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Assignment 1: Assessing The Genitalia And Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

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In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Assignment 1: Assessing The Genitalia And Rectum

GENITALIA ASSESSMENT

Subjective:

CC: “I have bumps on my bottom that I want to have checked out.”

HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed. Assignment 1: Assessing The Genitalia And Rectum.

PMH: Asthma

Medications: Symbicort 160/4.5mcg

Allergies: NKDA

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Diagnostics: HSV specimen obtained

Assessment:

Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Assignment 1: Assessing The Genitalia And Rectum

To prepare:

With regard to the SOAP note case study provided:

Review this week’s Learning Resources, and consider the insights they provide about the case study.

Consider what history would be necessary to collect from the patient in the case study.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify 
at least five
 possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or Why not?

Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Assignment 1: Assessing The Genitalia And Rectum. Explain your reasoning using at least 3 different references from current evidence based literature.

CALSS RESOURCES

Learning Resources

Note:

To access this week’s required library resources, please click on the link to the Course Readings List, found in the

Course Materials

section of your Syllabus.

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
Seidel’s guide to physical examination
(8th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 16, “Breasts and Axillae” (pp. 350-369)

This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)

In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia Assignment 1: Assessing The Genitalia And Rectum.

Chapter 19, “Male Genitalia” (pp. 466-484)

The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)

This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016).
Advanced health assessment and clinical diagnosis in primary care
(5th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 5, “Amenorrhea” (pp. 47-60)

Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)

This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam Assignment 1: Assessing The Genitalia And Rectum.

Chapter 7, “Breast Pain” (pp. 73-80)

Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge” (pp. 318-324)

The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding” (pp. 419-433)

In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)

This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies. Assignment 1: Assessing The Genitalia And Rectum.

Sullivan, D. D. (2012).
Guide to clinical documentation
(2nd ed.). Philadelphia, PA: F. A. Davis.

Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)
Note:
Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Physical Examination Objective Data Checklist was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/ 

Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045

Retrieved from the Walden Library Databases. Assignment 1: Assessing The Genitalia And Rectum

Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete?
Journal of Women’s Health, 20
(1), 5–10.

Retrieved from the Walden Library databases.

This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2012).
Sexually transmitted diseases (STDs)
. Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

University of Virginia. (n.d.).
Introduction to radiology: An online interactive tutorial
. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for
Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014).
DeGowin’s diagnostic examination
(10th ed.). New York, NY: McGraw Hill Medical.

Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)

Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions. Assignment 1: Assessing The Genitalia And Rectum

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)

In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)

The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527) Assignment 1: Assessing The Genitalia And Rectum

Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

Psychotherapy and Biology

Before the question of whether psychotherapy has a biological basis, we must first understand what psychotherapy means. Psychotherapy is “any alteration in an individual’s interpersonal environment, relationships, or life situation brought about especially by a qualified therapist and intended to have the effect of alleviating symptoms of mental or emotional disturbance” (Merriam-Webster, 2018).

There is an increasing consensus with evidence provided by neuroscience, psychology, and the cognitive sciences the psychotherapy does have a biological basis (Prosser, Helfer, & Leucht, 2016). The combination of these three sciences developed the free-energy principle which acknowledges that the environments we inhabit are complex and ever changing and the brain must constantly adapt to these changes (Prosser, Helfer, & Leuch, 2016). The free-energy framework claims that the brain attempts to adapt to the changing environment by minimizing prediction error, and by doing this the brain changes how the structure of the environment is encoded in the brain sometimes causing mental disorders (Prosser, Helfer, & Leucht, 2016). Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay.

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Psychotherapy has also been shown to change activity levels in the prefrontal cortex. According to a UCLA study on depression people with this condition had abnormally high activity in the prefrontal cortex (Deen, 2015). The researchers found that the patients who participated in interpersonal therapy had a decrease in prefrontal cortex activity (Deen, 2015). The author continues with a study preformed in the Netherlands with individuals with chronic fatigue syndrome (CFS). It was found the people with CFS have a decrease in the gray matter in the brain but after several sessions of cognitive behavioral therapy there was a significant increase in gray matter volume in the prefrontal cortex (Deen, 2015).

Influences on Psychotherapy Treatment

There are many factors that influence a person’s value of psychotherapy including socioeconomic status, race and racial beliefs, racial match, and religious factors. Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay. With many factors potentially influencing the clients perspective of psychotherapy it is important that the practitioner become culturally competent.

Racial factors can hinder quality care for the mental health patient. In some studies racial match of clients can be associated with an increase in the utilization of mental health services and promote favorable outcomes (Meyer & Zane, 2013, p. 3). The increase in more favorable outcomes could be because the ethnic minority clients may view ethnically similar psychotherapists as a more credible source of help because the assume a shared culture or values (Meyer & Zane, 2013, p. 3) Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay.

As stated before, there are many factors that can influence the value a person placed on psychotherapy, even the words used can increase the value a client places on therapy. Regarding the Navajo and psychotherapy, they see it as a practice pertaining to illness and healing and the terminology used becomes important (Lewis-Fernández, 2011, p. 5). When the word belief is applied to aspects of therapy it carries the connotation of falsehood, instead of saying what is your belief on mental illness and psych therapy one should use the terms values, attitudes on, view, but never beliefs (Lewis-Fernández, 2011, p. 6). Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay In this example of culture and how it influences psychotherapy it would be very important to be culturally competent in the Navajo culture because just the verbiage used could alter the outcome of psychotherapy.

References

Deen, S. (2015). How Psychotherapy Changes the Brain.
American Psychiatric Association
.

Lewis-Fernández, R. (2011). Commentary on “Elements of Psychotherapy in Navaho Religion”: A Perspective from Contemporary Cultural Psychiatry.
Psychiatry: Interpersonal and Biological Processes
,
74
(4), 293-300. doi:10.1521/psyc.2011.74.4.293 Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

Merriam-Webster. (2018, February 24). PSYCHOTHERAPY. Retrieved from https://www.merriam-webster.com/dictionary/psychotherapy

Meyer, O. L., & Zane, N. (2013). THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.
Journal of Community Psychology
,
41
(7), 884-901. doi:10.1002/jcop.21580

Prosser, A., Helfer, B., & Leucht, S. (2016). Biological v. psychosocial treatments: A myth about pharmacotherapy v. psychotherapy.
British Journal of Psychiatry
,
208
(04), 309-311. doi:10.1192/bjp.bp.115.178368 Nurs 6640 week 1 discussion – Psychotherapy and Biology Sample essay

NURS 6001: Foundations of Graduate Study – My Goals and Walden University Vision and Mission

INITIAL POST

My Goals and Walden University Vision and Mission

As a nurse for over 10 years and with the advances in technology applied to the health care arena, I have become more interested in the role of a nurse within informatics. My professional goal is to work full-time in the area of nursing informatics. Unfortunately, I knew that obtain this position, I needed to advance my degree. I began looking into various colleges and universities that can provide me with the education needed to obtain an advanced degree with a focus in nursing informatics.

After several months of investigating, I located Walden University. At first, I was drawn to Walden because it offered the flexibility that I needed. NURS 6001: Foundations of Graduate Study – My Goals and Walden University Vision and Mission. However, as I investigated the university further, Walden’s mission and vision statement resonated with me. I knew I had made the right choice. The School of Nursing (SON) vision and mission statements described what I felt and thought yet could not put into words. According to the Walden University SON (2011a), their vision is for graduates to transform nursing to meet the needs of communities. Technology is transforming health care and the degree I will obtain at Walden will help me to assist my organization with this transformation.

