Executive Solution Overview
**files (1)** – ## NUR650Wk7Replys.pdf **## NUR650Wk7Replys.pdf** NUR 650 Peer 1. Joshua Perez Hip Fracture This 71-year-old widower's anxiety and persistent insomnia are being treated with clonazepam (Klonopin) and triazolam (Halcion). In addition, he recently had a hip injury and is experiencing i…
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**files (1)**
– ## NUR650Wk7Replys.pdf
**## NUR650Wk7Replys.pdf**
NUR 650
Peer 1. Joshua Perez
Hip Fracture
This 71-year-old widower's anxiety and persistent insomnia are
being treated with clonazepam (Klonopin) and triazolam (Halcion). In
addition, he recently had a hip injury and is experiencing increasing
disorientation. The most crucial thing to gather on the first visit is a
complete medication history, including dosage, frequency, length of
usage, and whether he takes any over-the-counter medications, alcohol,
or other sedatives. It would also be critical to evaluate how drug use or
dose changes relate to the start of disorientation and falls. A thorough
cognitive assessment is required to determine his level of concentration,
memory, and orientation. A fall risk evaluation must also include
questions regarding blood pressure, mobility, home safety, dizziness, and
changes in vision. Information on his sleep patterns, anxiety triggers,
mood symptoms, and day-to-day functioning would need to be gathered
in order to assess if his current medications are still appropriate. Given
that he is a widower, it is especially important to assess his social
support system because loneliness can make anxiety and insomnia
worse. The primary goal of the patient's treatment is to effectively
manage his anxiety and insomnia while enhancing his safety and
cognitive capacities. Preventing more falls and injuries is critical,
especially after a hip fracture. Benzodiazepines, such as clonazepam and
triazolam, have been demonstrated to increase the risk of sleepiness,
falls, disorientation, and memory loss in older adults.
A higher risk of 6-month death was linked to the prescription of
benzodiazepines at the time of hospital discharge; however,
deprescription may reduce this excess risk (Bellelli et al., 2026).
Consequently, a major focus of treatment would be to offer safer
substitutes while appropriately decreasing off these drugs. There could
be several obstacles to change. The patient may be concerned that
stopping his medication may exacerbate his anxiety or sleeplessness. He
may also feel dependent on these drugs because he has been using them
for a long time. Additionally, rebound anxiety or insomnia brought on by
benzodiazepine withdrawal might make tapering challenging. When
these drug classes' inhibitory effects are abruptly stopped, the central
nervous system experiences an overall excitatory reaction (Regina et al.,
2024). To overcome these challenges, the PMHNP should use an
educational and patient-centered approach. Motivational interviewing
would be helpful to look into his concerns and build trust. Because of his
misconception, instruction should be clear-cut, simple, and repeated as
needed. Including family members or caregivers in the discussion can
improve understanding and promote plan adherence, if at all possible.
Teaching the patient about the Beers Criteria is essential. The Beers
Criteria, a list of medications that may be harmful or unsuitable for
elderly people, was developed by the American Geriatrics Society. To
put it simply, older bodies have a harder difficulty absorbing certain
medications, and they can cause side effects including confusion and
falls.
Halcion is on this list because it can stay in the body longer in
elderly people and increase their risk of fractures, vertigo, and memory
problems. A safer medication option for older persons with insomnia is
low-dose doxepin. At very low doses, doxepin has modest
anticholinergic effects and mainly supports sleep maintenance by acting
on histamine receptors. Compared to benzodiazepines, it is not
associated with the same level of cognitive impairment and fall risk.
Another option is melatonin, which can help regulate the sleep-wake
cycle and has fewer side effects. In addition to medication modifications,
cognitive behavioral therapy which is considered a first-line treatment
for insomnia and is safe for older adults, should be recommended. In
general, the primary goals of care should be safety, education, supportive
follow-up, and a gradual drug transition. By addressing the risks
associated with benzodiazepines and providing safer alternatives, the
patient's risk of falls and confusion can be reduced while still safely
managing his anxiety and insomnia.
