Concept Synthesis Paper

In nursing, the environment of operations requires that a professional adheres to the four metaparadigms. These metaparadigms focuses on the discipline and they entail person, health, nursing, and environment. These four concepts are critical in defining the philosophy of a nurse profession, especially the organ transplant nurse.


A person is the first paradigm concept which refers to an individual patient who; who as organ transplant nurse, must care for. Without a doubt, the nursing client represents an open system which is dynamic in terms of the mutual process with the dynamic environment (Thompson, 2017). The person concept goes beyond the patient by encompassing the family members and friends of patients. It is assumed that nurses have the ability to empower and nurture the patient; hence allowing the patient to manage his/her own life to his/her ability (Krinsky, 2012).  Importantly, I have realized that the person is an important concept in this profession because, without it, the nursing profession is insignificant.


Health is an important aspect of nursing profession because it focuses on the outer and inner state of wholeness, integrity, and wellness. According to Monforte-Royo and Roque (2012), health as a concept considers illness and disease from either a collective and individual perspective. An organ transplant nurse understands the nursing science which guarantees the knowledge regarding the illness and health process. Since the organ transplant nurse is an emergency room nurse, the application of the nursing science is inevitable because it has helped me in determining the best nursing interventions which ensure patients gain optimal patient care. The health experience reflects the whole person who is supposed to connect the four metaparadigm concepts with the person (Thompson, 2017). To me, I consider the overall wellness conditions of an individual based on the emotional, spiritual, physical, and mental conditions.


The environment concept of metaparadigm focuses on the surroundings; which comprises of the external and internal components. Without a doubt, the internal components and external components interact; thus affecting a patient’s health conditions. In most cases, the health status of a person depends on the environment. According to Dupree (2017), theorists assumed that nurses have the ability to place their patients in the best conditions to allow nature to act effectively. As an organ transplant nurse, I handle patients and donors from unsanitary environments. These stakeholders’ health is in jeopardy while in their homes, but upon arriving in our facilities, they experience improved health conditions because of the clean hospital environments. The treatment and clean environment are assumed to be the cause of their health improvements (Dupree, 2017). To this effect, educating the patients and their families about the significance of sanitary environment would ensure they understand how illness and environment are related.

Also Read : Nursing Writing Services


The environment affects an individual’s overall patient health.  Nursing is a profession focusing on improving the patient’s health outcomes (Thompson, 2017). The human illness and health processes are viewed as a science whose study is considered as nursing. To this effect, nursing should be defined by the right actions, attitudes, and relationships to achieve positive effects on the patient’s wellbeing. Through the nursing comfort theory, it is possible to understand nursing education, nursing leadership, and nursing practice (Collins-Perrica, 2016). Although many people have the potential of comforting others; there are many individuals who need guidance on how to assess the situation. Kolcaba’s theory provides the best guidelines for nurses to assess the patient’s level of comfort or discomfort and provides them with the opportunity to create appropriate interventions (Krinsky, 2012). In my experience as an organ transplant nurse, I have had the opportunity to assess the level of comfort and offered care meant to relieve pain and discomfort. I have thus integrated this theory into my professional practice. The healthcare has also offered the proper plan of care which limits interruptions; therefore, allowing patients to trust the care and feel comfortable.

Genitourinary Disorders

Genitourinary disorders are diseases experienced when the genital and urinary organs function improperly. In most cases, such disorders are associated with injury, illnesses, and aging. The genitourinary disorders appear in different forms including interstitial cystitis, urinary incontinence, kidney stones, neurogenic bladder, urinary tract infection, prolapsed uterus, and pelvic inflammatory disease. Apart from these disorders causing urinary problems, they can also affect an individual’s reproductive systems. The genitourinary illnesses are life-altering as they affect the quality of life.

Differential Diagnosis

Diagnoses are meant to help physicians to detect and act on the disease, however, some diagnoses cause flank pains including trauma, pyelonephritis, and urinary tract infections.

