7 minutes ago Casey Hoffman  Case #7 Do Not Heal Thyself COLLAPSE Top of Form Case #7  The Case: The case of physician do not heal thyself The Question: Does the patient have a complex mood disorder, a personality disorder or both? The Dilemma: How do you treat a complex and long-term unstable disorder of mood in a difficult patient? *List three questions you might ask the patient if he or she were in your office:  1. Has there ever been a period of time when you were not your usual self and thoughts raced through your head or you couldn't slow your mind down (Hirschfeld, 2002)?  Rationale: This question specifically inquires about whether the client feels they have been their usual self and specifically references their energy levels (Hirschfeld, 2002). These symptoms are important to identify and rule out if a manic episode related to a mood disorder (such as Bipolar I) is occurring. By narrowing down correct symptomologies, the correct and appropriate psychiatric diagnosis can be made, along with the appropriate treatment.  2. Has your mood or behaviors caused major problems in your life like being unable to work; having a family, money or legal troubles; getting into arguments (Hirschfeld, 2002)? Rationale: This question specifically focuses on how much of a problem the symptoms have been in a client's everyday life. Mood disorders such as Bipolar I and Bipolar II can significantly impact a client's life. Patients suffering from a mood disorder, such as Bipolar I, are at a significantly higher risk for suicide, harm to self, or harm to others (Hirschfeld, 2002).  3. How frequently would you estimate that you have experienced racing thoughts or elevated energy in relationship to your mood or fights and have any of these issues occurred during the same period of time (Hirschfeld, 2002)?  Rationale: This particular question addresses if the symptoms that are being experienced, occurred during the same time period, which would be indicative of the diagnosis of Bipolar I mood disorder. This question is important when assessing a client for a mood disorder in those patients who are misdiagnosed may experience rapid cycling or mania (Hirschfeld, 2002).  *Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. According to Stahl (2013), it is essential for healthcare providers to obtain information from not only the client but also from outside sources. Outside sources for a client may include their spouse, parents, or siblings. Information obtained from outside sources may be significantly different than what the client describes and can assist in accurately diagnosing the client (Stahl,2013). Clients that are accurately diagnosed, can then be appropriately treated with pharmacological agents.   -Were there any significant triggering factors related to the client's first major depression episode at age 23?  The ...

1. 7 minutes ago
Casey Hoffman
Case #7 Do Not Heal Thyself
COLLAPSE
Top of Form
Case #7
The Case: The case of physician do not heal thyself
The Question: Does the patient have a complex mood disorder,
a personality disorder or both?
The Dilemma: How do you treat a complex and long-term
unstable disorder of mood in a difficult patient?
*List three questions you might ask the patient if he or she were
in your office:
1. Has there ever been a period of time when you were not your
usual self and thoughts raced through your head or you couldn't
slow your mind down (Hirschfeld, 2002)?
Rationale: This question specifically inquires about whether the
client feels they have been their usual self and specifically
references their energy levels (Hirschfeld, 2002). These
symptoms are important to identify and rule out if a manic
episode related to a mood disorder (such as Bipolar I) is
occurring. By narrowing down correct symptomologies, the
correct and appropriate psychiatric diagnosis can be made,
along with the appropriate treatment.
2. Has your mood or behaviors caused major problems in your
life like being unable to work; having a family, money or legal
troubles; getting into arguments (Hirschfeld, 2002)?
Rationale: This question specifically focuses on how much of a
problem the symptoms have been in a client's everyday life.
Mood disorders such as Bipolar I and Bipolar II can
significantly impact a client's life. Patients suffering from a
mood disorder, such as Bipolar I, are at a significantly higher