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Another reason I was drawn to Walden University was the high standards they have for all students. The SON stated in their mission that their program is “academically rigorous…contextually relevant…” (Walden University, 2011a, para. 4). This statement matches my academic goal. I am not looking for just a piece of paper at the end, I am looking to gain the necessary knowledge that I need to make an impact within my organization.

 Incorporation of Social Change

Walden University (2011b) defined positive social change as a “deliberate process of creating and applying ideas, strategies, and actions to promote the worth, dignity, and development of individuals, communities, organizations, institutions, cultures, and societies” (para. 4). I have always had a feeling that I want my life to mean something and to have an effect on those around me whether it is directly or indirectly. As a nurse, the will to help others is a core foundation of why I got into nursing in the first place. I plan to incorporate social change with the knowledge gained at Walden University by “putting that knowledge into practice” (Walden University, 2010b, para. 3). I plan to contribute to my field when I graduate by helping lead my coworkers and my organization through the computerized changes and advancement of technology at work. While helping others, I will be part of the clinical informatics team as the team transitions the organization into new computerized programs. NURS 6001: Foundations of Graduate Study – My Goals and Walden University Vision and Mission.

References

Walden University. (2011a). About the school. Retrieved from

http://www.waldenu.edu/Colleges-and-Schools/College-of-Health-Sciences/15863.htm

Walden University. (2011b). Vision, mission, and goals. Retrieved from

http://catalog.waldenu.edu/
content.php?catoid=21&navoid=2450 NURS 6001: Foundations of Graduate Study – My Goals and Walden University Vision and Mission.

Nurs 6640 week 1 discussion Post Response

Great post Daniel on the cultural beliefs effect psychotherapy. I agree when you said that it is important that the PMHNP needs to be culturally competent and aware of the different stigmas that culture can play on the perception of psychotherapy. The concept of cultural competence is especially true when dealing with the Navajo nation because even the use of the word “belief’ can cause problem because of the way their culture interprets its meaning. The Navajo regard psychotherapy as a practice pertaining to illness and healing and the terminology used becomes important (Lewis-Fernández, 2011, p. 5). When the word belief is applied to aspects of therapy it carries the connotation of falsehood, instead of saying what is your belief on mental illness and psych therapy one should use the terms values, attitudes on, view, but never beliefs (Lewis-Fernández, 2011, p. 6). Nurs 6640 week 1 discussion Post Response

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The feeling of shared cultural beliefs and values plays an important role in psychotherapy. If a client feels that you do not understand where they are coming from because of cultural differences, it can cause negative effects. There are some studies that show that ethnically similar clients and therapists can result in more favorable outcomes. The increase in more favorable outcomes could be because the ethnic minority clients may view ethnically similar psychotherapists as a more credible source of help because the assume a shared culture or values (Meyer & Zane, 2013, p. 3).

Through your research have you found any data that supports racial matching of clients causing more favorable outcomes? Do you think that racial matching is appropriate in todays society? Nurs 6640 week 1 discussion Post Response. Again Daniel this was a very informative post and I look forward to reading more from you in the future.

 

Reference

Lewis-Fernández, R. (2011). Commentary on “Elements of Psychotherapy in Navaho Religion”: A Perspective from Contemporary Cultural Psychiatry.
Psychiatry: Interpersonal and Biological Processes
,
74
(4), 293-300. doi:10.1521/psyc.2011.74.4.293

Meyer, O. L., & Zane, N. (2013). THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.
Journal of Community Psychology
,
41
(7), 884-901. doi:10.1002/jcop.21580. Nurs 6640 week 1 discussion Post Response

Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

The Sheehan Disability Scale

Assessment tools such as the Sheehan Disability Scale (SDS) are important in helping the PMHNP in assessing the functional status and functional impairment of their clients (Wheeler, 2014). The impact of mental disorders on the clients’ life does not only depend on the diagnosis of the condition but on the disability that the disorder causes (Luciano et al., 2010, p. 896). The SDS is an assessment tool that can be done in the waiting room that focuses on three groups of activities including home management, work abilities, the ability to form and maintain relationships and social life (Luciano et al., 2010, p. 897). Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

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In the case of major depressive disorder (MDD) there are associations between the mental illness and functional impairments in the affected client (Sheehan et al., 2015). The impairment associated with MDD have strong social and economic impacts causing clients to miss work, have a reduction in quality relationships, and an increase in family disruption (Sheehan et al., 2015). The SDS is a validated and accepted measure of functional outcome in clients with MDD with higher scores indicating a greater functional impairment (Sheehan et al., 2015).

Sheehan Disability Tool and Psychopharmacology

Psychopharmacology can be an important part in the client’s recovery process. The prescribing of medications for clients with mental illness is a difficult task because medications could exacerbate symptoms or even mask symptoms. It is important to be able to use a reliable assessment tool such as the SDS to determine if the medications prescribed are effective.  It is important to monitor the client’s progress early in the course of antidepressant treatment using a functional assessment such as the SDS can help clinicians determine whether or not medication adjustments are needed (Soares, Zhang, & Boucher, 2017).  Mental health recovery does not only mean symptom remission but the restoration of functional ability and that is where SDS plays a major rule in medication management. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples. The SDS is among the most commonly used function scales in clinical trials of antidepressant treatment of MDD (Soares, Zhang, & Boucher, 2017). The SDS shows great potential to enhance the quality of care for mental health clients and may help clinicians determine sooner than later whether treatment adjustments are needed.

It is important for the PMHNP to understand the assessment tools that are used and their limitations. SDS may help clinicians determine sooner than later whether treatment adjustments are needed (Soares, Zhang, & Boucher, 2017). The SDS can not only be used as a primary assessment tool but can also be used to determine the efficacy of the medications being prescribed. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

Reference

Luciano, J. V., Bertsch, J., Salvador-Carulla, L., Tomás, J. M., Fernández, A., Pinto-Meza, A., … Serrano-Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample.
Journal of Evaluation in Clinical Practice
,
16
(5), 895-901. doi:10.1111/j.1365-2753.2009.01211.x

Sheehan, D. V., Mancini, M., Wang, J., Berggren, L., Cao, H., Dueñas, H. J., & Yue, L. (2015). Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors.
Human Psychopharmacology: Clinical and Experimental
,
31
(1), 53-63. doi:10.1002/hup.2500

Soares, C. N., Zhang, M., & Boucher, M. (2017). Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine.
CNS Spectrums
, 1-11. doi:10.1017/s1092852917000633

Wheeler, K. (2014).
Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition
. Springer Publishing Company. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

 

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment

“A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.”

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

This week, as you explore assessment and diagnosis in psychotherapy, you examine assessment tools, including their psychometric properties and appropriate use. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers.

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment

NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers Learning Resources

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Required Readings

Wheeler, K. (Ed.). (2014). 
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
 (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 3, “Assessment and Diagnosis” (pp. 95–168)

Chapter 4, “The Initial Contact and Maintaining the Frame” (pp. 169–224)

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

 

Note:
 It is highly recommended that you use this resource as a reference guide throughout the course. You will access this text from the Walden Library databases.