  •         Pyelonephritis is a diagnosis that has been found common with preschool children. This disease is flanked by pain and other febrile diseases, such as emotional stress, chronic recurrent abdominal pain, early appendicitis, and gastrointestinal syndromes (Santos, Lopes, & Koyle, 2017).
  •         Urinary tract infection (UTI) is a common urinary infection. Diagnosis is based on the accurate urine culture findings which reveal that the individuals with the disease experience bad smelling urine or looking reddish or cloudy (Nelson, 2016). The patient always feels an urge to urinate, as well as feeling pain during urination. The individual with UTIs would experience pain in the back, tiredness, fever, or shakiness.
  •         Intersex abnormalities which involve physical examination to help determine the anatomical classification (Burns, 2013). This is evident when the syndrome is associated with cryptorchidism.

Primary diagnosis and rational

The initial evaluation of patient’s conditions will involve physical and clinical history examination. Bowel and voiding diaries will offer relevant and reliable information about the condition of the patients (Santos et al., 2017). The diary should be based on a 48-72-hour reading; therefore, the records of patient’s urine volumes can be estimated in terms of the maximum voided volumes. With the help the Bristol stool chart, it is possible to monitor and diagnose constipation treatment response, especially for children with balder bowel dysfunction.

Also Read : Nursing Writing Services

Orders to address the issues

Based on the urgency to address this syndrome, I will give orders covering behavioral, pharmacological, and surgical treatment plans.

Behavioral orders

Parents, caregivers, and children must be educated on urotherapy because this is the only non-surgical and non-pharmacological treatment method available (Burns, 2013). The orders will encompass:

  •         Caregivers and parents must ensure adequate hydration
  •         Conduct pelvic floor muscle awareness
  •         Undertake timed avoiding
  •         Conduct bowl regiment through stool softeners, optimal hydration, and high intake of dietary fibers

The urotherapy will maximize contraction and relaxation of muscles.

Pharmacological orders

When the urotherapy fails to yield expected outcomes, pharmacological treatment should be the second option. Patients with chronic conditions need long-term treatments using different anticholinergics (Santos et al., 2017). The adult patients should use any of these anticholinergics depending on the physician’s prescriptions:

  •         Oxybutynin
  •         Trospium
  •         Tolterodine

Surgical treatment

In a situation where a patient has experienced the disorder for over nine months, it would be prudent to recommend surgical treatments including:

  •         Refractory detrusor overactivity: In children, sacral transcutaneous stimulation is advisable because it lacks negative side effects, especially in children with symptom severity and bowel bladder dysfunctions (Santos et al., 2017).
  •         If the maximum medical therapies, such as enema therapies, medications, and diet fail, an antegrade continence enema procedure should be considered (Santos et al., 2017). This will help to handle cases of intractable defecation disorders.

These orders, however, should only guide the patient, physician, and families in making individualized informed decisions to meet the patient’s needs.

 Patient and parent education

Education and reassurance relating to the syndrome should focus on the repair, etiology, and outcome. In fact, the need for a careful assessment of children or newborn should be conducted, especially, when cases of hypospadias had been reported in the family. Nonetheless, hypospadias is a unique and isolated glitch which needs further workups so as to assess for other anomalies within the urinary system anatomy. Patient education should focus on encouraging patients to accept further assessments on their urinary systems to detect any anomalies (Burns, 2013). As such, it is possible to undertake responsive and early steps to salvage the situation. Besides, the practitioner should share with the families relevant educational materials because of the growing frustrations, anxiety, and concerns regarding the persistent wetting. These educational materials should include handouts, brochures, and videos should give the parent an opportunity to opt for the urotherapy while pursuing medical interventions (Santos et al., 2017). These efforts will improve treatment compliance. However, these educational materials must be composed of simple language and they should contain the general information about bladder dynamics, urinary tract anatomy, causes of the disease, natural history, and tips on appropriate postures and position.

The impact of culture

Health beliefs remain a significant factor in mediating between an individual’s behaviors and experience of symptoms. These health beliefs vary from one ethnic group to another (Welch, Botelho, & Tennstedt, 2011). In most cases, many people attribute such syndrome to personal behaviors or aging; hence never find it amenable to seek medical treatment. The Black Americans associate the genitourinary disorders to personal behaviors which make it difficult to control. However, the Hispanics treat the disease with uncertainty regarding the symptoms and the future health consequence. Consequently, the combination of different health beliefs seems to determine the behavior of individuals in seeking medical care. The cognitive representations are shaped by the socio-cultural differences. To this effect, patient education and assessment depend on the cultural competency.

