual abuse. Also, she mentioned recurrent and intrusive thoughts about something terrible that would happen.

I agree with the PMHNP treatment plan, where she will start working with the depression symptoms. Since the client reports feeling sad, having low energy, and thinking about “crazy stuff,” we will prioritize those symptoms and treat them to avoid future serious problems like Suicide Ideations.

Case Formulation and Treatment Plan

C is a 15-year-old African American female client being seen for a first-time psychiatric evaluation. She is alert and oriented in person, place, time, and situation. She is restless, acting out, and looks irritable but cooperative. She mentioned being referred to a psychiatry evaluation in 6th grade, and since then, she has been in and out of treatment. The client presents depression symptoms like sadness, low energy, decreased activities that cause joy, irritability, poor concentration, and sleep disturbance. Also, she mentioned the difficulty in controlling her concern about something terrible will happen. She verbalizes a history of sexual, physical, and emotional abuse. The client avoids talking about the abuse. However, she will follow recommendations and continue with a treatment plan.

Most adolescents with major depression symptoms reported severe impairment in home life, school/work, family relationships, and social life. Studies have revealed that neurologic changes happen in the brain structure of those who have suffered sexual abuse during their childhood, and, therefore, they become more predisposed to suffer depression, anxiety, substance use, and other mental and behavioral problems. (Gokten, 2021) It is essential to start working with the adolescent since symptoms are notable, like in this client's case. The PMHNP chose Lexapro 5 mg PO daily; this medication is one of the two approved by the FDA. Lexapro has been approved for use in adolescents aged 12 years and older. (FDA, Nd) Jiang (2017) mentioned in his research that Lexapro helps to decrease depression and anxiety levels and significantly improve the quality of life, helping with the enjoyment and satisfaction of patients taking this medication. Besides the depression, she suffers from anxiety, which is why this medication is the first line of treatment since it helps to improve the two primary diagnoses for her. Anvari (2020) also recommends using Lexapro as a first-line antidepressant treatment for children and adolescents, optimally in conjunction with cognitive behavior therapy. He stated the conjunction of this therapy should optimize school, peer, and family communication, given a patient's sense of connectedness.

The second medication that the PMHNP prescribed is Lamotrigine 25 mg PO daily. Lamotrigine is an anticonvulsant medication that can be used as adjunctive treatment as a mood stabilizer. Prabhavalkar (2015) found Lamotrigine to be outstandingly effective in preventing bipolar depression in patients experiencing episodes of major depression. Lamotrigine can be a mood stabilizer that calms mood swings by lifting the depression symptoms. Also, he found that in 64.5% of the adjunctive treatment using lamotrigine, the symptoms of depression improved during the initial treatment and maintained for about one year.

Psychotherapy will be crucial to the treatment plan; changing the behavior and developing coping skills can benefit her treatment goal. Cognitive behavioral therapy is showing efficacy in GAD and MDD symptom reduction. In his research, Oud (2019) found that 63% of the child/adolescent has less risk of having a depressive disorder at follow-up and a 36% more chance of recovery. Also, CBT can be used to treat clients with PTSD. For that reason, this will be the therapy of choice.

Also, as part of the plan, the PMHNP ordered blood work CBC, BMP, Vit D, lipid panel, and thyroid function test. EKG will be ordered as well.

The risks, benefits, side effects, and dosage schedules of medication were explained to the client. Otherwise, the benefits of continuing psychotherapy were explained for managing and controlling her emotions. We will recommend daily exercise, good hygiene, and a balanced diet. She was educated and encouraged about abstinence from drugs and alcohol. The potential risks, long-term consequences of Tardive Dyskinesia, and treatment alternatives were discussed with and understood by the client. The client has emergency numbers: Emergency Services 911, Suicide & Crisis Lifeline 988, and National Suicide Prevention Lifeline 1800-273-8255

 

Agonist-to-Antagonist Spectrum of Action

The agonist-to-antagonist spectrum refers to the  range of actions that psychopharmacologic agents can have when they  interact with receptors. Agonists activate receptors, while antagonists  block them. Partial agonists and inverse agonists provide intermediate  or opposite actions (Stahl, 2021).