2. risk for suicide, harm to self, or harm to others (Hirschfeld,
2002).
3. How frequently would you estimate that you have
experienced racing thoughts or elevated energy in relationship
to your mood or fights and have any of these
issues occurred during the same period of time
(Hirschfeld, 2002)?
Rationale: This particular question addresses if the
symptoms that are being experienced, occurred during the same
time period, which would be indicative of the diagnosis of
Bipolar I mood disorder. This question is important when
assessing a client for a mood disorder in those patients who are
misdiagnosed may experience rapid cycling or
mania (Hirschfeld, 2002).
*Identify people in the patient’s life you would need to speak to
or get feedback from to further assess the patient’s situation.
Include specific questions you might ask these people and why.
According to Stahl (2013), it is essential for
healthcare providers to obtain information from not only the
client but also from outside sources. Outside sources for a
client may include their spouse, parents, or siblings.
Information obtained from outside sources may be significantly
different than what the client describes and can assist in
accurately diagnosing the client (Stahl,2013). Clients that are
accurately diagnosed, can then be appropriately treated with
pharmacological agents.
-Were there any significant triggering factors related to the
client's first major depression episode at age 23?
These questions can assist in distinguishing between Bipolar
Mood Disorders and Borderline Personality Disorder. Bipolar
Mood Disorders typically manifest in the early to mid-'20s ( It
must be determined if the depression was an initial onset of a
hypomanic episode or if it was due to an existing personality
disorder.
-What other moods did the client exhibit when they were not in

3. a depressive episode? How long did these moods last?
According to Stahl (2013), individuals often downplay their
manic symptomologies and their duration. These episodes and
their duration are essential in order to accurately diagnosing a
client.
-Does the client have any significant psychiatric history, such
as Bipolar I, Bipolar II, or other mood disorders?
According to Stahl (2013), first-degree relatives who also have
bipolar disorder can indicate the likelihood that the client also
suffers from a bipolar disorder. If the client does have a
significant family history of bipolar disorder, any effective
treatments, the severity of the condition, and any
hospitalizations that occurred should be documented in the
client record.
Explain what physical exams and diagnostic tests would be
appropriate for the patient and how the results would be used.
Certain diagnostic tests such as a Complete Metabolic Panel
(CMP), Liver Function Tests (LFT's), Hemoglobin A1c, and a
urine specific gravity can be ordered to evaluate the
functionality of the client's kidneys, liver, and the presence/risk
of diabetes mellitus. A mood stabilizer such as Lithium may be
used to manage the client's severe fluctuation in moods.
Lithium, however, can be severely nephrotoxic. Kidney function
tests should be drawn prior to initiating therapy and throughout
the course of therapy to assess for kidney dysfunction
(Tolliver & Anton, 2015). A urine specific gravity can also
indicate the functionality of the kidneys. Antipsychotic
medications may be used to treat long-term unstable mood
disorders. Antipsychotic medications, both first and second
generations, can cause metabolic syndrome. The development of
metabolic syndrome can be monitored by obtaining a CMP,
LFTs, & Hemoglobin A1C prior to starting medication therapy
and then throughout the medication therapy course. According
to Stahl (2013), clients taking antipsychotic medications should
have lab diagnostic studies done every 3-6 months. A urine drug

4. screen (UDS) should also be done to rule out the illicit
substances as the causation of the mood disorder.
It is essential to assess all clients if they have any suicidal
ideations. The Columbia-suicide severity rating scale can be
used to assess the severity of suicide risk. COLUMBIA-
SUICIDE SEVERITY RATING SCALE (C-SSRS): This
screening tool is used to detect suicidal ideations and their
severity. It is scored from 0-5. A score greater than 0 may
indicate a need for mental health intervention. A score of 4-5
indicates active suicidal ideation with some intent
to act ("Columbia-Suicide Severity," 2019).
This client should have a full head-to-toe physical assessment
completed including a mental status exam, and vital signs.
These initial findings can be used as a baseline for the patient
and any future assessment changes can be compared to the
initial findings (Tolliver & Anton, 2015).
**List three differential diagnoses for the patient. Identify the
one that you think is most likely and explain why.
1. Recurrent major depression with an
anxious/dysphoric temperament Most likely diagnosis
According to the DSM V (2013), the client's symptoms most
likely indicate a mood disorder. Due to the limited amount of
time with the patient and limited past mania history, a Bipolar
mood disorder could be ruled out. The client's main symptoms
present as depressive in nature, with one suicide attempt 40
years ago (Stahl Online, 2018). Recurrent major depression with
an anxious/dysphoric temperament, which is also a complex
mixed mood disorder, is the most likely diagnosis given the
patient's current symptoms. According to the scenario provided
by Stahl Online (2018), the client has been experiencing a
mixed dysphoric state with the depression occurring the
majority of the time.
2. Bipolar II mixed episode:
Per the client's history, he has been experiencing symptoms that
are consistent with hypomania since the age of 23, such as