American Academy of Child and Adolescent Psychiatry. (1995). 
Practice parameters for the psychiatric assessment of children and adolescents
. Washington, DC: Author. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/psychiatric_assessment_practice_parameter.pdf

American Psychiatric Association. (2016). 
Practice guidelines for the psychiatric evaluation of adults
 (3rd ed.). Arlington, VA: Author. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Walden Library. (2017). NURS 6640 week 2 discussion guide. Retrieved from http://academicguides.waldenu.edu/nurs6640week2discussion

Walden University. (n.d.). Tests & measures: Home. Retrieved February 6, 2017, from http://academicguides.waldenu.edu/library/testsmeasures

Note:
This database may be helpful in obtaining assessment tool information for this week’s Discussion. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Required Media

Laureate Education (Producer). (2015a). Counseling competencies—The application of ethical guides and laws to record keeping [Video file]. Baltimore, MD: Author.

Provided courtesy of the Laureate International Network of Universities.

 

Note:
 The approximate length of this media piece is 23 minutes.

NURS 6640 Week 2: Assessment and Diagnosis in Psychotherapy Assignment Discussion: Assessment Tools

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples.

Learning Objectives

Students will:

Analyze psychometric properties of assessment tools

Evaluate appropriate use of assessment tools in psychotherapy

Compare assessment tools used in psychotherapy

Note:
 By Day 1 of this week, the Course Instructor will assign you to an assessment tool that is used in psychotherapy.

To prepare:

Review this week’s Learning Resources and reflect on the insights they provide.

Consider the asessment tool assigned to you by the Course Instructor.

Review the Library Course Guide in your Learning Resources for assistance in locating information on the assessment tool you were assigned.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking 
Submit! Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

By Day 3

Post
 an explanation of the psychometric properties of the assessment tool you were assigned. Explain when it is appropriate to use this assessment tool with clients, including whether the tool can be used to evaluate the efficacy of psychopharmacologic medications. Support your approach with evidence-based literature. NURS 6640 – Assessment and Diagnosis in Psychotherapy Essay Assignment Papers.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to at least 
two
 of your colleagues by comparing your assessment tool to theirs.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 2 Discussion

 

The assessment tool that I will use for assessing my client will be the Sheehan Disability Scale (SDS). This tool important for the PMHNP to assess the functional status and functional impairment for the clients during assessment (Wheeler, 2014). In client’s life, the impact that the mental illness cause does not just depend on the diagnosing of the condition but also on the disorder that causes disability. This tool can also be useful in the waiting room for assessment which depends on three different groups of programing such as management at home, abilities to work, and ability for a client to have a relationship and maintain it and social life. With clients with major depressive disorder (MDD), the client is effected by the mental illness and functional impairments (Sheehan et al., 2015). These impairments are associated client with MDD have impact on their social and economic affecting their work, having low quality of friendship, and has an increase in disrupting their family.

Sheehan Disability Scale and Psychopharmacology

Psychopharmacology is necessary during client’s process of recovery as a part of treatment for mental illness. For providers to prescribe medications for a mental illness client is very difficult because some medications can cause the illness to be worst or even mask the symptoms. SDS tool plays a very important part in making sure the medications prescribed by the provider will be effective. The provider needs to monitor the progress of the client’s antidepressant regimen by using the functional assessment such as the SDS to find out if the medication is working or need to be adjusted (Soares, Zhang, & Boucher, 2017). SDS plays an important role in medication management for mental illness recovery not only to symptom remission but also to restore the functional ability of the client. This tool is the only tool used in clinical trials for function scales of the antidepressant regimen and it showed a great potential in enhancing the quality of care the providers care for mental illness clients and helps the clinician in determining treatment sooner if it needs to be adjusted or not than waiting for later.

The PMHNP needs to know the and understand the assessment tools used, also know their limit but can be used the primary tool use to determine the efficacy of the medications that the provider is prescribing.

 

References;

Hodgins, D. C. (2013). Reliability and validity of the Sheehan Disability Scale modified for pathological gambling. BMC Psychiatry, 13177. doi:10.1186/1471-244X-13-177

 

Luciano, J. V., Bertsch, J., Salvador-Carulla, L., Tomás, J. M., Fernández, A., Pinto-Meza, A., … Serrano-Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample. Journal of Evaluation in Clinical Practice, 16(5), 895-901. doi:10.1111/j.1365-2753.2009.01211.x

Sheehan, D. V., Mancini, M., Wang, J., Berggren, L., Cao, H., Dueñas, H. J., & Yue, L. (2015). Assessment of functional outcomes by Sheehan Disability Scale in patients with major depressive disorder treated with duloxetine versus selective serotonin reuptake inhibitors. Human Psychopharmacology: Clinical and Experimental, 31(1), 53-63. doi:10.1002/hup.2500

Soares, C. N., Zhang, M., & Boucher, M. (2017). Categorical improvement in functional impairment in depressed patients treated with desvenlafaxine. CNS Spectrums, 1-11. doi:10.1017/s1092852917000633

Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition. Springer Publishing Company. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

SHEEHAN, D. V., GASIOR, M., MCELROY, S. L., RADEWONUK, J., HERMAN, B. K., & HUDSON, J. (2018). Effects of Lisdexamfetamine Dimesylate on Functional Impairment Measured on the Sheehan Disability Scale in Adults With Moderate-tosevere Binge Eating Disorder: Results from Two Randomized, Placebo-controlled Trials. Innovations In Clinical Neuroscience, 15(5/6), 22-29. Nurs 6640 week 2 discussion – Sheehan Disability Scale (SDS) Essay examples

NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Week 1 Discussion: Initial Post

Foundational Neuroscience

Agonist to antagonist spectrum of action of psychopharmacologic agents

Agonist of psychopharmacologic agents binds to neurotransmitter and caused an activation of receptors; whereas, antagonist agents then binds to those receptors that are activated by agonists, thus preventing them from being in an inactivated state; thus, causing them to be in the state that is desirable (Stahl, 2013). One such example can be seen from the neurotransmitter receptors dopamine, serotonin and norepinephrine.

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G-protein is a protein that binds energy molecules, they are the biggest and most versatile of proteins, their job is to activate intracellular action by signaling pathways and modulate activities of ion channel (Gohar, 2018). Ion channels are transmembrane proteins that regulates the movement of ions across cell membranes and then divide them into groups according to their specificity, some of which includes sodium channels, potassium channels and calcium channels (Gohar, 2018). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Ion channel receptors are mostly multimeric proteins that are found in the plasma membrane, they form pathways from one membrane to the next; they are able to open and close chemical and mechanical signals; when these ion channels are in an open site, then they move in and out of the cell, they each have a specific allowing only one ion to pass through (Suitable by Nature, n.d).

G-protein receptors are receptors that interact with neurotransmitters as well as psychotropic medication.  G-protein and ion channel are triggered by neurotransmitters; both starts with a different messenger that binds to a specific receptor that causes activation of different downstream chemical messenger; both G-protein and Ion channels signals transduction; G-protein uses protein kinase, its job is to activate or inactive ion channels or open and close the sequence to regulate ion concentration (Stahl, 2013).