Understanding the agonist-to-antagonist spectrum is  critical for achieving the desired therapeutic effect while minimizing  side effects. For instance, clozapine is an atypical antipsychotic that  acts as an antagonist at various neurotransmitter receptors, including  dopamine D2 and serotonin 5-HT2A receptors. Unlike typical  antipsychotics, which are primarily dopamine D2 antagonists, clozapine’s  broader receptor profile may explain its efficacy in  treatment-resistant schizophrenia as well as its different side-effect  profile (Stahl, 2021).

Partial Agonists: Buspirone is a  partial agonist at serotonin 5-HT1A receptors and is used to treat  generalized anxiety disorder (GAD). Its partial agonist activity allows  for anxiolytic effects without the sedation seen with benzodiazepines,  which are full agonists at GABA receptors (Stahl, 2021).

Inverse Agonists: The antihistamine  loratadine acts as an inverse agonist at the H1 histamine receptor, not  only blocking the action of histamine but reducing the baseline activity  of the receptor, which can be beneficial for controlling allergic  symptoms (Stahl, 2021).

Clozapine, an atypical antipsychotic, acts primarily  as an antagonist at various neurotransmitter receptors, demonstrating  how multi-receptor targeting can be beneficial for certain psychiatric  conditions. On the other hand, buspirone serves as a partial agonist at  5-HT1A receptors, providing anti-anxiety effects with less potential for  sedation. Loratadine, an antihistamine, acts as an inverse agonist,  reducing the baseline activity of H1 histamine receptors.

G-Protein-Coupled Receptors vs. Ion-Gated Channels

G-Protein-Coupled Receptors (GPCRs) and Ion-Gated  Channels are two different types of protein structures that drugs can  target to produce therapeutic effects. GPCRs are involved in slow,  modulatory signaling, while Ion-Gated Channels provide fast synaptic  transmission (Stahl, 2021).

Beta-blockers like propranolol interact with GPCRs,  specifically beta-adrenergic receptors, to modulate cardiac activity by  reducing heart rate and blood pressure. They do this by antagonizing the  beta-adrenergic receptors, thereby inhibiting the action of adrenaline  and noradrenaline (Stahl, 2021)

In contrast, via Ion-Gated Channels, drugs like  gabapentin act on voltage-gated calcium channels, not by blocking them  but by modulating their activity. This makes gabapentin useful for  conditions like neuropathic pain and epilepsy (Stahl, 2021).

Role of Epigenetics in Pharmacologic Action

Epigenetics in pharmacology refers to the  modification of gene expression rather than altering the genetic code  itself. These modifications can affect how an individual responds to  medications (Stahl, 2021).

Antidepressants like fluoxetine (Prozac) may not only  affect neurotransmitter levels but also induce epigenetic changes that  impact long-term mood regulation. They can modify DNA methylation  patterns related to the expression of neuroplasticity-related genes,  possibly contributing to their therapeutic effect (Castrén & Kojima,  2017).

Impact on Prescription Decisions

The impact on prescription decisions refers to how  the aforementioned factors might influence a healthcare provider’s  choice of medication, dosage, and treatment plan for individual  patients(Stahl, 2021).

Understanding the agonist-antagonist spectrum can be  vital in cases like dual diagnosis of opioid addiction and anxiety.  Here, a partial agonist like buspirone could be more appropriate than a  benzodiazepine due to its lower potential for abuse. Also, for patients  with treatment-resistant depression, considering a medication like  ketamine that works through different mechanisms and has potential  epigenetic impacts could offer another treatment avenue (Zanos et al.,  2016).

For example, in a patient with a dual diagnosis of  opioid addiction and anxiety, a nurse practitioner might opt for a  partial agonist like buspirone for the treatment of anxiety instead of a  benzodiazepine, which has a higher abuse potential. Similarly, if a  patient has treatment-resistant depression and has not responded to  typical SSRIs, considering an agent like ketamine, which works through  NMDA receptor antagonism and also induces epigenetic changes, could be a  thoughtful next step (Zanos et al., 2016).