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The Pregnant Teenager with a Genetic Problem

Nursing Homework Help

Case Study Assignments

Melinda Eades was a 14-year-old adolescent diagnosed at an outpatient neurology clinic with the gene for neurofibromatosis-type 2 (NF2), an autosomal-dominant disorder that causes nervous system tumors that usually demonstrate symptoms during the late-teen years or early 20’s. At the time of diagnosis, genetic counseling was recommended to Melinda’s mother because any children born to Melinda would have a 50% chance of also carrying the NF2 gene. Melinda was quite upset about the genetic testing results and did not seem to comprehend the information, so Mrs. Eades decided to wait a few weeks before making the appointment with the genetic counselor to discuss future issues, such as childbearing decisions, with Melinda. There was no reason to believe that Melinda was sexually active, so it was agreed that Mrs. Eades would contact the clinic for genetic counseling in a month or so.

Before this appointment was made, however, Melinda went to an OB/GYN clinic on her own for problems with menstruation. Testing revealed that she was approximately 7 weeks pregnant. She was counseled by the clinic nurse about abortions options and was advised to discuss her pregnancy with her parents. When Melinda mentioned that she was recently identified as having the gene for a genetic disorder, the clinic nurse recommended that she return to the neurology clinic for follow up and counseling. Melinda did not seem to understand that her disease was genetically transmissible to her offspring.

After several days of agonizing over her pregnancy, Melinda told her mother. Mrs. Eades was very upset with Melinda and immediately decided that Melinda should have an abortion. When Melinda seemed uncertain whether she wanted to abort the pregnancy, Mrs. Eades told her that any of her offspring would have a 50% chance of having NF2. Melinda was surprised by this information but was still uncertain what she should do. She also wondered why she had not been informed of this earlier.

When Melinda showed up for her appointment at the neurology clinic, she was very confused. She asked Jane Goldstein, the nurse practitioner she previously saw in the clinic, why someone did not tell her that she needed to be careful about becoming pregnant. When she realized that her mother had decided to withhold this information from her for a period of time, Melinda became angry.

1. Did Melinda have the right to this information, even though she was a minor? Also, why had the nurse conveyed this information to her mother and not to her? Could her mother control her in that manner, even to the point of forcing her to have an abortion, a course of action that Melinda would not likely choose under other circumstances?

2. How should Ms. Golstein proceed with this situation? Given Melinda’s anger and confusion about her situation, what actions should Ms. Goldstein take to provide Melinda with the information she needs to make important choices about her pregnancy

· Respond to at least two other student’s postings with substantive comments.

· Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.

· References and citations should conform to the APA standards.

· Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.

· Plagiarism is never acceptable – give credit when credit is due – cite your sources.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

PERSON1[k]

Change Agent

I perceive myself as a change agent when I actively advocate for my patients and meet their needs. Outcomes should be identified before planning for specific interventions. After nursing interventions have been implemented, a nurse should evaluate the outcomes, and determine if they were met in the stipulated time frame. Therefore, this means that nurses should move from a process focus to an outcome focus. As an I am planning to work as an obstetrical nurse (OB), I have had to deal with a patient with should dystocia. The complication can occurs during vaginal birth and may cause serious and costly consequences if not managed as required. Safe delivery during a dystocia is the desired outcome and this demands that one approaches the process carefully (Werdenberg et al., 2018). When trying to help the patient, the obstetric team had to collaborate and utilize evidence-based obstetric tactics to resolve the shoulder dystocia. There are many evidence-based clinical care guidelines, there are limited evidence-based methodologies for implementation (McMahan et al., 2021).

Nurses can encounter many challenges when implementing evidence-based care. Therefore, the main goal should be to reach the desired outcome because even though there are many evidence-based clinical care guidelines, there are limited evidence-based methodologies for implementation (McMahan et al., 2021).  In this case, aspects such as real-time feedback, interpretation of patients’ preferences for care, and embedding of best-practice guidelines are considered. Outcome evaluation help assess the effectiveness of the procedure undertaken while the process is based on efficiency. When considering the health of a patient, the effectiveness of the outcome is more important than the efficiency of the procedure followed.

PERSON 2[AM]

Change Agents

Change agents are necessary to guide and lead change. It is important for a change agent to select a proper change theory or model to use as framework and ideation (Mitchell, 2013). When I look at my role in leadership in guiding change, I can really find value in the three stages that Lewin identified, unfreezing, moving, and refreezing (Mitchell, 2013). To stop and identify the need for change, to make the change and then to reinforce and make it stick. I have found it easier to execute a change, and tougher to make a change stick, so I believe that the refreezing portion is where my biggest efforts would need to be spent when making change.