Epigenetics

Epigenetics is described as the formation of genetics that above information coded exclusively by one’s genetic code (Stefanska & MacEwan, 2015).  Epigenetics is a system that determine if there are any gene that is made into RNA and protein specific to that gene, if is silenced; it turns genes on and off by the modification of chromatin structure that is in the cell nucleus (Stahl, 2013).  There are circumstances in which epigenetics pattern of gene activation may change from stabilization  of a silenced gene making it active or an active one, silenced based on what happens to a neuron; where pharmacologic agent can be a factor; it may cause a favorable or unfavorable response; a favorable response can be the good/therapeutic epigenetic effect where one is triggered to learn something or unfavorable effect where one is triggered to e addicted to drugs or develops conditions like anxiety disorder (Stahl, 2013). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

How we respond to pharmacological agents can be affected by epigenetics; drugs that are epigenetic may help in drug therapies as well as operations and management of pain (Stefanska & MacEwan, 2015).

An example is how those with a diagnosis of schizophrenia is treated; the pharmacological agent that is used to treat it, acts by reducing dopamine levels in the brain; the antagonist of dopamine works by binding the receptors causing a deactivation (Stahl, 2013).

References

Gohar, O. (2018). Ion channel modulation by g-protein coupled receptors. Alomone Labs. Retrieved from https://www.alomone.com/article/issue-no-21?cn-reloaded=1

Stefanska, B., & MacEwan, D. J. (2015). Epigenetics and pharmacology. 
British Journal of Pharmacology
, 
172
(11), 2701–2704. http://doi.org/10.1111/bph.13136

Stahl, S. M. (2013). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
 (4th ed.). New York, NY: Cambridge University Press

Suitable by Nature. (n.d.). Ion Channel | Learn science at suitable. Retrieved from https://www.nature.com/scitable/topicpage/ion-channel-14047658

 

agonist is a drug that activates certain receptors in the brain. An antagonist drug blocks opioids by attaching to the opioid receptors without activating them. Antagonists cause no opioid effect and block full agonist opioids (Stahl, 2013). A GTP-binding protein that relays signals from a plasma membrane signal receptor, known as a G protein-coupled receptor, to other signal transduction proteins inside the cell( Stahl,2013). A protein pore in cellular membranes that opens or closes in response to a signaling chemical (its ligand), allowing or blocking the flow of specific ions. Ion channel receptors are usually multimeric proteins located in the plasma membrane (Stahl, 2015). Each of these proteins arranges itself so that it forms a passageway or pore extending from one side of the membrane to the other. These passageways, or ion channels, have the ability to open and close in response to chemical or mechanical signals. When an ion channel is open, ions move into or out of the cell in single-file fashion. Individual ion channels are specific to particular ions, meaning that they usually allow only a single type of ion to pass through them ( Stahl, 2015).                                                                                                                        Epigenetics is the study of heritable changes in gene expression (active versus inactive genes) that do not involve changes to the underlying DNA sequence — a change in phenotype without a change in genotype — which in turn affects how cells read the genes(  Deans, C. & Maggert ,2015 ). Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state. Epigenetic modifications can manifest as commonly as the manner in which cells terminally differentiate to end up as skin cells, liver cells, brain cells, etc. Or, epigenetic change can have more damaging effects that can result in diseases like cancer. At least three systems including DNA methylation, histone modification and non-coding RNA (ncRNA)-associated gene silencing are currently considered to initiate and sustain epigenetic change ( Deans, C. & Maggert , 2015 ). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

Psychotropic drugs are valuable resources in treating many mental health illnesses, but inappropriate prescribing can cause serious harm or possible death. The high numbers of inappropriate prescribing is associated with increased morbidity, mortality and decrease in quality of life ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016  ). It is estimated that 30% of elderly people’s admissions in hospitals is due to problems related to drugs or to toxic effects of drugs ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016 ). The elderly population is at great risk of adverse drug effects. The elderly experience altered pharmacokinetics and pharmacodynamics, which result in prolonged and increased effects of many drugs. The altered pharmacodynamics of the aging brain leads to a higher sensitivity to central nervous system acting agents ( Curkovic, Dodig-Curkovic , Eric, Kralik & Pivac, 2016        ).

Antidepressants, anxiolytics and antipsychotics are the most common potentially inappropriate psychotropics. Tricyclic antidepressants can causes dementia, cardiac conductive abnormalities, chronic constipation, and other adverse reactions (Sharma, Loh,., Nightingale, Mohile, & Holmes,2016 ). Tricyclic antidepressants should be avoided due to the anticholinergic, sedating and orthostatic hypotension   Selective serotonin reuptake inhibitors (SSRIs) should be used with caution, as they may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia. Also, some drug-interactions involving antidepressants offer risks, i.e. tricyclic antidepressants and SSRIs, shows increased risk of falls (Sharma, Loh,., Nightingale, Mohile, & Holmes,2016 ). NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay

 

 

NURS 6630

Foundational Neuroscience

Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Psychopharmacologic agents induce changes in people’s thinking, mood, and behavior. They act through interaction with target receptors or sites in the nervous system to induce changes in patient’s psychological or physiological functions. According to Stahl (2013), most psychopharmacological drugs target ion channels or enzymes where they lead to production of biological responses among patients. This process is achieved through binding of pharmacological agents to receptors.

In pharmacology, ligands are molecules which bind to receptors. Once they bind to receptors, ligands can lead to production of biological responses or block the production of biological responses. Agonists are ligands responsible for activating receptors to produce biological response. On the other hand, antagonists are ligands which block agonist mediated responses. While agonists execute their task by activating receptors to produce biological responses, the antagonists block receptor activation, thus making it impossible to produce any biological responses.

Compare and contrast the actions of g couple proteins and ion gated channels

G couple proteins transmit signals from stimuli outside the interior of the cell to its interior. They act as molecular switches inside the cell. Action of G couple proteins is controlled by factors that regulate their ability to bind and hydrolyze guanosine triphosphate (GTP) to guanosine diphosphate (GDP) (Lodish et al, 2000). G couple proteins are turned off when bound to GDP and are turned on when bound on GTP. According to Lodish et al (2000), different mammalian cell-surface receptors have a trimeric signal transducing G protein. Ligands which bind to these receptors activate their relevant G protein, which in turn activates the effector enzyme to produce intracellular second massager (Lodish et al, 2000). It is worth noting that all G protein coupled receptors have 7-membrane spanning areas within their N-terminal segment. NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay. On the other hand, ion gated channels are transmembrane proteins of excited cells which only allow ions to pass under specific circumstances (Stahl, 2013). Gated ion channels may be either sodium channels of neurons or voltage gated channels like the acetylcholine

Explain the role of epigenetics in pharmacologic action

Epigenetics are changes occurring in human beings as a result of modifications of gene expression rather than alteration of the real genetic code. According to Stahl (2013), epigenetics affects ways in which cells read genes and produce proteins. Through epigenetics, some genes can be expressed over time or become dormant. Epigenetics makes each person unique and is reversible. It is worth noting that there are many different combinations of genes that can be turned on or off through pharmacologic action thus impacting the health outcome of an individual. For example, if genetic combinations leading to bad states in human health can be eliminated while only maintaining the gene’s states that foster good health, then some health conditions can be successfully eliminated.