5. inflated self-esteem, irritability, and decreased need for sleep
(Stahl Online. 2018). Per the DSM 5, Bipolar II is defined as an
abnormally elevated or irritable mood with an increased activity
that lasts at least 4 uninterrupted days along with at least three
behaviors such as inflated self-esteem, decreased need for sleep,
increased talking, flight of ideas, racing thoughts, goal-driven
activity, and participating in high-risk behaviors (American
Psychiatric Association, 2013). Hypomanic episodes should also
be noted by those close to the client per the DSM 5. Further
interviewing with the client's family needs to be completed in
order to determine if the client exhibited hypomanic episodes.
3. Primarily a cluster B personality disorder
(antisocial/histrionic/narcissistic/borderline)
The client's irritability, anxiety, and past failed relationships
may be explained by a cluster B personality disorder, per the
DSM 5.
1. ** 2 Pharmacological Agents: The medications of choice
for this client would be those that aim at stabilizing the client's
mood, such as lithium or Lamictal. According to Stahl (2013),
Lamictal is a second-line medication therapy that can be used to
treat mixed state depression symptoms. The goal dosage of
Lamictal would be 200 mg PO Daily. Lamictal dosages need to
be titrated up slowly because of the serious side effect known as
Steven Johnson's Syndrome. Dosing Schedule: 25 mg PO daily
for 2 weeks-50 mg PO Daily for 2 weeks- 100 mg PO Daily for
1 week-Double dose every week to maintenance at 200 mg
Daily PO. Lithium is used for the maintenance treatment for
manic-depressive conditions and major depressive disorder
(Stahl, 2017). The main goal of treatment with lithium therapy
is complete remission of symptoms (Stahl, 2017). The client
should have initial kidney function tests done prior to starting
therapy and 1 to 2 times a year during therapy. Serum lithium
levels should be drawn every 1-2. weeks until the desired serum
concentration is achieved, then every 2-3 months for 6 months
(Stahl, 2017). After the first 6 months of lithium therapy, stable
serum lithium levels should be drawn 1-2 times per year. I

6. would choose Lamictal therapy over lithium therapy due to the
lack of lab work needed to maintain and dose Lamictal,
compared to lithium.
**Dosing Considerations in Regard to Ethnicity
This particular client's race was not identified in the case study.
According to Prescribing Information (2005), Lamictal had an
oral clearance that was 25% lower in non-Caucasians than
Caucasians. If this patient were not Caucasian, he would most
likely require a lower dose of Lamictal due to the 25% decrease
in oral clearance.
**Check Points
12 Week Follow Up:
- The client discontinued his methylphenidate per PMHNP
recommendation due to the increased risk of causing the client
to have cycling unstable mood states.
-The client started lamotrigine by his local psychiatrist, 400mg
PO Daily. I would decrease this dose to 200mg PO Daily per
current lamotrigine initiation recommendations (Stahl, 2013).
16 Week Follow Up:
- The client decided to discontinue his lamotrigine because it
was making him more depressed and inhibiting his sex life. I
would review the patient's renal function and urinalysis and
initiate lithium therapy in order to stabilize his mood. I would
prescribe the patient 400mg PO QHS
20, 24, 28 Week Follow Up:
-The client's lithium levels are 0.4, his dose finally increased to
1800 mg daily. The client unhappy with his lithium therapy due
to it negatively affecting his Chron's disease. The dose is
titrated down to 1500mg of lithium and Lamictal therapy is
restarted at 25mg and titrated to a max dose of 200mg, which
was half of his initial dosage. The hope is that using two mood
stabilizers will work together and produce therapeutic effects
- The client restarted methylphenidate therapy against medical
advice. The client attested to restarting it because of his low