Peer 2. Sergio Pereira
Hip Fracture
In older adults, hip fractures are often a sign of a cocktail of
medication, risk, cognitive impairment, and frailty that needs urgent
medical care. The case of a 71-year-old divorced man with a history of
insomnia, anxiety, falls, and confusion is a multifaceted presentation
related to benzodiazepines. Benzodiazepines are known to increase the
fall risk in older adults (Na et al. 2022). In addition, confusion post-fall
may be a sign of delirium, which is a sign of frailty in older people, and
as a result, an approach that is medical and psychiatric is crucial.
Critical Assessment
The initial consultation should focus on collecting information to
guide diagnosis and safety strategies. Information about the medication
history, dose, and adherence to triazolam and clonazepam is important,
as inappropriate prescribing is common in older people (Bidarolli et al.
2026). Cognitive screening is also important to identify the presence of
delirium or dementia, as acute confusion may be due to stress response
(Bellelli et al. 2021). Balance and falls history will cover physical
factors. Collateral information from family and/or carers may improve
symptom and disability reporting.
Treatment Goals
The goal of treatment is to reduce falls, preserve cognitive function,
and treat insomnia. It is important to wean benzodiazepines, as these
cause ataxia and falls in the elderly (Na et al., 2022). Intervention for
possible delirium is also crucial, as it is associated with worse outcomes
and increased death. Non-pharmacological strategies for sleep should be
emphasized, such as sleep hygiene. Drug therapies can be introduced
with a change in cognition or function assessed.
Barriers and Education
There are many barriers to treatment, such as benzodiazepine
addiction and the fear of worsening insomnia. Dementia may reduce the
patient's understanding of risk and the ability to follow through on new
instructions (Sharma et al. 2025). Social supports may also impact
change. The PMHNP should educate simply by repeating instructions
with motivational interviewing strategies. Linking medication use to the
fall will increase insight and motivation. Involving the caregiver and
providing written instructions will enhance education and medication
compliance when adjustments are made.
Beers Criteria Education
Beers Criteria education should include the fact that some
medications are high risk in the elderly due to side effects. Triazolam is
listed because of its potent hypnotic effect and risk for confusion and
falling (Bidarolli et al. 2026). The PMHNP should point out that these
are significant and the reason for the falls. Short statements and images
will help the patient to better understand. Encouraging the patient to ask
questions and the teach-back method will confirm that the patient
understands the need to change medication and is empowered to do so.
Medication Alternative
An alternative medication to treat insomnia in the elderly is low-
dose melatonin, which allows normal sleeping patterns without too
much sedation and confusion (Sharma et al. 2025). It is less likely to
cause falls than benzodiazepines, which may cause dizziness and falls
(Na et al. 2022). The drug should be used with care in persons with
cognitive impairment to avoid worsening confusion (Sharma et al.
2025). Melatonin could be combined with behavioral approaches, and
regular follow-up will maximize effectiveness, enhance safety, and allow
an effective shift to the new medication.
NUR 650-CL
Peer 1. Jessica Bruceta
Module 7 Discussion
The group observed was the Alcoholics Anonymous Sabal Palm
Group, attended on April 27, 2026, through a Zoom meeting based in the
Kendall area of Miami, Florida. I chose this specific meeting because it
was accessible virtually, local to Miami-Dade County, and offered an
opportunity to observe peer recovery support in a familiar community
setting. Alcoholics Anonymous has been helping individuals with
alcohol-related problems for more than 80 years and describes its model
as one alcoholic helping another, with recovery supported through
shared lived experience and mutual support. Entrance into the group
appeared simple and low-barrier: individuals needed only a desire to
address alcohol use or maintain sobriety; no payment, referral,
diagnosis, insurance, or formal intake was required. The group
demographics appeared mixed, with approximately 15–20 members,
including adults ranging from young adulthood to older adulthood, both
men and women, and a racially and ethnically diverse membership
reflective of the Kendall/Miami community. The organization’s goal was
to provide a safe, confidential, supportive space where members could
discuss recovery, maintain abstinence, reduce isolation, and receive
encouragement from others with lived experience. Objectively, the
group appeared effective in meeting client needs because it offered
structure, emotional support, accountability, and immediate access,
which are important because mutual-help groups remain an integral and
free recovery resource within the U.S. substance use treatment system
(Hai et al., 2022). Two therapeutic factors observed were universality
and instillation of hope. Universality was evident when members shared
similar struggles with cravings, relapse fears, shame, and rebuilding
relationships, helping others feel less alone. Instillation of hope was
present when members with longer sobriety encouraged newer
participants by sharing realistic examples of recovery progress. The
group process was effective because the leadership style was calm, peer-
led, respectful, and structured, with clear norms around confidentiality,
taking turns, and avoiding judgment. No major patient management
issues were observed; when one participant became emotional, the group
responded supportively without interrupting or trying to “fix” the
person. I felt the group was welcoming, humble, and surprisingly
powerful in its simplicity. It enriched my understanding of recovery by
showing that peer connection can sometimes reach people in ways
formal treatment cannot. I would refer future clients to this group as an
adjunct to clinical care, especially because online recovery meetings
may improve access and appeal to individuals earlier in recovery (Timko
et al., 2022).
