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“Captain of the Ship” Bipolar Disorders

Recommend psychopharmacologic treatments based on therapeutic end points for clients with bipolar disorders

Recommend psychotherapy based on therapeutic end points for clients with bipolar disorders

Identify medical management needs for clients with bipolar disorders

Identify community support resources for clients with bipolar disorders

Recommend follow-up plans for clients with bipolar disorders

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Select an adult or older adult client with a bipolar disorder that you have seen in your practicum.

In 3-4 pages, write a treatment plan for your client. In which you do the following:

Describe the HPI and clinical impression for the client.

Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic

agent. (This should relate to HPI and clinical impression.).

Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

Identify medical management needs, including primary care needs, specific to this client.

Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client “Captain of the Ship” Bipolar Disorders.

Recommend a plan for follow-up intensity and frequency and collaboration with other providers

 

“Captain of the Ship” Bipolar Disorders

Introduction

Bipolar disorder us a mental disorder characterized by extreme mood swings that encompass mania/hypomania (high moods) and depression (low mood). During hypomania/manic episode, the person is full of energy while during the depressive episode, the person feels sad and loses interest in most activities (McCormick et al, 2016). This paper will analyze a client with bipolar disorder and discuss the appropriate treatment options for the client.

HPI and Clinical Impression for the Client

The client Mr. M a 32-year-old male presented complaining of symptoms such as difficulty in concentrations, loss of appetite, sadness, irritability, sleep disturbances, lack of energy and lack of interest in most activities. The client reported that in spite of taking lamotrigine 100 mg/day and moclobemide 600 mg/day, the symptoms had persisted. The client further reported that sometimes he was full of energy, overly sociable, aggressive, talkative, sleep for only 2 hours at night, and would take risky decisions, which was unlike him “Captain of the Ship” Bipolar Disorders.

From the above data, the client experiences hypomanic episodes and depressive episodes and hence the diagnosis is bipolar II disorder. The DSM-5 criteria stipulate that depressive episodes are characterized by symptoms such as fatigue, sadness, lack of interest, appetite and weight changes, as well as suicidal thoughts. Hypomania episode is characterized by risky behaviors, high energy levels, reduced need to sleep, delusions, and feeling euphoric (Muneer, 2016). The client presented with hypomanic and depressive symptoms and this justifies the diagnosis of bipolar II disorder “Captain of the Ship” Bipolar Disorders.

 

Psychopharmacologic Treatments

Lithium 300 mg 3 times a day: Lithium will be prescribed as the mood stabilizer. Shah et al, (2017) explain that the efficacy of lithium in the treatment and prevention of hypomania and mania episodes. The medication is also effective in improving suicidal thoughts in people with bipolar disorder.

Lurasidone 20 mg PO qDay: Lurasidone will target the bipolar depressive symptoms. The medication is approved by the FDA in treating bipolar depressive symptoms, either as a monotherapy or in combination with lithium (Bawa & Scarff, 2015). Moreover, the medication is associated with few side effects and therefore the client is not likely to experience metabolic symptoms such as weight gain “Captain of the Ship” Bipolar Disorders.

Psychotherapy Choices

Cognitive-behavioral therapy (CBT): CBT is the psychotherapy choice for the client. CBT targets the maladaptive thinking patterns and the dysfunctional beliefs that lead to the hypomanic and depressive symptoms for the client (Geddes & David, 2013). As a result, the negative/maladaptive thinking pattern will be transformed into more a positive thinking pattern and this will help eliminate the negative feeling and improve the symptoms of bipolar and normal functioning for the client (Geddes & David, 2013).

Medical Management Needs

The client and his immediate family members will require education regarding the client’s condition to enable them to understand his condition and handle him better. They will also be educated about the possible triggers for depressive and hypomanic symptoms and how to avoid the triggers. There will also be a need to encourage the client to adhere to the prescribed treatment.  (Kilbourne et al, 2013). Moreover, bipolar is characterized by suicidal thoughts and therefore it will be necessary to monitor the client closely. It will also be important to educate the client about the importance of maintaining regular schedules when it comes to activities of daily living such as sleep. More importantly, one of the prescribed medications (lithium) is associated with toxicity and side effect and therefore the client will be educated about the side effect and possible toxicity. The client will also be monitored and assessed closely to avoid any possible toxicity (Kilbourne et al, 2013) “Captain of the Ship” Bipolar Disorders.

Community Support Resources

The client will be linked to the locally available support groups so that he can meet and socialize with individuals undergoing similar mental health problems. This will motivate the client to cope with his conditions and adhere to the prescribed treatment. The client will also be provided with educative resources such as booklets and magazines about his condition so that he can gain information about how to avoid triggers and manage the symptoms (Culpepper, 2014).

Follow-up Plan

The treatment plan and the client’s progress and response to the prescribed treatment will be reviewed after four weeks. The psychiatrist in collaboration with the PMHNP will assess the client and prescribe treatment according to his progress, tolerance, and response to the treatment. The PMHNP will also educate the client and administer the medications as well (Culpepper, 2014). A social worker will have the role of monitoring the progress of the client while at home.

Conclusion

The diagnosis for this client is bipolar II disorder as per the hypomanic and depressive symptoms. The prescribed medications include lithium as the mood stabilizer and lurasidone to treat the depressive symptoms. The psychotherapy choice for the client is cognitive behavioral therapy in order to change the maladaptive thinking pattern into a more positive thinking pattern. The medical management needs include monitoring the client for suicide and treatment adherence, as well as educating the client about the possible triggers and symptom management. The client will be linked with the local support groups and given reading resources about the condition “Captain of the Ship” Bipolar Disorders.

 

References

Bawa R & Scarff. (2015). Lurasidone: A New Treatment Option for Bipolar Depression—A Review.
Innov Clin Neurosci
, 12(1-2), 21–23.

Culpepper L. (2014). The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care.
Prim Care Companion CNS Disord
, 16(3): PCC.13r01609.

Geddes & David M. (2013). Treatment of bipolar disorder.
Lancet
, 381(9878).

Kilbourne A, David G, Allison N & Miller C. (2013). Integrating Bipolar Disorder Management in Primary Care.
Curr Psychiatry Rep
, 214(6), 687–695 “Captain of the Ship” Bipolar Disorders.