7. energy and dysphoric mood.
32, 34, & 36 Week Follow Up:
-The client is non-compliant with prescribed medications and
therapy and continues to disregard PMHNP recommendations
**Lessons Learned and Ethical Considerations
This case study has taught me to always remember that difficult
clients will inevitably be difficult to treat. There will be times
when I will need to ask those who have more experience than
me for help in deciding the appropriate course of treatment in
certain challenging clients. I also learned that treating
challenging clients will take time and results may not be
observed for a while. It is important to give the specific choice
of treatment time to work. One ethical consideration that I took
away from this case study is that this patient is a physician, who
has taken the liberty of making his own therapeutic decisions in
the past. As a provider, I need to monitor and observe this client
closely in case he chooses to self prescribe his own medications
and disregard his care plan.
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author
Columbia-Suicide Severity Rating Scale. (2016). Retrieved
December 9, 2019,
from http://cssrs.columbia.edu/scoring_cssrs.html
Hirschfeld, R. M. (2002). The Mood Disorder Questionnaire
(MDQ). Retrieved December 9, 2019, from
SAMHSA website:
https://www.integration.samhsa.gov/images/res/MDQ.pdf
Perscribing Information for Lamictal. (2005). Retrieved
December 11, 2019, from FDA website:
https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/
020241s10s21s25s26s27,020764s3s14s18s19s20lbl.pdf
Stahl, S. M. (2013). Stahl’s essential psychopharmacology:

8. Neuroscientific basis and practical applications (4th ed.). New
York, NY: Cambridge University Press
Stahl, S. M. (2017). The prescriber’s guide (6th ed.). New York,
NY: Cambridge University Press
Tolliver, B. K., & Anton, R. F. (2015). Assessment and
treatment of mood disorders in the context of
substance abuse. Dialogues in clinical neuroscience, 17(2),
181-190.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518701/
Rubric Detail
Select Grid View or List View to change the rubric's layout.
Excellent
Good
Fair
Poor
Add a section to the paper you submitted in Module 1. In 4–5
pages, address the following:
· Identify and describe at least two competing needs impacting
your selected healthcare issue/stressor.
23 (23%) - 25 (25%)
The response accurately and clearly identifies at least two
competing needs impacting the healthcare issue/stressor
selected.
20 (20%) - 22 (22%)
The response identifies at least two competing needs impacting
the healthcare issue/stressor selected.

9. 18 (18%) - 19 (19%)
The response identifies at least two competing needs impacting
the healthcare issue/stressor selected that is vague or
inaccurate.
0 (0%) - 17 (17%)
The response describes at least two competing needs impacting
the healthcare issue/stressor selected that is vague and
inaccurate, or is missing.
· Describe a relevant policy or practice in your organization
that may influence your selected healthcare issue/stressor.
· Critique the policy for ethical considerations and explain the
policy's strengths and challenges in promoting ethics.
27 (27%) - 30 (30%)
The response accurately and thoroughly describes in detail a
relevant policy or practice in an organization that may influence
the healthcare issue/stressor selected.
The response accurately and thoroughly critiques in detail the
policy for ethical considerations and explains in detail the
policy's strengths and challenges in promoting ethics.
24 (24%) - 26 (26%)
The response accurately describes a relevant policy or practice
in an organization that may influence the healthcare
issue/stressor selected.
The response accurately critiques the policy for ethical
considerations and explains the policy's strengths and
challenges in promoting ethics.
21 (21%) - 23 (23%)
The response describes a relevant policy or practice in an
organization that may influence the healthcare issue/stressor
selected that is vague or inaccurate.
The response critiques the policy for ethical considerations and
explains the policy's strengths and challenges in promoting