Peer 2. Geslande Dessalines
I attended the Hope for Newcomers Al-Anon Family Group via
Zoom on April 26, 2026, at 11:00 AM. I chose this meeting because,
among the various support groups I explored this semester, Al-Anon
resonated most deeply with my personal experiences related to the
substance use of my ex-fiancé and my brother. While I had previously
attended a different Al-Anon meeting, I wanted to broaden my
perspective by observing another group. Al-Anon is a mutual support
program founded in 1951 for individuals affected by another person’s
alcohol use, emphasizing shared experiences, coping strategies, and
emotional support (Al-Anon Family Groups, 2026). Membership is open
to anyone concerned about another person’s drinking, regardless of
whether the individual with alcohol use disorder is actively seeking
treatment, making the program highly accessible and inclusive (Al-Anon
Family Groups, 2026).
The meeting I attended included approximately 30 participants from
diverse geographic regions, including the United States, Canada, Puerto
Rico, and Bermuda. The group appeared to include a mix of adults in
their 20s-60s, mostly women, and fairly diverse in ethnic backgrounds.
The primary goal of Al-Anon is to help members develop healthier
coping mechanisms, reduce emotional distress, and foster personal
growth despite living with or being affected by someone else’s substance
use (personal communication, April 26, 2026). One participant shared
that the program helped them “focus on what I can control, like my
reactions and my peace, rather than trying to fix my loved one”
(personal communication, April 26, 2026), which aligns with the
organization’s emphasis on detachment with love and self-care.
From an objective standpoint, the group appeared effective in
meeting participants’ emotional and psychological needs. The structured
yet supportive environment allowed members to share openly without
fear of judgment, which is consistent with therapeutic group principles
(Tusaie & Fitzpatrick, 2016). The meeting fostered a sense of safety and
consistency, both of which are essential for individuals coping with
chronic stressors like a loved one’s addiction. Additionally, the virtual
format increased accessibility, which is particularly relevant in modern
mental health care delivery (Wheeler, 2020).
Two key therapeutic factors observed during the session were
universality and instillation of hope. Universality was evident as
participants shared similar struggles, reducing feelings of isolation and
stigma. Hearing others articulate nearly identical emotional experiences,
such as guilt, frustration, and helplessness, helped normalize these
feelings, a process known to be therapeutic in group settings (Wheeler,
2020). Instillation of hope was also prominent with several long-term
members sharing their progress in setting boundaries and achieving
emotional stability. These testimonies appeared to encourage newer
members by demonstrating that change and personal growth are possible
over time. Such factors are foundational to effective group
psychotherapy and are associated with improved coping outcomes
(Tusaie & Fitzpatrick, 2016).
The group process itself was well managed. There was a clear
leader who maintained structure, guided discussion, and ensured
adherence to group norms. This was particularly important given the
relatively large number of participants. The leader effectively addressed
minor patient management issues, such as multiple individuals speaking
simultaneously, by reminding participants to remain muted until it was
their turn. This demonstrated appropriate limit-setting and helped
maintain a respectful and organized environment, which is critical in
large therapeutic groups (Wheeler, 2020).
Personally, I found the experience both meaningful and enriching.
Listening to others describe how they learned to live without being
consumed by worry or judgment toward their loved ones was especially
impactful. One participant shared that they “finally feel free to live my
own life without guilt” (personal communication, April 26, 2026), which
resonated deeply with my own journey. This perspective helped me
reframe my understanding of support, not as control or sacrifice, but as
maintaining personal boundaries while still caring for others.
Overall, I would confidently refer future clients to Al-Anon. The
program offers a supportive, accessible, and evidence-informed
approach to coping with the challenges of a loved one’s substance use.