McCormick U, Murray B & McNew B. (2015). Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses.
J Am Assoc Nurse Pract
, 27(9), 530–542.

Muneer A. (2016). The Neurobiology of Bipolar Disorder: An Integrated Approach.
Chonnam Med J
, 52(1), 18–37.

Shah N, Grover S & Rao P. (2017). Clinical Practice Guidelines for Management of Bipolar Disorder.
Indian J Psychiatry
, 59(1), S51–S66 “Captain of the Ship” Bipolar Disorders.

Nurs 6670 decision tree – antisocial personality disorder essay

Decision Tree

Introduction

Personality disorders refer to the extreme personality traits that interfere with an individual’s daily life and functioning. Personality disorders are characterized by unhealthy and persistent long-term patterns of thoughts, feelings and behavior. The behaviors can lead to serious problems in work and relationships (Sadock et al., 2014). This case study presents a client with a personality disorder Nurs 6670 decision tree – antisocial personality disorder essay. Accordingly, three decisions will be made about the diagnosis of the client’s personality disorder as the treatment choices for the client. The paper will conclude by discussing ethical issues likely to impact the treatment of this client.

Decision Point One

The diagnosis for this client is antisocial personality disorder. According to the DSM-5 diagnostic criteria, antisocial personality disorder is characterized by…

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Evaluate clients for treatment of mental health disorders

Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

 

Case #1

A woman with personality disorder

SUBJECTIVE

Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help.

Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you Nurs 6670 decision tree – antisocial personality disorder essay. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!”

Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.” Nurs 6670 decision tree – antisocial personality disorder essay.

Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.”

OBJECTIVE

Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail Nurs 6670 decision tree – antisocial personality disorder essay.

Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police.

MENTAL STATUS EXAM

Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation. Nurs 6670 decision tree – antisocial personality disorder essay.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO RHONDA?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Borderline Personality Disorder

Histrionic Personality Disorder

Antisocial Personality Disorder

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/index.html

You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select? I CHOSE ANTI-SOCIAL PERSONALITY DISORDER

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 Nurs 6670 decision tree – antisocial personality disorder essay.

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

Decision #2: Treatment Plan for Psychotherapy

I CHOSE REFER TO PSYCHOLOGIST FOR PSYCHOLIGICAL TESTING

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?

Decision #3: Treatment Plan for Psychopharmacology

REFER TO GROUP-BASED COGNITIVE BEHAVIOR THERAPY

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 and their family Nurs 6670 decision tree – antisocial personality disorder essay.

 

Decision Tree

Introduction

Personality disorders refer to the extreme personality traits that interfere with an individual’s daily life and functioning. Personality disorders are characterized by unhealthy and persistent long-term patterns of thoughts, feelings and behavior Nurs 6670 decision tree – antisocial personality disorder essay. The behaviors can lead to serious problems in work and relationships (Sadock et al., 2014). This case study presents a client with a personality disorder. Accordingly, three decisions will be made about the diagnosis of the client’s personality disorder as the treatment choices for the client. The paper will conclude by discussing ethical issues likely to impact the treatment of this client.

Decision Point One

The diagnosis for this client is antisocial personality disorder. According to the DSM-5 diagnostic criteria, antisocial personality disorder is characterized by patterns of manipulation, exploitation and violating the rights of other people without any remorse or guilt. The behavior may lead to problems in work and relationships. In addition, people with this type of personality disorder tend to violate the law and may be involved in criminal activities. The key characteristics of antisocial personality disorder include disregard for wrong and right; poor/abusive relationships; persistent deceit to exploit other people; callousness and cynicism; arrogance; impulsivity; persistent problems with the law; lack of empathy or remorse; engaging in risky and impulsive behaviors; irritability; violence; and consistent irresponsibility (American Psychiatric Association, 2013).

The client in this case study manifested symptoms such as relationship problems; lack of friends and blaming others for her problems; taking unnecessary impulsive risks such as when she bought a car that was later repossessed; lack of remorse; reported that she was always in trouble even in childhood, inability to maintain employment; stealing and failure to admit her mistakes; problem with the law as indicated by incarceration, as well as violence as indicated by beating up a girl Nurs 6670 decision tree – antisocial personality disorder essay. These symptoms fit the diagnostic criteria for antisocial personality disorder justifying the selected decision (American Psychiatric Association, 2013).

With this decision, it is expected that the right diagnosis will facilitate the appropriate treatment for this client.

Decision Point Two

The second decision is to refer the client for psychological testing. The rationale for this decision is to ensure that the client will undergo psychological tests that will help in confirming or ruling out the diagnosis of antisocial personality disorder. According to Dixon-Gordon K et al., (2015) psychologists use a variety of assessment tools and specially designed interviews to assess individuals with personality disorders. The psychologist basis the diagnosis on the findings from the assessment tools and also the client’s descriptions of the symptoms and the observation of the behavior and attitude of the client.

The expected outcome of this decision is that the diagnosis for the client will be confirmed using psychological testing. This is because in psychological tests various tools are used to assess different types of personality disorders using objective and subjective data Nurs 6670 decision tree – antisocial personality disorder essay.

Just like it was expected, when the client returned after four weeks, the comprehensive psychological battery test performed for this client indicated that the client manifested traits of various personality disorders but the highest score was of antisocial personality traits, indicating that the diagnosis for this client was antisocial personality disorder. A psychological assessment explores thoughts, feelings, behavior, relationships, as well as family history (Dixon-Gordon K et al., 2015).

There was no difference between the expected results and the actual outcome because the psychological testing confirmed the diagnosis of antisocial personality disorder for this client. Psychological tests are useful in assessing various mental traits and abilities that include personality and neurological functioning (Dixon-Gordon K et al., 2015). Therefore, just like it was expected the psychological testing assessed the client’s mental traits and personality and therefore confirmed the diagnosis of antisocial personality disorder.