10. ethics that is vague or inaccurate.
0 (0%) - 20 (20%)
The response describes a relevant policy or practice in an
organization that may influence the healthcare issue/stressor
selected that is vague and inaccurate, or is missing.
The response critiques the policy for ethical considerations and
explains the policy's strengths and challenges in promoting
ethics that is vague and inaccurate, or is missing.
· Recommend one or more policy or practice changes designed
to balance the competing needs of resources, workers, and
patients while addressing any ethical shortcomings of the
existing policies. Be specific and provide examples.
· Cite evidence that informs the healthcare issue/stressor
and/or the policies and provide two scholarly resources in
support of your policy or practice recommendations.
27 (27%) - 30 (30%)
The response provide one or more accurate, clear, and thorough
recommendations for policy or practice changes designed to
balance the competing needs of resources, workers, and patients
while addressing any ethical shortcomings of the existing
policies.
Specific and accurate examples are provided.
Accurate and detailed evidence is cited that informs the
healthcare issue/stressor selected and a specific synthesis of at
least two outside scholarly resources in full support of the
policy or practice recommendations is provided. The response
integrates at least 2 outside resources and 2 or 3 course-specific
resources that fully support the healthcare issue/stressor
selected.
24 (24%) - 26 (26%)
The response provides one or more recommendations for policy
or practice changes designed to balance the competing needs of

11. resources, workers, and patients while addressing any ethical
shortcomings of the existing policies.
Specific examples may be provided.
Evidence is cited that informs the healthcare issue/stressor
selected and a synthesis of at least one outside scholarly
resource that may support the policy or practice
recommendations is provided. The response integrates at least 1
outside resource and 2 or 3 course-specific resources that may
support the healthcare issue/stressor selected.
21 (21%) - 23 (23%)
The response provides one or more recommendations for policy
or practice changes designed to balance the competing needs of
resources, workers, and patients while addressing any ethical
shortcomings of the existing policies that is vague or
inaccurate.
Examples may be provided.
Vague or inaccurate evidence is cited from 2 or 3 resources that
informs the healthcare issue/stressor selected and may support
the policy or practice recommendations provided.
0 (0%) - 20 (20%)
The response provides one or more recommendations for policy
or practice changes designed to balance the competing needs of
resources, workers, and patients while addressing any ethical
shortcomings of the existing policies that is vague and
inaccurate, or is missing.
Examples are missing.
Vague and inaccurate evidence is cited that informs the
healthcare issue/stressor and may include at least 1 scholarly
resource that vaguely and inaccurately supports the policy
practice recommendations is provided, or is missing.

12. Written Expression and Formatting - Paragraph Development
and Organization:
Paragraphs make clear points that support well-developed ideas,
flow logically, and demonstrate continuity of ideas. Sentences
are carefully focused—neither long and rambling nor short and
lacking substance. A clear and comprehensive purpose
statement and introduction is provided which delineates all
required criteria.
5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and
conclusion is provided which delineates all required criteria.
4 (4%) - 4 (4%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment is
stated, yet is brief and not descriptive.
3.5 (3.5%) - 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is
vague or off topic.
0 (0%) - 3 (3%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting - English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) - 5 (5%)

13. Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) - 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation
errors.
3.5 (3.5%) - 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation
errors.
0 (0%) - 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors
that interfere with the reader’s understanding.
Written Expression and Formatting - The paper follows correct
APA format for title page, headings, font, spacing, margins,
indentations, page numbers, parenthetical/in-text citations, and
reference list.
5 (5%) - 5 (5%)
Uses correct APA format with no errors.
4 (4%) - 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) - 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
0 (0%) - 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Running head: DEVELOPING ORGANIZATIONAL POLICIES
AND PRACTICES 1
DEVELOPING ORGANIZATIONAL POLICIES AND
PRACTICES 4

14. Developing Organizational Policies and Practices
Name
Professor
Institution
Course
Date
DEVELOPING ORGANIZATIONAL POLICIES AND
PRACTICES
The ICU nurses experience psychological stress which affects
their general nursing performance. However, there are
competing needs that impact psychological stress among ICU
nurses. First, the continuous presence of family members in the
ICU limits the efficiency of nurses during the provision of care
to ICU patients. As a result, nurses are compelled to care for
both patients and family members. The "perceived interference"
by the family members emanates from differences in
educational, cultural and religious backgrounds. Consequently,
the family members require support from the nurses which is
not outlined in the ICU nurse's job description. This requires
the nurse to work extra hours to attend to both the patient and
the family members. This strain experienced by the nurses
induces psychological stress and eventually burnouts which lead
to poor nursing services in the ICU. Secondly, there is a limited
number of trained ICU nurses in the organization. This creates a
need for long working hours by the available ICU nurse. On
average, an ICU nurse is likely to stay in the shift for
approximately seventeen hours. However, Kumar et al (2016)
argues that long working hours by ICU nurses leads to increased