Its emphasis on shared experience, emotional validation, and personal
growth aligns well with psychiatric nursing principles and provides
meaningful adjunctive support to formal treatment modalities.
**## NUR650Wk7Replys.pdf**
NUR 650
Peer 1. Joshua Perez
Hip Fracture
This 71-year-old widower's anxiety and persistent insomnia are
being treated with clonazepam (Klonopin) and triazolam (Halcion). In
addition, he recently had a hip injury and is experiencing increasing
disorientation. The most crucial thing to gather on the first visit is a
complete medication history, including dosage, frequency, length of
usage, and whether he takes any over-the-counter medications, alcohol,
or other sedatives. It would also be critical to evaluate how drug use or
dose changes relate to the start of disorientation and falls. A thorough
cognitive assessment is required to determine his level of concentration,
memory, and orientation. A fall risk evaluation must also include
questions regarding blood pressure, mobility, home safety, dizziness, and
changes in vision. Information on his sleep patterns, anxiety triggers,
mood symptoms, and day-to-day functioning would need to be gathered
in order to assess if his current medications are still appropriate. Given
that he is a widower, it is especially important to assess his social
support system because loneliness can make anxiety and insomnia
worse. The primary goal of the patient's treatment is to effectively
manage his anxiety and insomnia while enhancing his safety and
cognitive capacities. Preventing more falls and injuries is critical,
especially after a hip fracture. Benzodiazepines, such as clonazepam and
triazolam, have been demonstrated to increase the risk of sleepiness,
falls, disorientation, and memory loss in older adults.
A higher risk of 6-month death was linked to the prescription of
benzodiazepines at the time of hospital discharge; however,
deprescription may reduce this excess risk (Bellelli et al., 2026).
Consequently, a major focus of treatment would be to offer safer
substitutes while appropriately decreasing off these drugs. There could
be several obstacles to change. The patient may be concerned that
stopping his medication may exacerbate his anxiety or sleeplessness. He
may also feel dependent on these drugs because he has been using them
for a long time. Additionally, rebound anxiety or insomnia brought on by
benzodiazepine withdrawal might make tapering challenging. When
these drug classes' inhibitory effects are abruptly stopped, the central
nervous system experiences an overall excitatory reaction (Regina et al.,
2024). To overcome these challenges, the PMHNP should use an
educational and patient-centered approach. Motivational interviewing
would be helpful to look into his concerns and build trust. Because of his
misconception, instruction should be clear-cut, simple, and repeated as
needed. Including family members or caregivers in the discussion can
improve understanding and promote plan adherence, if at all possible.
Teaching the patient about the Beers Criteria is essential. The Beers
Criteria, a list of medications that may be harmful or unsuitable for
elderly people, was developed by the American Geriatrics Society. To
put it simply, older bodies have a harder difficulty absorbing certain
medications, and they can cause side effects including confusion and
falls.
Halcion is on this list because it can stay in the body longer in
elderly people and increase their risk of fractures, vertigo, and memory
problems. A safer medication option for older persons with insomnia is
low-dose doxepin. At very low doses, doxepin has modest
anticholinergic effects and mainly supports sleep maintenance by acting
on histamine receptors. Compared to benzodiazepines, it is not
associated with the same level of cognitive impairment and fall risk.
Another option is melatonin, which can help regulate the sleep-wake
cycle and has fewer side effects. In addition to medication modifications,
cognitive behavioral therapy which is considered a first-line treatment
for insomnia and is safe for older adults, should be recommended. In
general, the primary goals of care should be safety, education, supportive
follow-up, and a gradual drug transition. By addressing the risks
associated with benzodiazepines and providing safer alternatives, the
patient's risk of falls and confusion can be reduced while still safely
managing his anxiety and insomnia.
Peer 2. Sergio Pereira
Hip Fracture
In older adults, hip fractures are often a sign of a cocktail of
medication, risk, cognitive impairment, and frailty that needs urgent
medical care. The case of a 71-year-old divorced man with a history of
insomnia, anxiety, falls, and confusion is a multifaceted presentation
related to benzodiazepines. Benzodiazepines are known to increase the
fall risk in older adults (Na et al. 2022). In addition, confusion post-fall
may be a sign of delirium, which is a sign of frailty in older people, and
as a result, an approach that is medical and psychiatric is crucial.
