Introduction

The surrogate role, as defined by Hildegard Peplau in her theory of interpersonal relations, is not frequently mentioned in recent nursing practice literature. This raises the question of whether this role is still relevant in contemporary nursing practice. In this discussion, we will evaluate the historical background of Peplau’s theory to understand the context in which the surrogate role was developed. We will then critically examine the applicability of this role to current nursing practice, considering the changes that have occurred over time. This analysis will help us determine whether the surrogate role is still relevant and in what ways.

Historical Background of Peplau’s Theory of Interpersonal Relations

Hildegard Peplau, a psychiatric nurse, developed her theory of interpersonal relations in the 1950s. During this time, the medical model dominated nursing practice, with little emphasis on the therapeutic relationship between nurses and patients. Peplau aimed to shift nursing practice from a task-oriented approach to a more patient-centered approach focused on the development of therapeutic relationships (Parker, 2006).

Peplau’s theory posits that nurses assume various roles when interacting with patients, one of which is the surrogate role. She defined the surrogate role as a nurse temporarily assuming the role of another person, such as a family member or friend, to meet the patient’s emotional needs during hospitalization (Peplau, 1952). This role was intended to provide emotional support, foster trust, and facilitate the patient’s recovery.

Relevance of the Surrogate Role in Contemporary Nursing Practice

In considering the relevance of the surrogate role in current nursing practice, it is crucial to acknowledge the changes that have occurred within healthcare and nursing over time. The shift towards patient-centered care, advancements in technology, and increased focus on evidence-based practice have significantly influenced the nursing profession. These changes have implications for the applicability of Peplau’s surrogate role.

One of the key changes in contemporary nursing practice is the emphasis on patient autonomy and shared decision-making. Patients are now more involved in their own care, actively participating in treatment decisions. This shift could potentially diminish the need for the surrogate role, as patients are increasingly capable of expressing their emotional needs and seeking support from their own networks of family and friends. However, it is important to note that there are still instances where patients may lack a strong support system or face difficulties in expressing their emotional needs. In such cases, the surrogate role can still be relevant by providing the emotional support and advocacy that patients require.

Furthermore, the development of multidisciplinary healthcare teams has expanded the range of professionals involved in patient care. Interdisciplinary collaboration has become a cornerstone of contemporary healthcare delivery. As a result, the surrogate role may not solely be the responsibility of the nurse anymore. Other healthcare professionals, such as social workers or therapists, may also play a pivotal role in meeting the patient’s emotional needs. Consequently, the surrogate role may need to be redefined within the context of a broader healthcare team, ensuring coordinated and comprehensive support for the patient’s emotional well-being.

Conclusion

In conclusion, Peplau’s theory of interpersonal relations introduced the surrogate role as a means to meet patients’ emotional needs during hospitalization. While the historical context in which this theory was developed emphasized the importance of building therapeutic relationships, contemporary nursing practice has undergone significant changes. Patient-centered care, advancements in technology, and interdisciplinary collaboration have impacted nursing practice and may affect the relevance of the surrogate role.

It is evident that the surrogate role may no longer be as prominent as it once was, given the increased emphasis on patient autonomy and shared decision-making. However, there are still instances where patients require emotional support and advocacy. In these cases, the surrogate role can be valuable in meeting the patients’ emotional needs. Moreover, the role might need to be redefined within the context of a multidisciplinary healthcare team to ensure comprehensive care.

Overall, while the surrogate role defined by Peplau may have evolved in light of contemporary nursing practice, it still holds relevance in certain situations, highlighting the importance of recognizing individual patient needs and tailoring care accordingly.

Gestalt therapy is a humanistic and experiential form of therapy that focuses on the present moment and the person’s experience of it. Developed by Fritz Perls, Laura Perls, and Paul Goodman in the 1940s and 1950s, Gestalt therapy emphasizes the importance of integrating the mind, body, and emotions in order to achieve personal growth and self-awareness.

In psychiatric practice, Gestalt therapy has had a significant influence and importance. It has been recognized as a valuable approach for understanding and treating psychological issues, including anxiety, depression, and trauma. Its unique emphasis on focusing on the here and now, rather than on past experiences or future expectations, allows the therapist to assist the client in gaining a deeper understanding of their current experiences and patterns of relating to others.