15. burnouts and high levels of patient dissatisfaction. Also, long
working hours are associated with poor psychological health
like anxiety and depression.
The organization has implemented a working schedule policy to
assist the ICU nurses in planning. The policy describes two
shifts; the day and night shifts. The weekend schedule starts
from Friday to Saturday which is an eight-hour-long schedule.
Based on this policy, any changes to the shift should be done
after one month. However, this only happens when the head
nurse receives a notification addressing illness and emergency
leave from a nurse. This indicates that the schedule continues
for even three months if no emergencies and illnesses present.
On the other hand, ICU nurses are allowed two days off per
week although this rarely happens due to the limited number of
trained ICU nurses in the organization. Any absenteeism by the
ICU nurse would lead to an increase in the workload of other
nurses. Nevertheless, the day shifts start at 6.001m and end at
6.00pm. This is similar to the night shift which starts at 6.00pm
and ends at 6.00am. Consequently, the organizational policy
dictates that each shift is 12 hours long. In case of emergency,
illness, and absenteeism the shifts are more than 12 hours long.
The 12-hour working policy has faced criticisms from critiques
who believe that 12-working hours create a potential risk to the
patients. According to Webster et al (2016), long working hours
lead to increased errors among the ICU nurses which result from
increased fatigue. Fatigue among ICU nurses emanates from
inadequate rest, straight shifts and sleep loss. This
organizational policy regarding the working hours results to
reduced motivation, increased accidents, slow reaction time,
decreased productivity and omission of details which
compromises patient safety. Nevertheless, this policy ensures
that a nurse is attending to the ICU patients at all times. Also,
the 12-hour shift policy has assisted the organization in curbing
the effects resulting from the organizational shortage of trained
ICU nurses. The nursing code of ethics stipulates that a nurse
should cause no harm to the patient. Unfortunately, the 12-hour

16. work schedule is less flexible as compared to an 8-hour work
schedule for nurses (Tahghighi et al, 2017). The increased risks
for patient safety violate this ethical code. The main ethical
challenge experienced by the ICU nurses is on providing
efficient services to ICU patients while maintaining high levels
of alertness when working a 12-hour shift.
To balance the competing needs, the organization must adopt
policies that promote an 8-hour work schedule for ICU nurses.
First, the organization must involve the nurse in the future and
present schedule. Through this, the opinions of nurses are
considered when creating the working schedule. This motivates
the nurse's thus increasing job satisfaction. Also, the
organization needs to adopt an 8-hour work policy. The 8-hour
shift creates more time for ICU nurses to relax and engage in
activities that promote mental health (Webster et al, 2018). This
will increase wakefulness among ICU nurses thus reducing
experiences of burnouts among the nurses. Also, this 8-hour
work policy promotes ethical practice in nursing. This is
because reduced errors promote the quality of care of the ICU
patients which leads to increased patient satisfaction. Also, the
organization needs to create a clear policy for managing the
family visits of ICU patients (Zboril-Benson, 2016). Such a
policy will address the visiting hours and support for the family
members. This will not only create room for nurses to care for
ICU patients but also identify the need for health professionals
to handle the family members of the ICU patients.

17. Reference
Kumar, A., Pore, P., Gupta, S., & Wani, A. O. (2016). Level of
stress and its determinants among Intensive Care Unit
staff. Indian journal of occupational and environmental
medicine, 20(3), 129.
Tahghighi, M., Rees, C. S., Brown, J. A., Breen, L. J., &
Hegney, D. (2017). What is the impact of shift work on the
psychological functioning and resilience of nurses? An
integrative review. Journal of advanced nursing, 73(9), 2065-
2083.
Webster, J., McLeod, K., O'Sullivan, J., & Bird, L. (2018).
Eight-hour versus 12-h shifts in an ICU: Comparison of nursing
responses and patient outcomes. Australian Critical Care.
Zboril-Benson, L. R. (2016). Why nurses are calling in sick: the
impact of health-care restructuring. Canadian Journal of
Nursing Research Archive, 33(4).