Critical Assessment
The initial consultation should focus on collecting information to
guide diagnosis and safety strategies. Information about the medication
history, dose, and adherence to triazolam and clonazepam is important,
as inappropriate prescribing is common in older people (Bidarolli et al.
2026). Cognitive screening is also important to identify the presence of
delirium or dementia, as acute confusion may be due to stress response
(Bellelli et al. 2021). Balance and falls history will cover physical
factors. Collateral information from family and/or carers may improve
symptom and disability reporting.
Treatment Goals
The goal of treatment is to reduce falls, preserve cognitive function,
and treat insomnia. It is important to wean benzodiazepines, as these
cause ataxia and falls in the elderly (Na et al., 2022). Intervention for
possible delirium is also crucial, as it is associated with worse outcomes
and increased death. Non-pharmacological strategies for sleep should be
emphasized, such as sleep hygiene. Drug therapies can be introduced
with a change in cognition or function assessed.
Barriers and Education
There are many barriers to treatment, such as benzodiazepine
addiction and the fear of worsening insomnia. Dementia may reduce the
patient's understanding of risk and the ability to follow through on new
instructions (Sharma et al. 2025). Social supports may also impact
change. The PMHNP should educate simply by repeating instructions
with motivational interviewing strategies. Linking medication use to the
fall will increase insight and motivation. Involving the caregiver and
providing written instructions will enhance education and medication
compliance when adjustments are made.
Beers Criteria Education
Beers Criteria education should include the fact that some
medications are high risk in the elderly due to side effects. Triazolam is
listed because of its potent hypnotic effect and risk for confusion and
falling (Bidarolli et al. 2026). The PMHNP should point out that these
are significant and the reason for the falls. Short statements and images
will help the patient to better understand. Encouraging the patient to ask
questions and the teach-back method will confirm that the patient
understands the need to change medication and is empowered to do so.
Medication Alternative
An alternative medication to treat insomnia in the elderly is low-
dose melatonin, which allows normal sleeping patterns without too
much sedation and confusion (Sharma et al. 2025). It is less likely to
cause falls than benzodiazepines, which may cause dizziness and falls
(Na et al. 2022). The drug should be used with care in persons with
cognitive impairment to avoid worsening confusion (Sharma et al.
2025). Melatonin could be combined with behavioral approaches, and
regular follow-up will maximize effectiveness, enhance safety, and allow
an effective shift to the new medication.
NUR 650-CL
Peer 1. Jessica Bruceta
Module 7 Discussion
The group observed was the Alcoholics Anonymous Sabal Palm
Group, attended on April 27, 2026, through a Zoom meeting based in the
Kendall area of Miami, Florida. I chose this specific meeting because it
was accessible virtually, local to Miami-Dade County, and offered an
opportunity to observe peer recovery support in a familiar community
setting. Alcoholics Anonymous has been helping individuals with
alcohol-related problems for more than 80 years and describes its model
as one alcoholic helping another, with recovery supported through
shared lived experience and mutual support. Entrance into the group
appeared simple and low-barrier: individuals needed only a desire to
address alcohol use or maintain sobriety; no payment, referral,
diagnosis, insurance, or formal intake was required. The group
demographics appeared mixed, with approximately 15–20 members,
including adults ranging from young adulthood to older adulthood, both
men and women, and a racially and ethnically diverse membership
reflective of the Kendall/Miami community. The organization’s goal was
to provide a safe, confidential, supportive space where members could
discuss recovery, maintain abstinence, reduce isolation, and receive
encouragement from others with lived experience. Objectively, the
group appeared effective in meeting client needs because it offered
structure, emotional support, accountability, and immediate access,
which are important because mutual-help groups remain an integral and
free recovery resource within the U.S. substance use treatment system
(Hai et al., 2022). Two therapeutic factors observed were universality
and instillation of hope. Universality was evident when members shared
similar struggles with cravings, relapse fears, shame, and rebuilding
relationships, helping others feel less alone. Instillation of hope was
present when members with longer sobriety encouraged newer
participants by sharing realistic examples of recovery progress. The
group process was effective because the leadership style was calm, peer-
led, respectful, and structured, with clear norms around confidentiality,
taking turns, and avoiding judgment. No major patient management
issues were observed; when one participant became emotional, the group
responded supportively without interrupting or trying to “fix” the
person. I felt the group was welcoming, humble, and surprisingly
powerful in its simplicity. It enriched my understanding of recovery by
showing that peer connection can sometimes reach people in ways
formal treatment cannot. I would refer future clients to this group as an
adjunct to clinical care, especially because online recovery meetings
may improve access and appeal to individuals earlier in recovery (Timko
et al., 2022).