Decision Point Three

The third decision that was selected is for the client to undergo group-based cognitive behavior therapy (G-CBT). The rationale for selecting this decision is that CBT is well-suited in addressing antisocial personality disorder because according to CBT, personality disorders such as antisocial personality disorder are maintained by maladaptive beliefs regarding self and other people, environmental/contextual factors reinforcing the problematic behavior, as well as the skill deficits that impede positive and adaptive responding (Nazar & Ramganes, 2017). CBT integrates various techniques to modify these factors through cognitive restructuring, modifying the behavior, psychoeducation, in addition to skills training (Stahl, 2014). Additionally, CBT in people with personality disorders highlights the significance of a supportive and collaborative therapeutic relationship because this improves the willingness of the client to make the necessary changes. Moreover, the client will participate in group-CBT and this will give the client a chance to discuss her feelings and behaviors with people facing similar issues.

The expected outcome with this decision is that the group CBT will effectively restructure the cognitive functioning of the client and her intermediate beliefs, and hence change her behavior (Nazar & Ramganes, 2017). Therefore, after undergoing group CBT it is expected that the symptoms of antisocial personality disorder will significantly improve.

Ethical Considerations

Ethical treatment for this client will require vigilant risk-benefit analysis in collaborating with the numerous issues of the client likely to affect the treatment and outcome for the client. It will be essential for the PMHNP to establish a collaborative relationship and honor it, seek informed consent from the client and use evidence to make treatment decisions for this client. It will also be important for the PHMNP to carefully manage the boundary issues with this client. This is because clients with personality disorders tend to have boundary issues such as excessively calling their therapists, as well as making unreasonable demands in terms of availability and accessibility.  Therefore, the PMHNP will need to carefully assess the genuine needs of the client and maintain boundaries in aspects key to competent and ethical treatment (Ekselius, 2018). Moreover, it will be important to respect the autonomy and decision-making ability of the client Nurs 6670 decision tree – antisocial personality disorder essay.

Conclusion

The first decision is that the diagnosis for this client is antisocial personality disorder. This is because the symptoms the client manifests are consistent with the DSM-5 criteria for antisocial personality disorder. The second decision was to refer the client for psychological testing in order to confirm the diagnosis for the client. The last decision was to have the client undergo a group cognitive behavior therapy. Ethical considerations for the client include maintaining boundaries, seeking informed consent from the client and respecting the autonomy and decision-making ability for the client Nurs 6670 decision tree – antisocial personality disorder essay.

References

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: American Psychiatric Association.

Ekselius L. (2018). Personality disorder: a disease in disguise.
Ups J Med Sci
, 123(4), 194–204.

Dixon-Gordon K, Whalen D, Layden B & Chapman A. (2015). A Systematic Review of Personality Disorders and Health Outcomes.
Can Psychol
, 56(2), 168–190.

Nazar N & Ramganes E. (2017). Cognitive Behavior Treatment of Personality Disorders.
International Journal of Humanities and Social Science Invention ISSN
, 6(11), 2319 –7714.

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

Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential

Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press Nurs 6670 decision tree – antisocial personality disorder essay

nurs 6670 Early Onset Schizophrenia Essay

Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia.

Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues.

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Early onset of schizophrenia is seen during the adolescent age and particularly before the age of 18 years.  The general symptoms of the condition appear during the mid- to late 20s even though rare cases are reported in children of below 13 years (Ball et l., 2018). Childhood schizophrenia presents a severe mental disorder in children between 7 and 13 years. The disorder occurs in there stages namely the prodromal, the acute and the recovery phases. It is also often comorbid with other mental conditions which challenges its management. The clinical manifestations of
schizophrenia
include behavioral, emotional and thinking problems even though the variations could include hallucinations, delusions impaired functioning abilities and disorganized speech nurs 6670 Early Onset Schizophrenia Essay.

Comparison of evidence-based treatment plans

Multiple interventions are applied in the treatment of schizophrenia. For instance, psychotherapy is effective in the management of most mental disorders. As such, individual therapy can be used to treat the adults, children an adolescents as well. It uses cognitive behavioral therapy to change the thought processes, emotions and behaviors of these individuals as guided by skilled mental health professionals (Green, Horan & Lee, 2015). In children, it helps in socialization and management of school work while in adults and children it seeks to change behaviors and improve their quality of lives. On the other hand, pharmacological approach is also effective and uses the antipsychotic drugs to achieve the alleviation of symptoms. However, the FDA does not approve the use of second-generation and some first generation antipsychotics to children and teenagers often those of below 12 years due to their intolerance and adverse side effects nurs 6670 Early Onset Schizophrenia Essay.

Legal and ethical issues

The State of Indiana and the US laws in general have provisions for situations involving the legal rights to refusal of treatment (Perlin, Cucolo & Lynch, 2017). However, this does not always cover mental health patients because; they are considered unfit to make sound decisions regarding their treatment. In the event of a child being forced to take medication after a diagnosis with schizophrenia, the parents are given the legal right to decide on their behalf since children are considered to be unable to decide regarding their health nurs 6670 Early Onset Schizophrenia Essay. The law also demands the scrutiny of medication to determine its appropriateness and approval by the Food and Drug Association. This is because; many medications for schizophrenia treatment are not approved for the use in children.

This caser also presents an ethical dilemma associated with the autonomy, non-maleficence and beneficence principles (Butts & Rich, 2019). For instance, the patient has the right to deny medication and or demand for alternatives. According to autonomy, the practitioner should respect the patient’s decision and provide treatment as per the client’s decision. However, the patient declines treatment which endangers his mental health and thus beneficence expects the nurse to take actions that benefit the child. The non-maleficence principle is also challenged by the decision of the patient which might cause him harm rather than good.

The PMHNP can address this case through the application of the Indiana legal guideline which gives the patients the right to make decisions on behalf of their children. Moreover, these provisions do not consider mental patients fit for decision-making and thus, the parents will have to decide regarding their child’s treatment (Perlin, Cucolo & Lynch, 2017). Consequently, the practitioner can seek alternative treatment options to patients that could be accommodative to them to prevent resistance nurs 6670 Early Onset Schizophrenia Essay. The application of ethical principles will also guide them in decision making and course of action together with evidence-based research from previous similar cases.

References

Ball, A., Rittner, B., Chen, Y. L., & Maguin, E. (2018). Impact of individualized education plans on academic success of youth with early onset schizophrenia. 
Journal of evidence-informed social work
, 
15
(5), 534-549.