According to Lundstrom (2015), epigenetic mechanisms which focus on miRNAs are important as diagnostic biomarkers. The reversible nature of epigenetic modifications makes the inhibition of DNA methylation possible against psychiatric diseases such as bipolar disorders and schizophrenia as well as some forms of cancers and other terminal illnesses. It is important for nurse practitioners to understand how medications impact on the patient’s gene expression among psychiatric patients. Some medications may suppress certain types of gene expression responsible for aggression among mentally ill patients and make them dormant while others may enhance gene expression and result to exacerbation of patient’s symptoms. NURS 6630 Week 1 discussion – Agonist to antagonist spectrum of action of psychopharmacologic agents Sample essay.

NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

NURS 6630 – Week 2

To prepare for this Assignment:

 

Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

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The Assignment

Examine
 Case Study: An African American Child Suffering From Depression
. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

 

At each decision point stop to complete the following:

 

Decision #1

 

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

 

Decision #2

 

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

 

Decision #3

 

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

 

Note:
 Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

“Bipolar disorder is one of the severe and chronic disorders, involving mood changes, which may appear as elevated mood episodes (mania or hypomania) to low mood episodes (depression)” (Khaleghi, et. al, 2015). Adults and children do not show the same symptoms of mood disorder so is very difficult to diagnose mood disorders in children because sometimes is very hard for them to express themselves or how they feel. Some of the symptoms of mood disorder seen in adults such as decrease and alteration in rapid eye movement (REM) sleep, elevated cortisol production during depression cycles, and the genetic risk factor can also be seen in children and their treatments is different depending on the symptoms. The main goal of treating this disorder early is to reduce the signs of this disorder.  Mood disorder is one of the disorder that is underdiagnosed in mental health. For the providers to accomplish this goal, a complete assessment is needed, family history, co-morbidities, any past medical history, previous pharmacological interventions, and psychological plan should be included in the plan.  “Therefore, child or adolescent patients may experience elevated or low mood frequently during a day; and it is likely that they live with these symptoms without treatment for a few years and that the disorder may severely impact their educational and interpersonal performance and interfere with their personal and social development” (Khaleghi, et al., 2015). NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

The providers should assess each client well, so they can diagnose and give the accurate treatment in managing the disorder. Mood disorder is caused by chemical imbalance in the brain and can include environmental factors such as any sudden life events and stress. This major depressive disorder affects children at a rate of 10 to 17% in this population worldwide and is more in female than male. According to Magellan Health (2013) the only one-fifth of these children with mental health concerns have supportive services from skilled clinicians and about 8 million children are on at least one psychotropic medication. There is an increase of depression in early teen years and it increases as the person gets old. If the person that has mental health condition does not seek treatment or not properly treated, the disorder can get worst and become persistent mental disorder. “Only one-fifth of these children with mental health concerns have supportive services from skilled clinicians and about 8 million children are on at least one psychotropic medication” (Magellan Health, 2013). The main aim of this assignment is to find a way in discussing this disorder and how it affects the children, evaluate any needed assessment, inquire diagnostic tools, accessible medications, and ethical decisions that might come up during the discussion. NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

Patient Case Study

 

Decision 1

Decision #2

Decision #3

Conclusion including the Ethical Consideration

References

Fortney, J. C., Pyne, J. M., Ward-Jones, S., Bennett, I. M., Diehl, J., Farris, K., & … Curran, G. M. (2018). Implementation of evidence-based practices for complex mood disorders in primary care safety net clinics. Families, Systems, & Health, doi:10.1037/fsh0000357

 

Kurtz, S., Levine, J., & Safyer, M. (2017). Ask the Question: Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care. Current Problems In Pediatric & Adolescent Health Care, 47(10), 241-253. doi:10.1016/j.cppeds.2017.08.002

 

Khaleghi, A., Sheikhani, A., Mohammadi, M. R., & Moti Nasrabadi, A. (2015). Evaluation of Cerebral Cortex Function in Clients with Bipolar Mood Disorder I (BMD I) Compared With BMD II Using QEEG Analysis. Iranian Journal Of Psychiatry, 10(2), 93-99. NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

 

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from https://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

 

Rubinstein, T., Wahezi, D., Mehta, J., Ilowite, N., Stein, R., Rybak, D., & … Putterman, C. (n.d). Mood Disorder Is Highly Prevalent in a Multi-Ethnic Urban Pediatric Lupus Cohort. Arthritis & Rheumatology, 67 NURS 6630 – Week 2 decision Tree – African American Child Suffering From Depression Case Study

NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature.

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Individual therapy focuses on developing a one-to-one relationship between the patient and the therapist. Initially the duo must build trust, which will help the patient feel comfortable enough to open up about their issues and have more of a willingness to change their thinking or behavior. During these sessions it is easy to talk freely about patient issues since there are no outsiders present in the room. NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment. After some time, family therapy may be initiated. This can consist of bringing in a significant other or an entire family, depending on the circumstances. At this point, legal and ethical considerations are very important because we as therapists must be vigilant on what we do and don’t say regarding all of the private information we now know about the patient.  It is very important to establish what the patient wants the family to know before going forward with family therapy. According to the American Association of Marriage and Family Therapy, therapists should be upfront with the family from the beginning of treatment to inform them of their right to confidentiality, and let them know that a therapist may not disclose to other family members any information an individual family member might share in private (American Association for Marriage and Family Therapy, 2011).  Transitioning into family therapy from individual therapy would impact my approach in regards to my note keeping. I would keep different documentation outside of the permanent psychotherapy or progress notes in order to remind myself of the specific details that can or cannot be shared with the others attending therapy. I would be very vigilant to address the group as a whole, rather than focus on the patient.

Reference

American Association for Marriage and Family Therapy (2011)
AAMFT code of ethics
. Retrieved from                 https://www.aamft.org/resources/lrm_plan/ethics/ethicscode2001.asp

 

Discussion: Legal and Ethical Considerations for Group and Family Therapy Assignment

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy.

Learning Objectives FOR NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

Students will:

Compare legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy

Analyze the impact of legal and ethical considerations on therapeutic approaches for clients in group and family therapy

NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Recommend strategies to address legal and ethical considerations for group and family therapy

To prepare:

Review this week’s Learning Resources and consider the insights they provide on group and family therapy.

View the media, Legal and Ethical Issues for Mental Health Professions, Volume I, and reflect on legal and ethical considerations for group and family therapy and individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3 of NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

Post an explanation of how legal and ethical considerations for group and family therapy differ from those for individual therapy. Then, explain how these differences might impact your therapeutic approaches for clients in group and family therapy. Support your rationale with evidence-based literature. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy.

NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Assignment

Members of a cohesive group feel warmth and comfort in the group and a sense of belongingness; they value the group and feel in turn that they are valued, accepted, and supported by other members.

—Irvin D. Yalom, The Theory and Practice of Group Psychotherapy

Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author. NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Note: The approximate length of this media piece is 2 minutes.

Group and family therapy offers a unique sense of community and support that may not be achieved through other therapeutic approaches. As you help clients effect change within themselves, they are able to in turn help others within the group change. Although many clients thrive in this environment, it is important to recognize that group and family therapy is not appropriate for everyone. Like any other therapeutic approach, group and family therapy has limitations that must be considered.

This week, as you begin exploring group and family therapy, you examine legal and ethical considerations of this therapeutic approach. You also prepare for your practicum experience by examining counseling theories and developing goals to guide your practice. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Assignment.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

Chapter 11, “Group Therapy” (pp. 407–428)

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Chapter 1, “The Foundations of Family Therapy” (pp. 1–6)

Chapter 2, “The Evolution of Family Therapy” (pp. 7–28)

Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 20–23. Retrieved from http://innovationscns.com/ NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Note: You will access this article from the Walden Library databases.

Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400–408. Retrieved from http://www.hsj.gr/medicine/group-therapy-in-psychotic-inpatients.php?aid=2644

Note: You will access this article from the Walden Library databases.

Lego, S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric & Mental Health Nursing, 5(3), 193–196. doi:10.1046/j.1365-2850.1998.00129.x

Note: You will access this article from the Walden Library databases.

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf

Document: Practicum Journal Template (Word document)

Document: Midterm Exam Study Guide (Word document)

Document: Final Exam Study Guide (Word document)

Required Media

Laureate Education (Producer). (2015). Microskills: Family counseling techniques 1 [Video file]. Baltimore, MD: Author. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy.

Note: The approximate length of this media piece is 32 minutes.

Laureate Education (Producer). (2015). Microskills: Family counseling techniques 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 32 minutes. NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Laureate Education (Producer). (2015). Microskills: Family counseling techniques 3 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 24 minutes.

Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008a). Legal and ethical issues for mental health professionals, volume 1: Confidentiality, privilege, reporting, and duty to warn [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 140 minutes.

Optional Resources

Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008b). Legal and ethical issues for mental health professionals, volume 2: Dual relationships, boundaries, standards of care and termination [Video file]. Mill Valley, CA: Psychotherapy.net. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

Note: You will access this media from the Walden Library databases. The approximate length of this media piece is 191 minutes.

By Day 6 of NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

Respond to at least two of your colleagues by suggesting strategies to address the legal and ethical considerations your colleagues discussed. Support your responses with evidence-based literature.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 1 Discussion

Assignment 1: Practicum – Week 1 Journal Entry

As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy.

Note: Be sure to use the Practicum Journal Template, located in this week’s Learning Resources.

Learning Objectives

Students will:

Analyze nursing and counseling theories to guide practice in psychotherapy*

Summarize goals and objectives for personal practicum experiences*

Produce timelines for practicum activities* NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 3.

In preparation for this course’s practicum experience, address the following in your Practicum Journal:

Select one nursing theory and one counseling theory to best guide your practice in psychotherapy.

Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources.

Explain why you selected these theories. Support your approach with evidence-based literature.

Develop at least three goals and at least three objectives for the practicum experience in this course.

Create a timeline of practicum activities based on your practicum requirements.

NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

By Day 7 of Week 4

Submit your Assignment.

NURS 6650 Week 1 Assignment 2: Board Vitals

This week you will be responding to twenty Board Vitals questions that cover a broad review of your Nurse Practitioner program courses up to this point.

These review questions will provide practice that is critical in your preparation for the national certification exam that’s required to certify you to practice as a nurse practitioner. These customized test questions are designed to help you prepare for your Nurse Practitioner certification exam. It is in your best interest to take your time, do your best, and answer each question to the best of your ability. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy

You can access Board Vitals through the link sent to you in email or by following the link below:

https://www.boardvitals.com/

By Day 7

Complete the Board Vitals questions.

Making Connections

Now that you have:

Explored legal and ethical considerations for group and family therapy

Prepared for your practicum experience by examining counseling theories and developing goals to guide your practice

Next week, you will:

Explore family assessment and therapy as you assess client families presenting for psychotherapy

Develop diagnoses for clients receiving family psychotherapy and consider legal and ethical implications of counseling these clients

Looking Ahead 1: Didactic Assignments

Week 3 Discussion: In a 3- to 5-minute Kaltura video, you will discuss a client family you have observed and/or counseled during your practicum experience. Be sure to make arrangements with your preceptor so you can fulfill the requirements of the Discussion. Refer to the Week 3 Discussion for additional guidance. NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Week 10 Discussion: In a 3- to 5-minute Kaltura video, you will discuss a child or adolescent group you have observed and/or counseled during your practicum experience. Be sure to make arrangements with your preceptor so you can fulfill the requirements of the Discussion. Refer to the Week 10 Discussion for additional guidance.

Week 11 Discussion: In a standard Discussion thread, you will discuss an older adult group you have observed and/or counseled during your practicum experience. Be sure to make arrangements with your preceptor so you can fulfill the requirements of the Discussion. Refer to the Week 11 Discussion for additional guidance. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy.

Looking Ahead 2: Practicum Assignments

Each week, you will complete practicum-related Assignments. It is highly recommended that you review the practicum assignments for Weeks 2–11 before Day 7 of Week 1. This will give you time to meet with your preceptor so that you can fulfill the requirements of each Assignment.

Week 2:You will write about two clients from a family you observed or counseled. (Assignment to be submitted by Day 7 of Week 4)

Week 3: You will complete a comprehensive client family assessment. (Assignment to be submitted by Day 7 of Week 4)

Week 5: You will write about two clients from a family you observed or counseled and explain whether solution-focused or cognitive behavioral therapy would be effective with the family. (Assignment to be submitted by Day 7 of Week 7). NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy.

Week 7: You will write a progress note and privileged psychotherapy note for the client family you assessed in Week 3 for the comprehensive client family assessment. (Assignment to be submitted by Day 7 of Week 7.)

Week 8: You will write about two clients you observed or counseled during a group therapy session and explain whether cognitive behavioral therapy would be effective with the group. (Assignment to be submitted by Day 7 of Week 10)

Week 10: You will write about two clients you observed or counseled during a group therapy session for children and adolescents. (Assignment to be submitted by Day 7 of Week 10)

Week 10: You will write a client termination summary for a client who is ready to complete group therapy. (Assignment to be submitted by Day 7 of Week 11). NURS 6650 Week 1 Discussion: Legal and Ethical Considerations for Group and Family Therapy Essay Assignment

Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

Week 1 Initial Discussion Post

During the initial mental health assessment of the adolescent client, the psychiatric mental health nurse practitioner(PMHNP) must ask open-ended questions in order to facilitate the conversation and develop trust between parties (client (s) and practitioner. The assessment conducted by the NP serves as a platform of interrelated purposes to present the chief complaint, formulate a primary/differential diagnosis, determine the cause of the issue, identify risk of suicidal/homicidal ideations and to gather an individualized treatment plan (Mash & Hundsley, 2005; Sands, 2004). In order for the PMHNP to elicit responses from the client, they rely on an exchange of and open line of communication. Many providers utilize ‘Socratic’ questioning to bring about insight on the presenting issues and assist in the exploration of additional views and solutions to those presenting issues (Kiyimba, Karim, & O’Reilly, 2017).