Gestalt therapy also highlights the importance of the therapeutic relationship and the dynamics that arise within it. This approach recognizes that the therapist and client are in a co-creative process and that both individuals are responsible for their interactions. The therapist strives to create a safe and non-judgmental environment in which the client can explore their feelings, thoughts, and behaviors. By fostering an authentic and genuine encounter, Gestalt therapy encourages clients to develop increased self-awareness and take responsibility for their own thoughts, feelings, and actions.

Psychiatric nurse practitioners can effectively incorporate Gestalt counseling techniques into their practice. By adopting a Gestalt approach, psychiatric nurse practitioners can help clients explore and gain insight into their current experiences. The emphasis on the present moment can be particularly helpful for clients who tend to focus on past traumas or future worries. By encouraging clients to pay attention to their immediate thoughts, feelings, and bodily sensations, psychiatric nurse practitioners can promote self-awareness and support the integration of mind, body, and emotions.

Gestalt therapy also offers techniques that can be employed by psychiatric nurse practitioners to assist clients in gaining a deeper understanding of their patterns of relating to others. Through role-play, empty-chair exercises, and other experiential activities, clients can explore and experiment with different ways of interacting with others. This can be particularly beneficial for clients who struggle with interpersonal relationships and who would benefit from developing new ways of communicating and relating to others.

Moreover, the emphasis on the therapeutic relationship in Gestalt therapy aligns with the person-centered approach often utilized by psychiatric nurse practitioners. The collaborative and non-judgmental stance of the therapist creates an environment in which the client feels supported and validated. This can be especially helpful for clients who may be hesitant or resistant to therapy. By building a strong therapeutic alliance, psychiatric nurse practitioners can cultivate an atmosphere of trust, facilitating the client’s exploration and growth.

In conclusion, Gestalt therapy has had a significant influence and importance in psychiatric practice. Its emphasis on the present moment, integration of mind, body, and emotions, and focus on the therapeutic relationship make it a valuable approach for understanding and treating various psychological issues. Psychiatric nurse practitioners can incorporate Gestalt counseling techniques into their practice to help clients gain insight, develop self-awareness, and improve their interpersonal relationships. By adopting a Gestalt approach, psychiatric nurse practitioners can enhance the therapeutic process and support clients in their journey towards healing and personal growth.

References:
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-regulation. New York, NY: W.W. Norton & Company.
Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-To Guide for Evidence-Based Practice. New York, NY: Springer Publishing Company.

Title: Management of Deep Vein Thrombosis: Role of Anticoagulant Therapy

Introduction:
Deep Vein Thrombosis (DVT) is a medical condition characterized by the formation of blood clots within deep veins, typically in the lower extremities. It can lead to serious complications if not managed promptly and appropriately. Anticoagulant therapy plays a vital role in the treatment and prevention of DVT, aiming to prevent further clot formation and reduce the risk of embolization. This paper focuses on the use of heparin and Coumadin (warfarin), commonly prescribed anticoagulants, in the management of DVT.

Anticoagulant Therapy in DVT Management:
Anticoagulant therapy is the cornerstone of treatment for DVT. The primary goal is to prevent the formation and growth of new blood clots, as well as to prevent embolization of existing clots. Heparin and Coumadin are two commonly used anticoagulant medications which exert their effects through different mechanisms.

Heparin:
Heparin is a fast-acting anticoagulant that indirectly inhibits clot formation by enhancing the activity of antithrombin III, a natural anticoagulant. It effectively helps to prevent the progression of DVT and reduce the risk of embolization. In the case of Sandra, who is hospitalized with a possible DVT, it is not uncommon for heparin to be initiated via a continuous intravenous drip (heparin drip) until the patient’s symptoms are stabilized. However, heparin is primarily administered intravenously or subcutaneously, making it unsuitable for long-term management.

Coumadin (Warfarin):
Coumadin (generic name: warfarin) is a vitamin K antagonist and is commonly used for long-term anticoagulation in patients with DVT. It inhibits the synthesis of vitamin K-dependent clotting factors, thereby reducing the ability of the blood to clot. Warfarin is typically started while the patient is still on heparin and continued until the International Normalized Ratio (INR) reaches the target therapeutic range (usually 2.0-3.0). Once the desired INR is achieved, heparin can be discontinued.

Rationale for Coumadin Use in Sandra’s Case:
In Sandra’s case, the provider anticipates sending her home with Coumadin, which suggests that she will require long-term anticoagulation. There are several factors to consider when deciding on the appropriate anticoagulant therapy for DVT management in an individual patient. In this case, Sandra’s medical history, concomitant medications, and lifestyle choices should be considered.

Smoking and Birth Control:
Sandra’s smoking habit and use of birth control pills are significant risk factors for thromboembolic events like DVT. Smoking has been shown to damage blood vessels and promote clot formation, while birth control pills containing estrogen increase the risk of clotting. The combination of these two factors significantly increases Sandra’s risk of developing DVT.

Obesity:
Sandra’s obesity is another important consideration in choosing an appropriate anticoagulant therapy. Obesity is associated with a higher risk of venous thromboembolism, and certain anticoagulant medications may have different efficacy and safety profiles in obese patients.

Hypertension:
Sandra’s history of hypertension may also influence the choice of anticoagulant therapy. Some anticoagulants, such as heparin, can affect blood pressure, and careful monitoring of blood pressure is required during therapy.

Based on these factors, Coumadin appears to be a suitable choice for Sandra’s long-term anticoagulation. It is an oral medication that can be easily administered at home, eliminating the need for frequent hospital visits for intravenous or subcutaneous heparin administration. However, the decision to initiate Coumadin should be made by a healthcare provider based on a comprehensive assessment of Sandra’s medical history, risk factors, and individual needs.

Conclusion:
Anticoagulant therapy plays a vital role in the management of Deep Vein Thrombosis (DVT), aiming to prevent clot formation and reduce the risk of complications. Heparin and Coumadin are commonly used anticoagulants for DVT treatment and prevention. For an individual patient like Sandra, various factors such as smoking, use of birth control, obesity, and hypertension should be considered when selecting the appropriate anticoagulant therapy. Coumadin appears to be a suitable choice in Sandra’s case, but the final decision should be based on a thorough evaluation by a healthcare provider.

Title: “The Effect of Exercise on Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis”

Summary:

The assigned article, “The Effect of Exercise on Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis,” aims to assess the impact of exercise on cognitive function in older adults by synthesizing and analyzing relevant research studies. The authors conducted a comprehensive search of multiple electronic databases and included studies that investigated the relationship between exercise interventions and cognitive outcomes in adults aged 60 years and older. They employed a meta-analysis approach, which allowed for the combination of results from multiple studies to provide a more robust and generalizable conclusion.

The systematic review identified a total of 15 eligible studies that met their inclusion criteria. These studies varied in terms of participant characteristics, study design, exercise interventions, and cognitive outcome measures. The included studies employed various exercise interventions, such as aerobic exercise, resistance training, and combined exercise programs.

The meta-analysis of these studies revealed a significant positive effect of exercise on cognitive function in older adults. The authors found that exercise interventions led to improvements in global cognitive function, executive function, processing speed, and memory. Moreover, the effect of exercise seemed to be greater in individuals with cognitive impairment or decline than in those without.

Appraisal:

Bias:

In terms of bias, the authors of this article used systematic methods to identify and select relevant studies, minimizing the potential for selection bias. They employed a comprehensive search strategy to identify eligible studies, including both published and unpublished literature. However, it is important to note that the inclusion criteria might have introduced a potential bias, as studies that did not meet these criteria were excluded. Additionally, the authors did not mention any specific criteria for assessing the quality of the included studies, which could introduce potential bias in the selection process.

Validity:

The validity of this article is supported by its rigorous methodology. The authors conducted a systematic review, which is considered a robust approach for synthesizing evidence. They employed a well-defined search strategy and clearly stated their inclusion and exclusion criteria. By using a meta-analysis, they were able to combine data from multiple studies and provide a more precise estimate of the effect of exercise on cognitive function in older adults. However, the heterogeneity among the included studies, such as differences in participant characteristics and exercise interventions, should be taken into consideration when interpreting the results.

Moreover, the authors provided a detailed description of their methods, including the data extraction process and statistical analysis techniques. This transparency enhances the validity of their findings and allows for replication by other researchers. Additionally, the authors acknowledged limitations in their study, such as the potential for publication bias and the limited number of eligible studies, which demonstrates a critical appraisal of their own research.

Rationale:

The appraisal of bias and validity was based on a careful examination of the article’s methodology and reporting. The inclusion of a rigorous systematic review and meta-analysis enhances the credibility and generalizability of the study’s findings. The potential bias arising from the inclusion criteria and the exclusion of studies that did not meet these criteria was identified. However, without explicit criteria for assessing the quality of the included studies, it is difficult to determine the potential impact of this bias on the results. Nevertheless, the authors’ acknowledgment of limitations adds transparency to the study and demonstrates a holistic approach to appraising their research.

In conclusion, the article “The Effect of Exercise on Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis” provides a comprehensive summary of relevant studies and employs an appropriate methodology to assess the impact of exercise on cognitive function in older adults. The findings suggest a significant positive effect of exercise on cognitive outcomes, supporting the importance of physical activity for maintaining cognitive health in older adults. However, it is crucial to consider the potential bias arising from the inclusion criteria and the limitations within the included studies when interpreting the results.

The Patient Protection and Affordable Care Act (PPACA), commonly known as the Affordable Care Act (ACA) or Obamacare, is a landmark healthcare legislation passed in March 2010. This legislation encompasses a wide range of reforms aimed at improving access to healthcare, enhancing quality of care, and reducing healthcare costs. As a healthcare professional, especially as a nurse, it is important to understand the impact of this legislation on nursing practice. In this essay, we will explore two key nursing provisions outlined in the American Nurses Association’s “Key Provisions Related to Nursing” summary and discuss how these provisions have influenced or will influence the field of nursing.

The first key nursing provision focuses on increasing access to care by expanding Medicaid eligibility and creating Health Insurance Marketplaces. Under the ACA, Medicaid eligibility has been expanded to include individuals and families with incomes up to 138% of the federal poverty level. This expansion in Medicaid coverage has had a significant impact on nursing practice, particularly in states that have chosen to adopt this provision. Nurses, as frontline healthcare providers, have witnessed an increase in the number of patients seeking care as a result of expanded Medicaid eligibility. This has led to higher patient volumes in healthcare settings such as hospitals, clinics, and community health centers.

The increased number of Medicaid beneficiaries has placed added demands on nursing staff, requiring them to adapt to the changing healthcare landscape. Nurses have had to provide care for a more diverse patient population, some of whom may not have had regular access to healthcare in the past. This has necessitated nurses to possess strong cultural competence and the ability to effectively communicate with patients from various backgrounds. Additionally, nurses have had to develop strategies to efficiently manage their time and resources to accommodate the increased patient load.

Moreover, nurses have been playing a crucial role in assisting patients in navigating the newly created Health Insurance Marketplaces. These online marketplaces provide individuals and families with a platform to compare and purchase health insurance plans. Nurses have been involved in educating and guiding patients in understanding their healthcare coverage options, explaining the benefits and limitations of different insurance plans, and helping individuals enroll in suitable insurance plans. This provision has expanded the scope of nursing practice beyond direct patient care, empowering nurses to serve as advocates for patients’ healthcare needs and rights.

The second key provision to be examined is the emphasis on preventive care and wellness promotion. The ACA has placed significant importance on preventive services by requiring insurance plans to cover preventive services and screenings without cost-sharing, such as co-pays and deductibles. As a result, nurses’ roles have expanded to include a greater focus on health promotion activities and preventive care services. Nurses are well-positioned to deliver these services, as they are often the primary point of contact for patients in healthcare settings.

Nurses have been actively involved in educating patients about the importance of preventive care, promoting healthy behaviors, and providing vaccinations, screenings, and counseling services. This provision has helped to shift the healthcare paradigm from a reactive model to a proactive one, with nurses playing a fundamental role in preventing or identifying diseases at an early stage.

Overall, these two nursing provisions of the ACA have had a transformative impact on the practice of nursing. By expanding Medicaid eligibility and creating Health Insurance Marketplaces, the ACA has increased access to healthcare for many individuals and families. Nurses have had to adapt to the increased patient volumes, making patient education and advocacy essential components of their practice. Additionally, the emphasis on preventive care and wellness promotion has empowered nurses to take on a more proactive role in healthcare delivery.

In conclusion, the ACA has significantly influenced nursing practice through its key provisions related to access to care and preventive services. Nurses have adapted to the changing healthcare landscape by providing care to a larger and more diverse patient population, assisting patients in understanding their healthcare coverage options, and promoting preventive care and wellness. The impact of the ACA on nursing practice continues to unfold, with nurses at the forefront of delivering high-quality and accessible healthcare to individuals and communities.