Butts, J. B., & Rich, K. L. (2019). 
Nursing ethics
. Jones & Bartlett Learning.

Green, M. F., Horan, W. P., & Lee, J. (2015). Social cognition in schizophrenia. 
Nature Reviews Neuroscience
, 
16
(10), 620.

Perlin, M. L., Cucolo, H. E., & Lynch, A. (2017). 
Mental disability law: Cases and materials
. Carolina Academic Press nurs 6670 Early Onset Schizophrenia Essay.

For this nurs 6660 practicum decision tree Early onset Schizophrenia essay Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia

Decision Tree Week 9

Introduction

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The client in this case study is about a 13-year-old girl who presented to the office with the parents reporting about her “difficult behavior”. The main complaints included the client “talking” to imaginary friends and having delusions about individuals in the television recognizing her and showcasing for her. The social skills of the client are impaired and her academic performance has declined significantly. The mother further reported a family history of schizophrenia. nurs 6660 practicum decision tree Early onset Schizophrenia essay The mental examination further released that the client sees, hears, and communicates with strange nonexistent things. Accordingly, in this paper, one decision will be made about the diagnosis of the client’s condition while the other two decisions will be made about the treatment of the client. Finally, the ethical issues relevant to the treatment of this client will be discussed.

Decision Point One

The selected diagnosis for the client is early-onset schizophrenia. The rationale behind selection of this decision is that the symptoms the client is manifesting fit the diagnostic criteria of early-onset schizophrenia as per the DSM-5 criteria. According to the DSM-5 criteria, symptoms of early-onset schizophrenia include negative symptoms, delusions, disorganized speech, hallucinations, and disorganized behavior (Stahl, 2014). The American Psychiatric Association (2013) stipulates that a person should manifest two or more of these symptoms to fit the diagnosis of schizophrenia. The client in this case study has three symptoms that include negative symptoms as manifested by constricted affect; delusions as indicated by the television assertions; and hallucinations indicated by the client seeing, hearing and talking to imaginary and strange people. nurs 6660 practicum decision tree Early onset Schizophrenia essay Bartlett (2014) further indicates that negative symptoms in people with schizophrenia include lack of motivation, flat affect, anhedonia, and lacking interest in social interactions. The client in this case study does not have any interest to interact with her classmates, manifests constricted affect, and also manifests blunt affect which is evident when she is asked regarding her assignment indicating symptoms of schizophrenia (Stahl, 2014).

By selecting this diagnosis for the client, the expectation is that this is the correct diagnosis and thus it will facilitate the appropriate treatment for the client.

Decision Point Two

The second decision is referring the client for psychological testing. The reason for suggesting the client be referred for psychological testing is to ensure that the client undergoes psychological tests that will examine her personality, identify any intellectual disability, and also examine the cognitive functioning of the client (Andersen et al, 2016). In addition, comprehensive psychological testing for this client will be used to rule out other causes that are non-psychiatric and may be causing psychosis and other symptoms nurs 6660 practicum decision tree Early onset Schizophrenia essay.

By selecting the decision to have the client undergo psychological testing, is have the diagnosis confirmed or ruled out.  This is because a psychological test will examine the personality of the client, identify any intellectual disability, and also examine the cognitive functioning of the client and at the same time inform if the symptom the client is manifesting may be as a result of other non-psychiatric causes (Andersen et al, 2016).

The outcome of this decision is that the psychological tests indicated a high likelihood of the client having early-onset schizophrenia. This confirmed the earlier diagnosis, as expected.

Decision Point Three

The third decision is having the client start Lurasidone 40 mg orally daily. The reason for choosing Lurasidone for this client is because the efficacy of the medication in treating schizophrenia has been proved and that children tolerate the medication well (Goldman et al, 2017) nurs 6660 practicum decision tree Early onset Schizophrenia essay. A study that was performed by Goldman et al (2017) indicated that administering Lurasidone to the pediatric population with schizophrenia led to significant improvement of symptoms as well as their ability to carry out activities of daily living. Moreover, the medication has few side effects and also weight gain is minimal and low sedative effects. In addition, lurasidone does not interfere with the functioning and cognitive ability of people taking it (Harvey, 2015).

Ethical Considerations

The client involved is a minor and thus all treatment decisions will be made by the parents. Moreover, medications like lurasidone are associated with some side effects, especially with the pediatric population. Therefore, it is important for the PMHNP to seek informed consent from the parents of the client and provide them with all information about the available medications to ensure that they make an informed treatment decision (Harvey et al, 2015).

Conclusion

The diagnosis for this client is early-onset schizophrenia because she is manifesting symptoms of schizophrenia as per the DSM-5 criteria. The second decision that was chosen is to refer the client for psychological testing. This was done to verify the initial diagnosis of early-onset schizophrenia. The psychological testing supported the diagnosis of early-onset schizophrenia for the client. The last decision is for the client to start lurasidone 40 mg orally daily. Lurasidone was selected because the efficacy of the medication in treating schizophrenia in pediatric population has been shown. Lastly, it will be important for the PMHNP to seek informed consent from the parents of the client before starting the treatment nurs 6660 practicum decision tree Early onset Schizophrenia essay.

 

References

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: American Psychiatric Association.

Andersen D, Vernal D, Bilenberg N, Vaever M & Stenstrøm A. (2016). Early-Onset Schizophrenia: Exploring the Contribution of the Thought Disorder Index to Clinical Assessment.
Special Issue: Early-Onset Psychosis and Child and Adolescent Schizophrenia
. 4(1). nurs 6660 practicum decision tree Early onset Schizophrenia essay.

Bartlett J. (2014). Childhood-onset schizophrenia: what do we really know?
Health Psychol Behav Med
. 1; 2(1): 735–747.

Goldman R, Loebel A, Cucciaro J, Deng L & Findling R. (2017). Efficacy and Safety of Lurasidone in Adolescents with Schizophrenia: A 6-Week, Randomized Placebo-Controlled Study.
J Child Adolesc Psychopharmacol
. 27(6), pp: 516–525.

Harvey P. (2015). The clinical utility of lurasidone in schizophrenia: patient considerations.
Neuropsychiatr Dis Treat
. 1(11), pp: 1103–1109.

Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.)
. New York, NY: Cambridge University Press nurs 6660 practicum decision tree Early onset Schizophrenia essay.

 

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/09/mm/decision_tree/index.html

Decission point #1 I chose =Early onset Schizophrenia

Decision point #2 I chose =Refer for psychological testing

Decision point #3 I chose =Begin Lurasidone 40 mg orally daily

Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client.

Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

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?

Decision #2: Treatment Plan for Psychotherapy

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?

Decision #3: Treatment Plan for Psychopharmacology

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 nurs 6660 practicum decision tree Early onset Schizophrenia essay.

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 and their families nurs 6660 practicum decision tree Early onset Schizophrenia essay.

PICA Eating Disorder parent guide brochure Essay

This needs to be like a parent guide brochure covering the following areas

Signs and symptoms

Pathophysiology

How the disorder is diagnosed

Treatment options Thanks

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Pica is an eating disorder characterized by eating non-food products that do not contain significant nutritional value. E.g. paint chips, dirt, soap, paper, ash, charcoal, chalk, soil, ice, starch, clay, wool, cloth, string and hair (Hartmann & Jurilj, 2017).

Signs and Symptoms

Stomach pain

Stomach upset

Blood in stool

Bowel problems. E.g. diarrhea or constipation

Developmentally inappropriate ingestion of substances

Eating substances that are not socially normative practice or culturally supported for at least once a month

PICA Eating Disorder parent guide brochure Essay

 

Diagnosis

Clinical history

No laboratory tests

Anemia tests

Pica is related to:
(
Delaney et al., 2015)

Obsessive compulsive disorder

Micronutrient deficiency

Neurological conditions

Gastrointestinal distress

 

Pathophysiology

Brain damage due to poisoning. E.g. from consuming lead vanishes and paints

Neurological problems

Death

Gastrointestinal tract damage causing constipation, abdominal distention, nausea, ulceration

Deficiency of minerals and nutrients: E.g. Vitamin C and D, Zinc, Iron, Phosphorous, Calcium, Thiamin, niacin

Dental abnormalities e.g. tooth surface loss, abrasion, abfraction and mouth cancer. (Nayak et al., 2017)

Infection and parasitic infestation

Toxocariasis and  Ascariasis can occur from consumption of soil

PICA Eating Disorder parent guide brochure Essay

 

Treatment

Correction of mineral deficiencies

Behavioral interventions

Redirection of attention away from desired substances

Rewards for discarding non-food items

Physical restraint (Kennedy, Wick & Keel, 2018).

 

References

Delaney, C. B., Eddy, K. T., Hartmann, A. S., Becker, A. E., Murray, H. B., & Thomas, J. J. (2015). Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity. 
International Journal of Eating Disorders
, 
48
(2), 238-248.

Hartmann, A. S., & Jurilj, V. (2017). Pica. In 
Handbook of DSM-5 Disorders in Children and Adolescents
 (pp. 319-332). Springer, Cham.

Kennedy, G. A., Wick, M. R., & Keel, P. K. (2018). Eating disorders in children: is avoidant-restrictive food intake disorder a feeding disorder or an eating disorder and what are the implications for treatment?. 
F1000Research
, 
7
.

Nayak, S. V., Kini, R., Shetty, U., Rao, P. K., Kashyap, R. R., & Bhandarkar, G. (2017). Pica-an eating disorder: A report and review. 
Archives of Medicine and Health Sciences
, 
5
(1), 82. PICA Eating Disorder parent guide brochure Essay

Entry Into Practice Nursing essay

DQ 1: Case Study, Chapter 1, Entry Into Practice: The Debate Rages On

The entry-into-practice debate in the United States continues to be one of the oldest and hottest professional issues nurses face as we enter the second decade of the 21st century. It appears that little progress has been made since 1965 in creating a consensus to raise the entry level into professional nursing practice, although experts do not agree even on that issue. Your neighbors ask you for information about considerations for selection of an appropriate nursing education program for their child. Entry Into Practice Nursing essay

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1. Your neighbor is confused because both ADN and BSN schools preparing graduates for RN licensure meet similar criteria for state board approval and have roughly the same number of nursing coursework units. How would you summarize the arguments for changing or not changing the nursing entry level?

2. There is current evidence-based research that explores the impact of registered nurse educational level on patient outcomes. What does the current evidence-based research conclude about the impact of RN educational level on patient outcomes?

3. Achieving the BSN as the entry degree for professional nursing practice will take the best thinking of our nursing leaders. What will it require in order to successfully achieve the BSN as the entry degree for professional nursing practice?

The entry-into-practice debate in the United States continues to be one of the oldest and hottest professional issues nurses face as we enter the second decade of the 21st century. It appears that little progress has been made since 1965 in creating a consensus to raise the entry level into professional nursing practice, although experts do not agree even on that issue. Your neighbors ask you for information about considerations for selection of an appropriate nursing education program for their child. Entry Into Practice Nursing essay

1. Your neighbor is confused because both ADN and BSN schools preparing graduates for RN licensure meet similar criteria for state board approval and have roughly the same number of nursing coursework units Entry Into Practice Nursing essay. How would you summarize the arguments for changing or not changing the nursing entry level?

2. There is current evidence-based research that explores the impact of registered nurse educational level on patient outcomes. What does the current evidence-based research conclude about the impact of RN educational level on patient outcomes?

3. Achieving the BSN as the entry degree for professional nursing practice will take the best thinking of our nursing leaders. What will it require in order to successfully achieve the BSN as the entry degree for professional nursing practice?Entry Into Practice Nursing essay

Accountability in healthcare essay

Explain the flow of funds within an organization including private pay and third party reimbursement.

Assignment Description:
 This assignment will be at least 1000 words or more

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This week you will reflect upon accountability in healthcare to answer the following questions:

How can you prevent abuses and inefficiencies in third party payments?

Briefly define the flow of funds in the Care Organization.

What challenges do consumers face who are enrolled in private insurance?

What methods can you use to empower the consumer? Accountability in healthcare essay

Assignment Expectations:
 How will students be successful?

Length:

1000-1250 words (4-5 pages); answers must thoroughly address the questions in a clear, concise manner

Structure:

Include a title page and reference page in APA style

References:

Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions Accountability in healthcare essay

Managed care Costs EACH DISCUSSION QUESTION IS 400 WORDS, APA FORMAT WITH 2 REFERENCES. PLEASE DON’T PUT THEM ALL TOGETHER, SEPARATE EACH WITH ITS OWN REFERENCES

1)In what ways does managed care manage costs? Is care compromised in the process?

2) Describe the difference between employer-sponsored health insurance plans and private plans.

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3) Answer both of the following questions honestly and professionally:

Discuss the factors and approach you will use to develop a professional partnership with your selected site (MY SITE IS PLANNED PARENTHOOD)

What is the importance of collaborating with other healthcare professionals in order to establish trusting relationships to gain commitment for mobilizing health initiatives?v

hu245 unit 2 assignment ethical theories comparison chart examples

HU245:
Unit 2 Assignment – Theories of Morality

 

Ethical Theories Comparison Chart

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Utilitarianism

Ethical Egoism

How is “good” Determined

An act that produces the greatest happiness and promotes the most good for the most people.

An act that promotes the individual’s long term interest.

Most Noted Philosopher(s)

Jeremy Bentham, John Stuart Mill

Ayn Rand, Thomas Hobbes

Major Strengths

Seeks to maximize happiness and benefit all.

Tries to encourage independence.

Major Weaknesses

One can’t always predict results or please everyone.

One can be viewed as selfish.

Ethics of Care

Kantianism

How is “good” Determined

An act that nurtures the connections among those closest to each other.

An act that is based on reason and duty, and would be considered ethical if everyone did the same.

Most Noted Philosopher(s)

Carol Gilligan, Nel Noddings

Immanuel Kant

hu245 unit 2 assignment ethical theories comparison chart examples

Major Strengths

We focus on those we love/who are closest to us.

Emphasizes the rights of the individual.

Major Weaknesses

Threatens to devolve into tribalism.

Emphasizes duty over the desire to do good.

Prima Facie
Duties

Divine Command Theory

How is “good” Determined

Adhere to
prima

facie
duties unless solemn reasons or circumstances say to do otherwise.

Adhere to the commands of God/religious beliefs, regardless of the consequences that might ensue.

Most Noted Philosopher(s)

Sir William David Ross

Joan of Arc

Major Strengths

Sets principles yet recognizes outcomes of actions.

Provides moral law and motivation to follow it.

Major Weaknesses

When is one duty stronger than another?

Evil has been done by so called “religious” people.

Virtue Theory

How is “good” Determined

Focus not on making good decisions but making good people who will decide correctly.

Most Noted Philosophers

Aristotle, Confucius, McIntyre

Major Strengths

Avoids problems/unifies emotions and reasoning.

Major Weaknesses

Very difficult to apply to specific questions.

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

Contribution to overall utility in maximizing happiness and pleasure.

Everyone ought to act in my own best self-interest.

Holding interpersonal relationships highly

Respecting rational beings and having dignity

Treating everything equal

Morality is somehow dependent upon God. Morality comes by the obedience of God’s commands

By bettering their self-characteristics

Most Noted Philosopher(s)

Jeremy Bentham and John Stuart Mill

Epicurusm Ayn Rand, Jesse Kalin, and John Hospers

Carol Gilligan

Immanuel Kant

William David Ross

Plato, Kai Nielson, and J. L. Mackie

Aristotle

Major Strengths

It is straightforward and based on the single principle of lowering pain and higher pleasure and happiness. Aims towards a happy life.

This encourages individual freedom and responsibility. It is easier to determine self-interest

Recognizes weaknesses in moral theories and emotions in moral reasoning

Humans are morally autonomous, authors of their own morality. The categorical imperative promotes quality.

This theory promotes an equal and safe environment

The theory commnds free humanity from having to laboriously discover what is proper human conduct

Encourages high levels of moral behavior. People learn to be moral by practice

Major Weaknesses

Providing support for ethical egoism, and that can be very difficult what will turn out to be good consequences for others. Everyone sees “good” and “bad” differently.

The theories apply only to one individual and cannot be laid down for humanity in general. Not being able to apply to a group of people or everyone is a real setback.

Some critics think that by accepting the theory, one may be raising female values above male values.

 Acting out of a sense of “duty for duty’s sakes” is cold and impersonal. Duty without guidance from human sympathy can lead to rigid moral fanacticism.

Someone’s way of treating someone equally could be the complete opposite of someone else’s

This theory, since it based upon God is very controversial

Which virtues are the most important? The virtues can become conflicts.

 

Ethics: Theory and Practice (Updated Edition) 11the Edition

 

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

Its determined by constructing the utmost joy and encouraged the greatest good for the most people.

A piece that encourages a person’s long-term welfares.

An item that fosters the connections amongst those closest to each other.

It’s constructed on purpose and duty; considered to be ethical if everyone did the same.

We must adhere to obligations unless circumstances tell us not too.

If you believe in God, anything you do is right, and everyone is good.

Described by oral distinction and emphasis on the good charisma of people

Most Noted Philosopher(s)

John Stuart Mill, Jeremy Bentham

Thomas Hobbes, Ayn Rand

Carol Gilligan, Ned Noddings.

Immanuel Kant

Sir William David Ross

Joan of Arch

Aristotle

Major Strengths

-Pursues to make the most of happiness and benefit everyone.

-Upfront in the aspect of pain, pleasure, and happiness.

-Tries to encourage

Freedom.

-Promotes good lifestyles for human beings to follow if they want to be moral.

-Promotes you to focus on the people we love and are closest to us.

-Defines the understandings as diverse, but similarly binding.

 

-Underlines the privileges of the individual.

-Delivers common moral strategies.

-It can provide a guideline for human rights and treat everyone fair.

-Operates on principles that everyone should follow.

-You can shadow commands without fear of consequence of anything else.

-If a “Higher Being” is the source of morality, then its teachings will certainly be moral.

-Following virtues makes for better individuals and motivates personal relationships. -Practical theory, dependable with human nature.

Major Weaknesses

-One can’t continuously expect outcomes or please every person.

– Its also immeasurable in the fact that you cant always compare feelings.

-People can view you as being selfish for being so detached from others.

-Tough to decide all consequences, unpredictable.

-Threatens to devolve into tribalism.

-Generates an one-sided ethical structure between the sexes.

Kind of harsh environment, people don’t look out for one another.

-Inconsistent moral laws, exception to moral laws.

-Difficult to understand what obligation takes precedence over another.

– No concrete evidence to support Ross’s logic.

-Hard for some to believe in; is it even reliable?

-It is extremely difficult to understand a “Higher Beings” teachings.

-It is restricted to helping individuals and not the overall population

– Lacks effective ethical guidelines; Aristotle’s Basic Human Function.

 

 

References:

Thiroux/Krasemann, 2015.  Ethics: Theory and Practice.  Updated 11th Edition.  Boston: Pearson

 

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

 

The moral rightness (or wrongness) of actions and policies

 

 

Utilitarianism defines the Good as pleasure without pain.

Human ought to act in their own self-interest,

 

Nothing was good in itself except a good will.

 

All human beings must obey in a general way before any considerations enter into the picture.

 

What is good and right is what this being has stated is good and right.

 

If one believes there is a God, goddess, or gods, and they have set up a series of moral commands, then an action is right and people are good if they obey these commands, regardless of the consequences.

 

 

 

Aspires to develop good people and good human communities.

 

Most Noted Philosopher(s)

 

Jeremy Bentham

and John Stuart Mill.

 

 

Epicurus, Ayn Rand, Jesse Kalin, and John Hospers, among others.

 

 

Carol Gilligan

 

 

Immanuel Kant

 

 

Sir William David Ross

 

Thomas Aquinas, Robert Adams, and Philip Quinn

Aristotle

Major Strengths

 

Utilitarianism requires that we consider
everyone’s
pleasure, not just our own.

 

There is more to life than
physical
pleasure.

 

 

Cannot be equated with selfishness, nor should it necessarily be equated with having a big ego or being conceited.

 

 

It is possible by reasoning alone to set up valid absolute moral rules that have the same force as indisputable mathematical truths.

 

 

If it feels good—do it and Do your own thing.

 

Major Weaknesses

 

There is not enough time to calculate the effects of our actions on the general happiness. Therefore it is useless.

 

Utilitarianism implies that we should
always
act in order to

Maximize happiness; this is too strict. It is asking too much of

people to be always motivated to promote the general happiness

 

 

There seems to be no clear criteria either for choosing which duties are prima facie or for deciding how to distinguish among them after they have been established.

 

 

Are inherent in the lack of rational foundation for the existence of some sort of supernatural being or beings and the further lack of proof that the support of such a being or beings is enough to make rational and useful the ethical system in question.

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

What will bring about a good or desirable ending. What it the greatest good for the majority.

In Ethical Egoism I would do what is in my best interest.

Men are concerned with Justice and rights. Women are concerned with generosity.

A person’s duty to act within a set of moral rules regardless of what happens.

A person must follow a set of rules but that person should think about the end result.

In order to be good than a person must follow supreme beings or the universes rules.

Having excellence and improving ones character.

Most Noted Philosopher(s)

Jeremy Bentham and John Stuart Mill

Ayn Rand

Carol Gilligan and Lawrence Kohlberg

Immanuel Kant

Sir William David Ross

Joan of Arc

Aristotle and Confucius.

Major Strengths

It looks at what is best for everyone. It thinks on a large scale; such as, globally, or the community as a whole, or what is good for the country.

The thought that a person should be responsible and self sufficient and allows others to do the same.

It works at helping to explain that men and women need to look at how the other gender think and strengthen their weaknesses.

Being able to set up moral rules that are based on reason and logic. All rules must be logical and consistent.

Following a set of rules before knowing all the particulars of the situation.

When a person follows the dictates of their higher power they are acting correctly regardless of the consequences.

This theory is based on improving oneself both from within and in the person’s environment.

Major Weaknesses

Sometimes in saying the greatest good for the masses, the minority gets left out.

What may be in my best interest may not be in my friends’ best interest, so whose interest do we act in? There is an inconsistency.

It can easily be said that men are superior to women and that gender makes a person right or wrong.

Conflicting duties. Under this theory nothing can be contradictory and we cannot obey 2 laws that contradict.

What is the basis for the Prima Facie duties?

There is no proof of a supreme being, even if there is whose ideology is the correct one to follow.

How is the model of virtue selected and who does the average person model their life after.

 

 

 

HU245 Unit 2 Assignment

 

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

The greatest good for the greatest number.

Perform act that will bring greatest good to all.

Based on the prescriptive approach.

Everyone should act in own self-interest.

What is morally right or wrong.

Importance of response

Reasoning alone will set up moral rules

Duties that must be adhered to unless circumstances tell us not to.

If I believe there is a God, any action is right and people are good regardless of consequences

Defined by oral excellence.

Emphasis on the good character of people

Most Noted Philosopher(s)

Jeremy Bentham

John Stuart Mill

Ayn Rand

Jesse Kalin

Alejandro Tugender

Carol Gilligan

Kant

Sir

William David Ross

Joan of Arc

Aristotle

Major Strengths

One must approach each situation individually.

Decisions are based on intuition.

People can appear humble.

More in self-interest to be selfless.

Attention to detail in situations to promote interest.

Consideration measured by vulnerability.

Logically consistent

Universalizable

hu245 unit 2 assignment ethical theories comparison chart examples

Does not believe that a conseque-nce makes an action right or wrong.

Telling the truth

Making up for what we do to others.

 I should obey a supernatural being regardless of consequences

What is good and right is stated by that being.

The end of human life is happiness.

Humans have the capacity fro goodness.

Major Weaknesses

This theory is based on consequences.

Morality cannot be rationalized.

This theory is inconsistent.

 

Hard to take moral advice.

 

 

Rests on the understanding of relationships.

Majority was feministic views, only one view point.

Act is immoral unless authorized.

Some rules have questionable moral values.

Being able to tell the difference between prima facie or not.

To know or not to know whether something is true.

Loss of life

Accept the consequences

Based on assumptions that are hard to prove.

Morality in innate.

 

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

Good is determined by the action that will bring the greatest good for all.