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What the Practitioner Did Well

As evidenced in Vignette 4 (2013c), this practitioner seemed as if he was welcoming to this client and made him feel relaxed in this new and unfamiliar environment. After the client was seated in the PMHNP’s office, the therapist explained how limited confidentiality works and what he is required by law to report. Limited confidentiality must be established during this initial interview process so that the client understands that though most information discussed during the session is confidential, there are instances where it can not be. Such examples are, the client being a danger to himself, poses a danger to others or there is someone that is a danger to the client (Sadock, Sadock, & Ruiz, 2014). After the conversation has begun and the PMHNP has asked the client some opening questions, through his line of questions he was able to quickly establish a positive rapport with this male client which can be helpful in his overall treatment later on. Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

Suggested areas of Improvement

As a NP student there are areas that the therapist could work on for future interactions with this client and those he will treat in the future. First of all, the therapist did not shake the client’s hand after they had entered the room. He did not greet the client with a smiling face and had body language that suggested to this author that he might be rigid in his thinking, not have a sense of humor or be judgmental about certain issues that may be discussed in session. The therapist may be subconsciously construing that he lacks empathy and genuineness. According to Sadock, Sadock, & Ruiz (2014), if the client is offered an extended hand to shake and does not shake it then that is likely to be indicative of some underlying issue that should be explored at a later time. The NP should be attuned to both verbal and nonverbal cues that the client is giving. Also, the therapist seems to be positioned at desk more than 6 feet from the client and adjacent to the client’s chair. This type of seating could be a source of added anxiety to an already anxious patient because of the awkwardness of placement. Finally, this author has noticed that the therapist tends to be writing a lot of notes during the initial line of questions and not maintaining direct eye contact. The client could perceive this nonverbal cue as the therapist not really having a personal interest in his issue or that he is writing information based on his opinion of their interaction during session. This can quickly cause the development of distrust in the client/counselor relationship and hinder progress to treatment and problem resolution.

Compelling Concerns during the Current Interview Stage

The only real concern that this author has is the fact that the mother, that is a major source of the client’s anger, is not present for the initial interview to support the client and to offer her perspective. The client’s mother may be able to offer an accurate account of when she thought that his symptoms became apparent or worsened to the point that she though professional help was warranted. His mother can also offer her own incite as to the client’s behaviors toward her or others and his possible triggers. Having the perspectives of the client and close family can provide the client with more information than having just the client’s rationale for the issues he is experiencing.

Student Nurse’s Subsequent Question during Mental Health Assessment

To gain trust and show empathy, the therapist may explore elements of the client’s life that provide him joy. For this client, it has been established that both his girlfriend and his coach offer him valuable advice and support when he does not feel as if this has been given by his mother. As a subsequent question during this interview the client should be asked, “So you said your coach gives you advice and support in a nonjudgmental or aggressive way. First, what sport do you play? And then, “What makes the coach’s advice more relatable to you versus advice your mother might give? Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

 

References

Kiyimba, N., Karim, K., & O’Reilly, M. (2017). The use of why questions in child and adolescent mental health assessments. 
Research on Child and Social Interaction,
 Retrieved on 2-28-18 from https://doi.org/10.1558/resi.30280

Mash, E.J. & Hundsley, J. (2005). Special section: Developing guidelines for the evidence-based assessment of child and adolescent disorders
. Journal of Child and Adolescent Psychology
, 34,362-379. Retrieved from 
https://doi.org/10.1207/s15374424jccp34031

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2014). 
Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11
th
 ed.).
Philadelphia, PA: Wolters Kluwer Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

Sands, N. (2004). Mental health in triage nursing: An Australian perspective
. Journal of Psychiatric Mental Health Nursing, 
11, 150-155. Retrieved from https://doi.org/10.1111/j.1365-2850.2003.00697.x

YMH Boston. (2013c. May 22). 
Vignette 4-Introduction to a mental health assessment [Video file
]. Retrieved from https: www.youtube.com/watch?v=JCJOXQa9wcE

Discussion: Comprehensive Integrated Psychiatric Assessment

The comprehensive integrated psychiatric assessment of a child or adolescent consists of gathering information from not only the child but from several sources, most notably the family members, caregivers, and the child’s teacher or school counselor. Because of this, the diagnostic assessment becomes more complicated. Issues of confidentiality, privacy, and consent must be addressed. Also, the PMHNP must take into consideration the impact of culture on the child.

In this Discussion, you review and critique the techniques and methods of a mental health professional as he or she completes a comprehensive integrated psychiatric assessment of an adolescent.

Learning Objectives

Students will:

Evaluate comprehensive integrated psychiatric assessment techniques

Recommend assessment questions

To Prepare for the Discussion:

Review the Learning Resources concerning the comprehensive integrated psychiatric assessment.

Watch the 
Mental Status Examination 
video.

Watch the two YMH Bostonvideos.

Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

Note: 
For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking 
Submit
!

By Day 3

Based on the YMH Boston
 Vignette 4 
video
, post answers to the following questions:

What did the practitioner do well?

In what areas can the practitioner improve?

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

What would be your 
next
 question, and why?

Week 1 Discussion

The purpose of the psychiatric interview is to elicit information from a patient to determine a diagnosis and subsequently, a treatment plan. According to Kaplan, Sadock, and Ruiz (2014) the interview can shape the patient- practitioner relationship and important aspects of the interview includes patient consent to an interview, explanation and follow through of confidentiality and privacy, providing the client with respect and consideration, developing a rapport with the client, while providing a safe and comfortable environment for the client (pp193-194).

What did the practitioner do well?

The provider did a great job providing a safe place for the client and explaining confidentiality and potential reasons why he would need to break that confidentiality. He gave his full attention to the client and asked questions to get a better understanding of the client’s answer. He asked if the client had someone he can talk to he can trust to assess support (YMH Boston, 2013).

In what areas can the practitioner improve?

Twice the client stated he did not like school and the practitioner failed to ask why. According to Scher (2016) “academic functioning is a common concern” (para 4, Adolescent interview). I believe this may have been an opportunity to see if he was having trouble at school either in academics or with peers. School was also the area of contention with the mother. The practitioner also could improve by wording his sentences in a different manner. After he said “she must have a reason” the client seemed as though he did not want to talk about the issue further (YMH Boston, 2013, 1:52). The practitioner could have asked how long this has been occurring, how often, and what other symptoms the client may have. Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

What would your next question be and why?

I would ask the client to describe a typical day from the time he wakes up until he goes back to bed. This question would allow more insight into the client and his activities and I would be able to explore any other symptoms or patterns that the client does not recognize. For example, the client may reveal he stays up late talking to his girlfriend and he is too tired to focus in class. Further exploration will help guide the treatment plan.

 

References

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). 
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry 
(11th ed.). Philadelphia, PA: Wolters Kluwer.

Scher, L.M. (2016). Psychiatric interview. Retrieved from 
https://emedicine.medscape.com/article/1941476-overview#a14

YMH Boston. (2013). Vignette 4- Introduction to a mental health assessment [Video file]. Retrieved from 

  Nurs 6660 Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 4 video

NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

NURS 6660

Week 2 Main Posting

Why Development assessment of children and adolescent important

Developmental assessment is a part of comprehensive medical care and it is a process of mapping a child’s performance compared with children of a similar age from a similar population (CDC, 2018). It is important because it helps highlight normal development pattern and timings. Also, it helps identify areas of regression or areas with a specific impairment that requires being referred for specialist assessment (CDC, 2018).