Change Agent in Leadership

When I picture myself as the change agent focusing on outcomes instead of processes, I would encourage my team to picture the ideal outcomes for a patient, because that is ultimately what we are in healthcare for. An example I think of from my experience is related to a change based on an accreditation. Such as our Oncology quality program that had many standards we had to meet. The team though “oh this is just going to be more work”. Mitchell (2013) tells us that unfreezing or thawing is a good time to let people acknowledge that what we are doing, also called the “status quo” wasn’t the best for our result, it might get us where we are going, but there are better ways. I think of unfreezing as a time for the team to learn why change is needed and to allow staff to get their venting done, as they get so attached to processes. The moving phase is when change starts (Mitchell 2013). This is where I would start to recruit other change agents, because to me, you need a team to help gain buy in from the rest of the team. This is when your cheerleaders or change agents make a big deal about the end-result and how cool it would be to get an A instead of a B, to be the center of excellence, which is like a badge of honor where our patients’ outcomes are the best they can be. Once the group creates the change, we will start refreezing. I like a slow freeze, if that makes sense. I like this so that there is plenty of time for presence, reinforcement, stabilization, and support along the way. Like Lewin, I believe this is the challenge, to not let people revert to the previous ways, looking away from the focus of outcomes!

PERSON 3 [mc]

Select one of the models presented in this unit.

The Iowa Model of Evidence-Based Practice “provides direction for the development of EBP in a clinical agency  The underlying theme of this model is that “only so many things can be focused upon at once, so prioritization of triggers is essential”(Gray & Grove! 2017).

Describe how this model would be effective for implementing EBP and/or best practices in the practice, administration, or education setting. 

An agency can use this mode to promote EBP because it identifies triggers for change, Implements patient care based on the best research evidence, monitors changes in practice to ensure quality care, and then disseminate results of internal evaluations of the changes efficacy (Gray & Grove, 2017). The medical profession as a whole regardless of which aspect is based on EBP. In each area potential problems/triggers can be identified and the Iowa Model can help to find an EBP or solution to implement whether it is in practice, administration, or education. It ultimately provides guidelines for implementing patient care based on the best research evidence and monitoring changes in practice.

Consider how you might introduce this change.

What barriers might you confront?

As with implementing any change there are potential barriers. Lewin’s planned change theory details two forces involved in change as driving and restraining. Driving forces encourage and facilitate while restraining block or impede progress. In a successful change these forces are identified early and minimized if possible. An example of a restraining force can be people resistant or fearful change.

PERSON 4 [sa]

One of the models presented in this unit that I select is The Stetler Model. The Stetler Model of research is an evidence-based practice (EBP) model that focuses on users’ internal characteristics and external environment, which might influence how they use their knowledge.

Describe how this model would be effective for implementing EBP and/or best practices in the practice, administration, or education setting?

The Stetler model presents existing practice and substantiating evidence frameworks for determining the usefulness and practicality of research works to address a problem. The model significantly helps practitioners assess research evidence and other relevant findings that could be applied in practice (Indra, 2018). Furthermore, the availability of substantiated evidence for given practices and the feasibility of the identified practices contribute to the effective implementation of the model. Interestingly, the Stetler model is practical and could effectively implement EBP. The Stetler Model is comprised of five distinctive phases during its implementation. The phases include preparation, validation, competitive evaluation renowned as decision making, translation or application, and finally, evaluation which are simultaneously renamed as phase I, phase II, phase III, phase IV, and phase V (Ryu et al., 2021). These steps facilitate critical thinking about the practical practice of studies, use of evidence in day-to-day practices, and mitigation of possible human errors during decision-making.

  Consider how you might introduce this change?

To effectively introduce this change, I would first identify the purpose of consulting research findings to recognize the need and importance of contextual factors they outlay. The sources would then be assessed for credibility before deciding on their feasibility. As a result, writing a generalization that logically expounds on the research findings would be relevant, thus enhancing applicability. Nonetheless, it would be necessary to evaluate identified applicability of the research findings. Therefore, research utilization appears to be a process that enhances the credibility and reliability of evaluated research findings.

What barriers might you confront?

 One of the greatest barriers that I might confront is transitioning from class to evidence-based practices which define the new trends in nursing. Another barrier is a lack of knowledge on the use of evidence-based practices, especially as a new nurse who has not gained enough experience. Finally, there could be barriers confronted due to patients’ unwillingness to comply with EBP as a result of bias which discourages practitioners.