Peer 2. Geslande Dessalines
I attended the Hope for Newcomers Al-Anon Family Group via
Zoom on April 26, 2026, at 11:00 AM. I chose this meeting because,
among the various support groups I explored this semester, Al-Anon
resonated most deeply with my personal experiences related to the
substance use of my ex-fiancé and my brother. While I had previously
attended a different Al-Anon meeting, I wanted to broaden my
perspective by observing another group. Al-Anon is a mutual support
program founded in 1951 for individuals affected by another person’s
alcohol use, emphasizing shared experiences, coping strategies, and
emotional support (Al-Anon Family Groups, 2026). Membership is open
to anyone concerned about another person’s drinking, regardless of
whether the individual with alcohol use disorder is actively seeking
treatment, making the program highly accessible and inclusive (Al-Anon
Family Groups, 2026).
The meeting I attended included approximately 30 participants from
diverse geographic regions, including the United States, Canada, Puerto
Rico, and Bermuda. The group appeared to include a mix of adults in
their 20s-60s, mostly women, and fairly diverse in ethnic backgrounds.
The primary goal of Al-Anon is to help members develop healthier
coping mechanisms, reduce emotional distress, and foster personal
growth despite living with or being affected by someone else’s substance
use (personal communication, April 26, 2026). One participant shared
that the program helped them “focus on what I can control, like my
reactions and my peace, rather than trying to fix my loved one”
(personal communication, April 26, 2026), which aligns with the
organization’s emphasis on detachment with love and self-care.
From an objective standpoint, the group appeared effective in
meeting participants’ emotional and psychological needs. The structured
yet supportive environment allowed members to share openly without
fear of judgment, which is consistent with therapeutic group principles
(Tusaie & Fitzpatrick, 2016). The meeting fostered a sense of safety and
consistency, both of which are essential for individuals coping with
chronic stressors like a loved one’s addiction. Additionally, the virtual
format increased accessibility, which is particularly relevant in modern
mental health care delivery (Wheeler, 2020).
Two key therapeutic factors observed during the session were
universality and instillation of hope. Universality was evident as
participants shared similar struggles, reducing feelings of isolation and
stigma. Hearing others articulate nearly identical emotional experiences,
such as guilt, frustration, and helplessness, helped normalize these
feelings, a process known to be therapeutic in group settings (Wheeler,
2020). Instillation of hope was also prominent with several long-term
members sharing their progress in setting boundaries and achieving
emotional stability. These testimonies appeared to encourage newer
members by demonstrating that change and personal growth are possible
over time. Such factors are foundational to effective group
psychotherapy and are associated with improved coping outcomes
(Tusaie & Fitzpatrick, 2016).
The group process itself was well managed. There was a clear
leader who maintained structure, guided discussion, and ensured
adherence to group norms. This was particularly important given the
relatively large number of participants. The leader effectively addressed
minor patient management issues, such as multiple individuals speaking
simultaneously, by reminding participants to remain muted until it was
their turn. This demonstrated appropriate limit-setting and helped
maintain a respectful and organized environment, which is critical in
large therapeutic groups (Wheeler, 2020).
Personally, I found the experience both meaningful and enriching.
Listening to others describe how they learned to live without being
consumed by worry or judgment toward their loved ones was especially
impactful. One participant shared that they “finally feel free to live my
own life without guilt” (personal communication, April 26, 2026), which
resonated deeply with my own journey. This perspective helped me
reframe my understanding of support, not as control or sacrifice, but as
maintaining personal boundaries while still caring for others.
Overall, I would confidently refer future clients to Al-Anon. The
program offers a supportive, accessible, and evidence-informed
approach to coping with the challenges of a loved one’s substance use.
Its emphasis on shared experience, emotional validation, and personal
growth aligns well with psychiatric nursing principles and provides
meaningful adjunctive support to formal treatment modalities.