Reply 1 and 2 by 01/13/2021 please add references

reply 1

My role of specialization is Family Nurse Practitioner.  As a fertility nurse, I have seen a consistent need for alternative ways of patient teaching when it comes to self-medication administration.  Although failure of treatment is not always due to improper self-medicating, it has created unneeded obstacles in care that have prevented success.  If I am able to continue my fertility journey as a Nurse Practitioner, I would like to examine and evaluate patient teaching methods success rates and possibly establish patient education and teaching methods for expert care and desired outcomes.

            To research this area of concern, I used the South University Online Library.  Under programs, I selected “Nursing Program Guide” and then searched in the library search bar for journal articles, within the last 5 years, on patient education and teaching.  I first searched for fertility medication teaching and unfortunately nothing resulted except a book on pharmacology.  I also realized that it was important to look at patient teaching tools in general and establish which of these methods were most effective on patients based on previous research.

            I was able to find three journal articles that gave me a good start to my patient education/teaching research.  In an article in the Clinical Journal of Oncology Nursing, eHealth education was the focus.  According to the Doorenbos et al (2020), eHealth includes mobile health applications, video and audio conferencing, text messaging, and web-based on demand education.  The study provided results from case studies where eHealth methods had been used and gave patients and caregivers less anxiety and more understanding about their condition, care, and overall treatment (Doorenbos et al, 2020).  In an earlier edition of the Clinical Journal of Oncology Nursing, I found an article that discussed patient teaching methods as related to self-injections.  This study evaluated 50 breast cancer patients who were undergoing adjuvant or neoadjuvant treatment and the benefits of simulation during teaching as opposed to no simulation.  The study found that there was no real difference whether simulation was used in teaching or not.  Researchers found that it was the overall “teaching experience” that allowed for less anxiety and success (Fischer-Cartlidge et al, 2016).  The last article I found was in Medsurg Nursing, and focused on the nurse as an educator.  According to Flanders (2018), patient education should not be “cookie cutter” and should be adjusted based on specifics of the patient and caregiver.  The nurse should consider things like education level, background, and access.  According to Flanders (2018), nurses should use resources to constantly evolve as environment and information can change.

            I feel confident that this is a good start in my research on patient teaching and education.  It seems that it may be an obstacle to find more specific research on patient teaching on fertility medications and treatment plans, but I should be able to use patient teaching methods that have been applied in other health areas to build effective patient education for fertility patients.

References

Doorenbos, A. Z., Min Kyeong Jang, Hongjin Li, & Lally, R. M. (2020). eHealth Education:

        Methods to enhance oncology nurse, patient, and caregiver teaching. Clinical Journal of

       Oncology Nursing, 24, 42–48. https://doi-org.su.idm.oclc.org/10.1188/20.CJON.S1.42-48

Fischer-Cartlidge, E., Romanoff, S., Thom, B., & Walters, C. B. (2016). Comparing Self-

       Injection Teaching Strategies for Patients With Breast Cancer and Their Caregivers: A Pilot

       Study. Clinical Journal of Oncology Nursing, 20(5), 515–521. https://doi-

       org.su.idm.oclc.org/10.1188/16.CJON.515-521

Flanders, S. A. (2018). Nurses as Educators. Effective Patient Education: Evidence and Common       

       Sense. MEDSURG Nursing, 27(1), 55–58.

reply 2

will be obtaining my master’s degree in Family Nurse Practitioner and my area of topic interest is that of narcissistic parenting and child abuse.  I believe mental health and complex trauma awareness is lacking and often victims of narcissistic abuse are diagnosed and treated for other mental issues without really addressing and fixing the core problem of abuse that individuals are receiving from their family members.  There is great awareness of Child Physical Abuse (CPA) yet not as much to the psychological and emotional abuse from parents.  Screening for child abuse is limited and mainly addresses physical child abuse and neglect.  This is of special interest to me because I am a Complex Trauma survivor.  However, from a very young age my narcissistic parent, who was my abuser, convinced me that there was something wrong with me.  I was physically abused from the ages of seven to fourteen and was even taken out of the home into the foster care system for eight months.  I was diagnosed as Bipolar as a teenager and my mother had me in therapy from a very young age of seven or eight because I wasn’t “ adjusting well” to the changes in our lives at the time.   Physical abuse ended, yet the psychological abuse never stopped and has been ongoing as an adult.  I went no contact with my family last year and began a trauma recovery program and also sought out therapy with a therapist who specializes in narcissistic family structure. I am just one voice of many.  I want to unearth and shed light to this very real mental health differential diagnosis issue and be an advocate for others.  

The problem is children who come from narcissistic families turn into adults with complex trauma issues and problems with emotional regulation, issues with self identity, dissociative tendencies and distress intolerance that they are not even aware of.  They are often misdiagnosed with a mood or personality disorder ( Mosquera, 2017) .  This easily falls in line and favor with their abuser, as the victim is continued to be led to believe that there is something wrong with them.  There is plenty of academic articles related to Complex Trauma and Borderline Personality disorders, I will have my reading cut out for me.  I am excited that there is much research and documentation on this topic.  I knew I wasn’t alone and that I was onto something.

I am not quite completely sure on what a potential innovation would be in this area.  However, ideally screening tools and questionnaires would be beneficial.  Enhanced awareness to practitioners on mental health issues and if they see diagnosis of mood or personality disorders in their patient’s history and physical, exploring this a little deeper.  If the patient is comfortable with the practitioner, they may be inclined to share the abuse aspects of their relationships with family or domestic partners.  This way we can accurately guide and tailor treatment to trauma recovery and not just behavior issues.

References

 Mosquera, D., & Steele, K. (2017). Complex trauma, dissociation and Borderline Personality Disorder: Working with integration failures. European Journal of Trauma & Dissociation, 1(1), 63–71. https://doi-org.su.idm.oclc.org/10.1016/j.ejtd.2017.01.010

Additional resources to be used in the future:

Mahoney, D. M., Rickspoone, L., & Hull, J. C. (2016). Narcissism, Parenting, Complex Trauma: The Emotional Consequences Created for Children by Narcissistic Parents. Practitioner Scholar: Journal of Counseling & Professional Psychology, 5(1), 45–59.

Bichescu, B. D., Steyer, J., Steinert, T., Grieb, B., & Tschöke, S. (2017). Trauma-related dissociation: Psychological features and psychophysiological responses to script-driven imagery in borderline personality disorder. Psychophysiology, 54(3), 452–461. https://doi-org.su.idm.oclc.org/10.1111/psyp.12795

Luyten, P., Campbell, C., & Fonagy, P. (2020). Borderline personality disorder, complex trauma, and problems with self and identity: A social-communicative approach. Journal of Personality, 88(1), 88–105. https://doi-org.su.idm.oclc.org/10.1111/jopy.12483

Hyland, P., Karatzias, T., Shevlin, M., & Cloitre, M. (2019). Examining the Discriminant Validity of Complex Posttraumatic Stress Disorder and Borderline Personality Disorder Symptoms: Results From a United Kingdom Population Sample. Journal of Traumatic Stress, 32(6), 855–863. https://doi-org.su.idm.oclc.org/10.1002/jts.22444