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Assessment Instruments Used for Children and Adolescents

The two-assessment instruments that are used specifically for the children and adolescent are the Child and Adolescent Psychiatric Assessment (CAPA) and the Diagnostic Interview for Children and Adolescents (DICA). CAPA is an interviewer-based diagnostic interview with versions for use with children and their parents. The interview covers the age range from 9 to 17 years and it focused on symptoms occurring during the preceding 3-month period and is adapted for assessments in both clinical and epidemiological research (Jozefak, & Berg- Nielsen, 2016). DICA was once considered a structured interview, but now can be used in a semi-structured format. It displays good reliability and is designed for use with children 6 to 17 years. It usually takes between 1 to 2 hours to administer. The DICA is a useful measure for both research and clinical settings, and it provides a reliable tool for assessing psychiatric information in behavior disorders, anxiety disorders, depressive disorders, and substance abuse disorders (Sadock, Sadock & Ruiz, 2014). The CAPA and DICA instruments are used for children and adolescent and not adults because they are structured specifically for them and so they are simpler and more direct interview/questionnaire. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Treatment options for children and adolescents

Two treatment options used for children and adolescent and not for adults are parenting training in behavior therapy and positive parenting program (Triple P). Parent training in behavior therapy or parent training is a treatment option, where parents learn new skills and or strengthen their existing skills to teach and manage their child’s behavior. It has shown to strengthen the relationship between the parents and their children and to decrease negative/problem behaviors in children and adolescent (CDC, 2017). The Triple P – Positive Parenting Program (Triple P) is a parent training program that is designed to prevent severe behavioral, and developmental problems in children. It helps to enhance the knowledge, skills, and confidence of parents. It gives parents simple and practical strategies to help them build strong, healthy relationships, confidently manage their children’s behavior and prevent problems developing (Aghebati, Gharraee, Hakim Shoshtari & Gohari, 2014). Triple P is used in many countries and has shown to work across cultures, socio-economic groups and in many kinds of family structures (Aghebati, Gharraee, Hakim Shoshtari & Gohari, 2014). NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Role Parents Assessment and Treatment

Parents play a significant role in their children’s assessment and treatment because they help in monitoring their health and development including facilitating their treatment attendance. They are often present in the assessment sessions and the observation of the child-parent interactions is an important aspect of the assessment. Parents also assist the professionals to make decisions and arrive at treatment plan (Haine-Schlagel, & Walsh, 2015).

Reference

Aghebati, A., Gharraee, B., Hakim Shoshtari, M., & Gohari, M. R. (2014). Triple P-Positive Parenting Program for Mothers of ADHD Children. Iranian Journal of Psychiatry and Behavioral Sciences, 8(1), 59–65.

Center for Disease Control and Prevention (CDC) (2017). Behavior Therapy, Including Training for Parents. Retrieved from: https://www.cdc.gov/ncbddd/adhd/treatment.html

Center for Disease Control and Prevention (CDC) (2018). Developmental Monitoring and Screening. Retrieved from: https://www.cdc.gov/ncbddd/childdevelopment/facts.html

Haine-Schlagel, R., & Walsh, N. E. (2015). A Review of Parent Participation Engagement in Child and Family Mental Health Treatment. Clinical Child and Family Psychology Review, 18(2), 133–150. http://doi.org/10.1007/s10567-015-0182-x

Jozefak, T., & Berg- Nielsen, T. S., (2016). Measuring characteristics of the Norwegian version of Child and Adolescent Psychiatric Assessment (CAPA) and Preschool Age Psychiatric Assessment (PAPA). Retrieved from: http://www.psyktestbarn.no/CMS/ptb.nsf/pages/capa-papa

Novick, J., Cawthorpe, D., & McLuckie. M., (2016). A measurable treatment plan: Using the Children’s Global Assessment and the Problem Severity scales as outcomes of clinical treatment. Retrieved from: http://www.sciedu.ca/journal/index.php/jha/article/viewFile/10407/6504

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Assessment in Child and Adolescent Psychiatry

Why are Development Assessments of Children and Adolescents Important

The assessment of children and adolescents in psychology is a very crucial component in the determination and diagnosing of maladaptive behaviors that can progress into more complicated disorders and challenges if not detected early. Early therapeutic treatment of children and adolescents is imperative for the proper achieval of developmental milestones.  Developmental assessment is so important because as a comprehensive medical care model it serves as a process map of children’s performance and can be used to compare children of similar ages and normal developmental patterns (CDC, 2018).  Additionally, notable areas of challenges and impairments can be addressed by a specialist when found.

Assessment Instruments Used for Children and Adolescents

Many diverse instruments are used in the assessment of children and adolescents and two of these assessment tools will be reviewed here.  One tool used in assessment is called the Child and Adolescent Psychiatric Assessment (CAPA) and another tool used is called the Diagnostic Interview for Children and Adolescents (DICA).  CAPA is a interview based instrument that is diverse in its variety of versions and used in the ages of 9-17. The CAPA looks at symptoms that have occurred in the preceding 3-month period and has established use in both the clinical arena and research (Jozefak, & Berg-Nielson, 2016).  DICA is another tool often used that was once a structured interview format that has been adapted to a semi-structure format with great accuracy in reliable measurements conducted over a 1-2 hour time period.  The DICA tool is used for children 6 to 17 years of age and assesses disorders in behavior, substance abuse, anxiety and depression (Sadock, Sadock & Ruiz, 2014).  Both of the tools reviewed are used specific to the population children and adolescents due to their simplistic nature.  These tools are not used in adults as they provide a direct/interview approach that is not required in this population to elicit details. The NHMRC has emphasized the need to use validated instruments in the developmental assessment of children and adolescents.  Two other validated tools that are often used in practice are the PSC-17; Pediatric Symptom Checklist and SCARED; Screen for Children and Anxiety-Related Emotional Disorders. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Treatment options for children and adolescents

Treatment options in the care of children and adolescents is a vital component that must be considered as the PMHNP, prescribing the most suitable and therapeutic modality can be challenging.  Each child and adolescent must be treated individually and this consideration means that treatment options are not a one size fits all. Early intervention is essential and works to provide better outcomes for children and adolescents.  Treatment options include parental education/training and positive parenting program.  Parent training is a behavior therapy modality that works to educate parents on new skills and the enhancement of existing skills in management of their childrens behavior.  The Positive parenting program was designed to alleviate severe behavior, and developmental problems in children.  This process is completed by heightening skills and confidence of parents through the use of practical strategies.  This program has proven effectiveness worldwide and in many cultures, family backgrounds and socio-economic groups (Aghebati, Gharraee, Gohari, 2014).

The Role of Parents in Assessment and Treatment

The use of parental reports is recommended as a significant part of the assessment of children and adolescents. Parents help in monitoring the efficacy of treatment and work to help facilitate consistent attendance to treatment.  The ability to observe parent-child interactions is a very important component to be assessed and these observations work to help the PMHNP develop and modify treatment plans (Haine-Schlagel & Walsh, 2015).

 

References

Aghebati, A., Gharraee, B., Hakim, Shoshtari, M., & Gohari, M. R. (2014). Triple P- Positive Parenting Program for Mothers of ADHD children. Iranian Journal of Psychiatry and Behavioral Sciences, 8(1), 59-65

Centers for Disease Control and Prevention (CDC) (2018). Developmental Monitoring and Screening.  Retrieved from
https://www.cdc.gov/ncbddd/childdevelopment/facts.html

Haine-Schlagel, R., & Walsh, N. E. (2015). A Review of Parent Participation Engagement in Child and Family Mental Health Treatment. Clinical Child and Family Psychology Review 18(2), 133-150.

Jozefak, T., Berg-Nielson, T. S., (2016). Measuring characteristics of the Norwegian version of Child and Adolescent Psychiatric Assessment (CAPA) and Preschool Age Psychiatric Assessment (PAPA). Retrieved from http://www.psyktestbarn.co/CMS

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry