Advocacy in Nursing Essay
The term advocacy has evolved above its legal connotations and is now an important idea in health and community care. Although there are reasons against nurses engaging in such a position, the job of advocate has been regarded as crucial within nursing (Fitzgerald et al., 2021).
Nurses must be informed of the legal guideline within which they practice, in aspects of responsibility for care in their role as a nurse advocate, sustaining standards of advocacy satisfactory to their professional body, accountability for actions and omissions of actions, guidance on avoiding stepping outside the limits of their professional practice of advocacy, and adequate understanding of the law.
As a nurse, in my years of practice, I have noted that some schizophrenic patients who do not respond to other antipsychotic medications are treated and maintained on olanzapine. Olanzapine therapy has been connected to hypertriglyceridemia. 23-year-old Maria is a schizophrenic patient diagnosed with schizophrenia at age 18.
On physical examination, the patient is morbidly obese, weighed 167 kgs, and had walking problems and breathing difficulties due to obesity. This can be attributed to the 20mg of olanzapine taken daily. On raising the issue with the psychiatrist and questioning why he sees the patient is obese and still maintains the maximum prescribed dose of olanzapine, he explained that that was the only drug the patient was responsive to. This particular case and similar cases are experienced, and the nurse’s role is to act as an advocate for the patient.
The patient is severely sick; the observations obtained during a thorough mental state examination (MSE) were that the patient displayed bizarre behaviors, delusions and flat affect. The patient also had auditory hallucinations. With this examination, it is obvious that the patient is not in a mental capacity to advocate for herself and her family does not understand that the cause of the obesity is related to olanzapine.
Switching to an antipsychotic with minimal weight gain was the greatest advocacy I could do as a nurse given the variance in antipsychotics’ ability to cause weight gain. In my previous readings, I discovered that changing from olanzapine to aripiprazole or quetiapine may be advantageous. However, any switch must be balanced against the risk of a decline in mental health.
It has also been demonstrated that adding aripiprazole to clozapine or olanzapine causes a slight weight loss (Fitzgerald et al., 2021). Decreasing the antipsychotic dose rarely results in weight loss because there is minimal evidence that an antipsychotic dose response affects weight gain.
The promotion of a healthy lifestyle is another aspect of my involvement as a psychiatric nurse. As part of my advocacy role, I may also provide specialized counseling on food and exercise, cognitive and behavioral treatments, well-defined, attainable goals, objective monitoring of progress, and the involvement of pertinent experts like dieticians. Prescribing pharmacologic medications such as metformin can be my advocacy role as a nurse.
According to Dayabandara et al. (2018), metformin has been shown to reduce weight by up to 3kgs. As a nurse, I can also advocate for maria by advising her family on the benefits of dietary counseling, exercise programs, and cognitive and behavioral techniques.
All patients started on antipsychotics should get dietary counseling and lifestyle guidance regularly. Those who gain weight should be engaged in a structured program that tracks patients’ adherence to the treatment plan. Nonpharmacologic therapies tend to be more helpful in individuals on antipsychotics who are prone to weight gain. Some research suggests that combining lifestyle changes with metformin is more beneficial than either intervention alone (Kao et al., 2018).
Socio-economic Impact Of The Advocacy
Because the majority of olanzapine-induced weight gain occurs during the initial months of therapy, olanzapine weight gain may have a social impact because fast weight increase is noticeable. This influences social interactions and the self-esteem of the patient. The patient may lose their job too. Advocating for medication changes and pharmacologic therapies will cost the patient money since the patient will have to purchase new drugs.
The progression of strategic clinical care pathways to resolve this problem within mental health amenities has been overlooked in the community, and there is, as of now, no care pathway or evidence-based treatment that is applied routinely and systematically when managing olanzapine weight gain, affecting patients suffering from mental health issues (Kao et al., 2018).
Focusing on the socioeconomic impact of advocacy, access to lifestyle treatments should be emphasized, and guidelines and therapeutic regulations should take into account this patient’s special requirements as well as the setting in which such interventions are normally administered.
For example, the use of metformin as part of an early, first-line therapeutic plan to proactively reduce olanzapine weight gain has a cost impact on the patient and family since they will not have to address obesity-related complications in the future.
Compared to lifestyle therapies, metformin usage is linked with a low acquisition cost and related resource consumption, a very low probability of producing catastrophic harm, and is available to a much larger and socioeconomically varied group in a sustainable manner (Fitzgerald et al., 2021).
When the unfavorable consequences of olanzapine weight increase on both physical and mental health are compared, the negative connections with metformin, particularly polypharmacy and related hazards, become less substantial (Fitzgerald et al., 2021). Overall, co-prescription of metformin to a far broader spectrum of olanzapine-treated patients and many other antipsychotics should be explored as a proactive early step to effectively manage olanzapine weight gain.
Conclusion
Weight gain with olanzapine not only impacts medicine tolerance but also poses a substantial risk factor for metabolic syndrome and cardiovascular disease in patients, contributing to the high morbidity and mortality associated with psychotic disorders.
Cognitive impairment is routinely documented in people with schizophrenia, even during the initial episode of the disease, and it is not alleviated and may even be aggravated by olanzapine therapy. As a result, an adjunctive treatment that decreases antipsychotic-mediated weight gain without jeopardizing the medication’s antipsychotic effect while improving overall the cognitive deficits seen in schizophrenia would be therapeutically advantageous, and it is the nurse’s role to act as an advocate in such a case.
There is evidence that adjusting to a less probability of weight gain antipsychotic, changing one’s lifestyle, and adding an adjuvant such as metformin or topiramate may help prevent and cure an antipsychotic-induced weight gain. A combination of therapies might be beneficial. Individual requirements will necessitate specific interventions. Preventing weight gain in antipsychotic-treated individuals should be prioritized.
References
Dayabandara, M., Hanwella, R., Ratnatunga, S., Seneviratne, S., Suraweera, C., & de Silva, V. A. (2018). Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatric Disease and Treatment, 13, 2231–2241. https://doi.org/10.2147/NDT.S113099
Fitzgerald, I., O’Dwyer, S., Brooks, M., Sahm, L., Crowley, E., & Ní Dhubhlaing, C. (2021). Worth the weight? Olanzapine prescribing in schizophrenia. A review of weight gain and other cardiometabolic side effects of olanzapine. Frontiers in Psychiatry, 12, 730769. https://doi.org/10.3389/fpsyt.2021.730769
Kao, A. C.-C., Spitzer, S., Anthony, D. C., Lennox, B., & Burnet, P. W. J. (2018). Prebiotic attenuation of olanzapine-induced weight gain in rats: analysis of central and peripheral biomarkers and gut microbiota. Translational Psychiatry, 8(1), 1–12. https://doi.org/10.1038/s41398-018-0116-8
Advocacy in Nursing Discussion
Write a paper using APA 7th edition format to identify a practice issue in which the psychiatric-mental health nurse practitioner can serve as an advocate. Discuss any socio-economic impact this advocacy role could have on an individual, family, or community.
Peer Review Assignment Instructions
You are to find aa peer reviewed scholarly article (from a journal of nursing, is preferred) and write a summary of that article. You need to read the whole article and summarize the article in your own words. Please include the following
Title Page
Thesis Statement
Include 250 word in the body of the paper
References page
Attach the entire article with your submission, not just the the abstract or summary of the article.
You need to follow APA 7, no extra spaces between paragraphs, do not justify the margins! Everything is only left justified, with References having the DOI or web address.
Remember, this is your summary of the article.
According to Polit and Beck, an article review contains the following in sentences (not bullet points).
Start with a summary or overview of the article which includes the author’s name and the title of the article.
Your summary should be about one third of the length of the original article. Your summary should include: Introduction
State the main ideas of the article.
Identify the most important details that support the main ideas.
Write your summary in your own words; avoid copying phrases and sentences from the article unless they’re direct quotations.
Express the underlying meaning of the article, not just the superficial details.
***The article and references must be within last 5 years***