Nursing Care to the Shelter’s Occupants

Homelessness remains a distressing experience for many citizens because it upsets family life, impedes childhood development, and dents the family members’ emotional and physical health (Maurer & Smith, 2013). Homelessness affects the wellbeing and health of family members. When children are homeless, they are vulnerable and experience poor health leading to over 25 percent higher rates of ear infections, speech problems, and asthma (Ambrosino, 2012). They further experience mental health problems like withdrawals, depression, and anxiety. The infectious diseases are common among the homeless families because they live in crowded conditions; hence making them vulnerable to common infectious diseases including diarrhea, ear infections, and respiratory tract infections. The unhygienic conditions also contribute to increased ear infections. This could lead to swimmer’s ear which is caused by bacteria and water getting trapped inside the canal leading to the buildup of wax.

Also Read : Nursing Writing Services

In most cases, homeless children come from a background of substance abuse, mental illness, and domestic violence. With these stresses of poverty and homelessness, their psychosocial wellbeing is affected. People who are mentally ill have high chances of becoming homeless because mental illness and homelessness are connected. Maurer and Smith (2013) found that about 13-15 percent of the mentally ill individuals show the symptoms of delusions and paranoia. Homeless families are thought to have spent some time in the streets; thus increasing the incidence of mental illness. According to Holland (2017), the Los Angeles authority estimated that about 30 percent of the current homeless people suffer from mental illness. Besides, Holland found that most of the mentally ill individuals have unstable income and jobless; thus making it difficult to escape the syndrome.

Declan can diagnose mental health among the homeless using dementia, personality disorder, bipolar disorder, and depression. However, Declan needs to pay attention to depression which is a common mental illness. In fact, the majority of patients with depression experience unmet needs. These patients must have not received proper treatment. Declan must understand that depression remains a manageable condition and the nurse can use medication and therapy to manage it.

Foundational Leadership Practices

Post I

The clinical environment is complex that foundational leadership skills can help an individual to manage. What has remained misunderstood and confusing is leadership because it supersedes an individual or a position. Based on the interview, it is evident that foundational leadership is founded on servant leadership theory. The servant leadership requires an individual to be a servant by developing a feeling and compassion for others. With this conscious choice, one finds it possible to aspire and lead. The nurses can only succeed in their practices by being full partners. This implies that partnering with different health professionals including physician guarantees nurses success. Healthcare sector needs strong leadership which can ensure healthcare system is transformed. This defines the significance of servant and transformational leadership system. However, many nurses rarely begin their profession in anticipation of becoming leaders.

Strong leadership is good for an organization and it can be used to redesign the healthcare system; hence, allowing the nursing profession to produce strong leaders to allow them to serve as partners and become accountable for their actions in delivering services. This shows that leadership is more than directing, dictating, and delegating duties but to help others to realize their potential (Neese, 2015). Collaboration and teamwork are important in achieving quality patient care. The foundational leadership focuses on collaboration which entails directing, problem-solving, and structuring. They anticipate that a leader should be an individual with interpersonal attributes including critical thinking, process skills, self-confidence, and cooperation (Germano, 2010). Communication and conflict resolutions are among the foundational skills expected from a healthcare professional.

To them, a well-managed healthcare worker results in quality patient care. This is because the nurse leader is knowledgeable and skillful in meeting goals of advanced healthcare and led the required changes (Neese, 2015). Without a doubt, the nursing shortage is an issue affecting healthcare industry. This calls for hiring more nurses to enhance service delivery and oversee nursing staff. The nurse leader should mentor and support the nursing staff; therefore, allowing them to deliver the expected patient care. Evans (2015) argued that the nurse leaders can support nurses to achieve their career growth. With the changing healthcare environment, the leaders are focusing on critical issues and initiatives affecting optimal patient care including patient safety, quality, healthcare reforms, value-based purchasing, and pay-for-performance. As a leader, it is important to build strong personal networks and become proactive (Asrar-ul-Haq & Kuchinke, 2016). A proactive leader will have to focus on teamwork, knowledge building, patient advocacy, patient assessments, and effective communication.

Also Read : Nursing Writing Services

Leaders use different leadership strategies to achieve the organizational goals. Depending on the leadership styles, the transformational leader embraces teamwork while the autocratic leader focuses on individual performance (Evans, 2015). This makes the difference because a servant or transformational leader values the interests of the followers instead of giving orders to the followers.

Post II

Organizations play a crucial role in shaping the practices and desires of a leader. This is based on the goals, culture, and values of an organization. The organizational culture can be the stumbling block for the development of a leader. However, the leader can overcome this barrier by adjusting their leadership behaviors to conform to the organizational mission (Tsai, 2011). Indeed, by creating a positive relationship between leadership behavior, organizational culture, and employee’s job satisfaction is important. The organizational culture should create a healthy and happy environment by influencing the work attitudes and behaviors (Asrar-ul-Haq & Kuchinke, 2016). Therefore, the interaction between employees and leaders must be good to enhance collaboration and team communication.

In conclusion, transformational and servant leadership theories have defined the success of many organizations. Based on this article, it is evident that the nursing environment is complex and nurses need leaders who embrace teamwork and collaboration. This makes it possible for nurse leaders to motivate, mentor, and support workers leading quality patient care.

EBP on Schizophrenia


Schizophrenia is a chronic disorder of the brain that affects the ability of an individual to interpret reality normally. An active schizophrenia reveals symptoms such as lack of motivation, hallucinations, delusions, difficulty with concentration and thinking. Although there is no cure for schizophrenia, various studies have been conducted to determine the causes of the disease and develop new and more effective therapies to the address the causes that exacerbate the symptoms. The causes of schizophrenia such as environmental, mental, genetic, and social factors vary significantly between individuals as well as the symptoms. These are risk factors that contribute to the onset and course of the disorder. Because of these multiple factors that contribute to the development of the disorder, it has made it difficult to identify specifically the exact cause of the disease in individual cases. The clinical question to be discussed in this paper includes, “What are the social, mental and environmental causes that exacerbate hallucinations in a patient diagnosed with schizophrenia?

Literature Review

According to the study conducted by McCarthy-Jones and Longden, 2015), the auditory verbal hallucination (AVH), which involves ‘hearing voices’ is a schizophrenia disorder linked with earlier exposure to emotionally or traumatic events that were overwhelming. The study suggests that these events may be recurring and if these memories form the basis of AVH, then changing an individual’s current perspectives and beliefs may alter memories that they create and causes their ability to contrast voices to arise from these events. Based on the study results, evidence suggests that there is a direct relation between trauma and hallucination. All these evidence indicate that a subsection of individuals with schizophrenia disorder have earlier experiences of trauma in their life and a subset of these traumas has associations with their hallucinations.

The implementation of this evidence in practice requires a trans-diagnostic strategy of treatment (Garwood, Dodgson, Bruce & McCarthy-Jones, 2015). Implementation of trauma-based interventions for AVH that are based on trauma is crucial to improving patient outcome. The trauma specialized interventions have proved to be appropriate for many patients. They change the negative content of voices thus have beneficial consequences and improved outcomes for many patients. Sariaslan et al. (2016) point out that various systematic reviews have shown that neighborhood contributes to the etiology of schizophrenia. Evidence indicates that based on interpretation of social causation, systematic reviews have revealed that early experiences of adverse neighborhood stressors over a period of time contribute to the development of schizophrenia. Neighborhoods that are socially disorganized are characterized by ethnic heterogeneity, marital instability, poverty, and residential mobility.

Also Read : Nursing Writing Services

The study findings indicated that the risk for development of schizophrenia and neighborhood deprivation was statistically significant. Although the results were inconsistent and inconclusive, it is evident that social factors have an influence on the social drift of patients with schizophrenia based on the social selection interpretation. The implementation of clinical and policy interventions in the treatment of patients with schizophrenia associated with social causation will contribute significantly towards the identification of the possible causal factors between socioeconomic courses and cognitive functions thus leading to improved outcomes.

Wright, Peters, Ettinger, Kuipers, and Kumari, (2016) conducted a study to determine the impact of environmental factors such as noise on the cognitive function of patients diagnosed with schizophrenia. Cognitive impairment is a common symptom related to poor functional outcomes in schizophrenia, especially the executive and memory function areas. Schizophrenia patients have been observed to have the oversensitivity to sensory stimuli and it is possible that environmental factors such as noise could exacerbate cognitive impairment especially those residing in urban environments (Bristow et al., 2014).  The study suggests that environmental noise has an adverse impact on various cognitive areas in healthy adults as well as those with schizophrenia. The results of the study revealed that environmental noise contributes to further cognitive impairment.

The study assessed the comprehensive cognitive battery in healthy participants such as measuring verbal learning and memory, executive functioning, attention, and psychotic speed. These measures were conducted under three major environmental conditions including social noise, for instance, the footsteps and babble background noise from a crowded hall, urban noise including the noise in the construction site, and in both conditions. Both the healthy participants and those with schizophrenia displayed considerable interruption of functioning memory by the social noise and the verbal recognition and recall by both the social and urban noise as opposed to the silent condition. Therefore, it is evident that environmental noise has an adverse impact on the areas of working and verbal memory both in healthy participants and patients with schizophrenia but may be challenging in patients because it can cause further deterioration of the pre-existing cognitive problems such as hallucinations. The study intervention includes noise management like minimizing exposure to noise where practical such as noisy wards. The implementation of this intervention could contribute towards improved outcomes by improving the lives of individuals with psychotic disorders.

Marín, Rodríguez-Franco, and Chugani et al. (2018) conducted a study to investigate the widespread of Schizophrenia Spectrum Disorders in Average-IQ Adults with Autism Spectrum Disorders. The ASD describes the behaviors and symptoms that have an adverse impact on how an individual comprehend and respond to the world around them. Chisholm, Lin, Abu-Akel, and Wood (2015) indicate that ASD affects the intelligence levels of a person. Their IQ scores are often below average and sometimes at mentally deficient intelligence levels. The results finding of the study revealed that there is a considerable percentage (6%) of the prevalence of SSD in the total ASD sample of 278 references. This suggests that the mentally deficient intelligence levels in ASD adults are a risk factor for the development of schizophrenia in these patients.

For many years, the SSD and ASD were being conceptualized as same disorders. However, since their separation into individual diagnostic, they have been identified as different disorders, that are mutually exclusive. The implementation of this aspect in practice could improve outcomes because it would contribute to the proper diagnosis of each disorder independently. The disorders share various risk factors and phenotypic similarities, which may co-occur at advanced levels hence they could lead to misdiagnosis. Moreover, having knowledge of how and why there is a high co-occurrence between these disorders has significant implications for establishing aetiological models, prognosis, treatment, and diagnosis of the disorders. Consequently, taking into consideration the predisposing factors of schizophrenia to the people with ASD will help to prevent and reduce its prevalence in members of ASD population.

According to Upthegrove, Marwahia, and Birchwood (2017), depression has been identified as a common syndrome in schizophrenia. It can be described as a mental causal for schizophrenia. It is related to increased duration of illness, poor quality of life, and frequent psychotic episodes. Despite existing of a clear indication of the need for effective strategies in the management of depression in schizophrenia there is no specific guidance outlined.This has resulted in challenges in treatment and management of depression in schizophrenia patients. The study results point out that depression in schizophrenia has been a problem to the Kraepelinian dichotomy that has affected the efforts to address the major difference such as refining and evoking diagnoses. The evidence revealed that identification of the presence of depression in schizophrenia would help to recognize and address the potential treatment and etiological pathways challenges (Dauwan, Begemann, Heringa, & Sommer, 2015). Additionally, an identification that depression is beyond comorbidity, as well as enhanced therapeutic interventions focusing majorly on mood symptoms would contribute significantly towards support prevention and improve outcomes for patients with schizophrenia.


From the discussed literature review above, it is evident that schizophrenia is caused by social, environmental, and mental factors. The identified environmental factors include urban noise from building sites and social noise from background footsteps of a crowd in the hall. The social factors include deprived neighborhoods, and mental factors include early exposure to traumatic events, depression, and mentally deficient intelligence levels in people with ASD. These factors exacerbate the pre-existing cognitive deficits in patients with schizophrenia leading to adverse effects such as hallucinations. Hallucination is a common symptom of schizophrenia that causes individuals to perceive the world around them abnormally. Therefore, appropriate interventions such as trauma-based interventions, noise management, and clinical and policy interventions related to the causal factor have significant implication in the prevention of exacerbation of hallucinations in schizophrenia patients thus resulting in improved outcomes.