 

Good is looking out for your own self-interest.

hu245 unit 2 assignment ethical theories comparison chart examples

Men and Women Are Different When It Comes to Ethical Decision Making

Does not depend on the consequences of actions, but on whether they fulfill our duty.

There are certain binding conditional duties to 
determine
 what it is we ought to do.

actions are morally 
good
 because of their being commanded by God. Moral obligation is obedience to God’s commands; what is morally right is what God desires.

Character based ethics. This type of moral theory is all about becoming a certain kind of person. Its concern, ideally, is the development of human excellence.

A good person is someone who lives virtuously – who possesses and lives the virtues.

 

Most Noted Philosopher(s)

Jeremy Bentham & John Stewart Mill

Epicurus, Ayn Rand, Jesse Kalin, and John Hospers

Carol Gilligan Lawrence Kohlberg

Immanuel Kant

Sir William David Ross

William of Ockham, St Augustine, Duns Scotus, and John Calvin

Aristotle, Confucius, Alasdair MacIntyre,Roger Ames, Henry Rosemont, St. Augustine, Ben Franklin

Major Strengths

Fewer Conflicts if the majority is happy.

It is simple, without complex rules.

It is easier to determine self-interest.

It promotes individual freedom and responsibility.

Recognizes weaknesses in moral theories and emotions in moral reasoning.

Recognizes need to rectify imbalances/inequities.

hu245 unit 2 assignment ethical theories comparison chart examples

Clarity. Absolute and easy to apply.

Creates a distinction between duty and inclination.

Bad actions may have good consequences.

Do not necessitate the difficult task of computing consequences for a moral action. Provide, in their rule form, a strong set of moral guides.

Avoid the pitfall of a cost–benefit analysis approach to morality.

Moral duties are absolute.

Preserves the sovereignty of God.

Provides moral law as well as motivation to follow it.

Holistic – Unlike other ethical theories that regard emotions as dangerous to morality, It considers the whole person, including their emotions, qualities of character and practical skills.

Agent-Centered – other ethical ethics are concerned with obligation or consequence. Virtue theory examines the character of the moral agent.

It regards Human relationships as important and stresses the need to look after those close to you. It allows people to make ethical decisions based on his or her own moral well-being.

 

 

Major Weaknesses

It is hard to know what would make most happy.

It is impossible to know what the consequence will be.

Communities are not self-sufficient.

Complete self-interest cannot be served.

Difficult to define, contexts difficult to identify. Moral emotions difficult to quantify/define.

Lack of agreement between theorists and framework

Promotes rule breaking due to sometimes severe consequence.

Situations are not the same, so morality cannot be so absolute.

hu245 unit 2 assignment ethical theories comparison chart examples

Makes morality into something arbitrary.

A lot of evil has been done by religious people in the name of religion.

Religious morality closes off dialogue, can leads to group intolerance and threaten church-state separation.

Broad – there is no single criteria for goodness.

It only concentrates on a limited number on virtues and therefore is not able to focus on the big picture.

Vague – there is no clear system for making moral choices

 

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Consequential Theories

Ethical Egoism

Utilitarianism

Ethics of Care

How is “Good” Determined

·    Based on individual morality

·    “Everyone should perform that act or follow that moral rule that will bring about the greatest good (or happiness) for everyone concerned.” (Thiroux, 2014)

·    By the joint ethical decision of a man and a woman

Most Noted Philosopher(s)

·    Epicurus

·    Ayn Rand

·    Jeremy Bentham

·    John Stuart Mill

·    Carol Gilligan

Major Strengths

·    Moral obligation not to harm yourself

·    Universal ethical egoism “states as its basic principle that
everyone
 should always act in 
his or her own
 best self-interest” (Thiroux, 2014)

·    It is easier to determine self-interest than to worry about others interests

·    Hive mind – people work together to determine the best outcome for all people instead of one’s self

·    Rule Utilitarianism – “Everyone should always establish and follow that rule or those rules that will bring about the greatest good for all concerned” (Thiroux, 2014)

·    Ethics of care identifies the emotional weaknesses of both sex’s and requires both to work together

·    Requires wisdom and not just a calculation of consequences

hu245 unit 2 assignment ethical theories comparison chart examples

Major Weaknesses

·    Willing to harm others

·    Individual and Personal ethical egoism focus on self rather than society

·    Open to interpretation of right and wrong

·    Relies heavily on isolation in order to be functional

·    “No absolute rules against killing, stealing, lying, and so on” (Thiroux, 2014)

·    Difficult to teach the younger generation when there are no rules or guidelines

·    Because of diversity it is nearly impossible to make everyone happy

·    There is no definition of what is right or wrong other than an agreement between the sex’s

·    Concerned more with context rather than principles

 

 

 

Non-Consequential Theories

Divine Command Theory (DCT)

Kantianism

Prima Facie Duties

How is “Good” Determined

·    God/Higher Power

·    Bible/religious readings

·    “Act in accordance with moral rules, laws, or principles regardless of interests or consequences.” (Thiroux, 2014)

·    Always do that act in accord with the stronger 
prima facie
 duty

·    Always do that act that has the greatest degree of 
prima facie
 rightness over 
prima facie
wrongness. (Thiroux, 2014)

Most Noted Philosopher(s)

·    Plato

·    Thomas Aquinas (Austin, n.d.)

·    Immanuel Kant

·    Sir William David Ross

Major Strengths

·    “Provides an objective metaphysical foundation for morality” (Austin, n.d.)

·    Removes the questioning of what is right or wrong

·    Forces morality and good nature of people in order to achieve a place among the gods/higher power

·    People need to think logically not emotionally

·    Easy to identify immoral people

·    Universalizable – “must be able to be stated so as to apply to everything without exception” (Thiroux, 2014)

·    Learn from other people’s mistakes

·    Uses the idea of intuitionism which states that people naturally know right from wrong and that we can naturally recover from mistakes. (Thiroux, 2014)

·    People have a duty to moral correct similar to DCT

Major Weaknesses

·    “Lack of proof that the support of such a being or beings is enough” (Thiroux, 2014)

·    People do not think outside of the box

·    Judgement towards those that are not religious which in turn breaks the religious ethic of “do not pass judgement”

·    Some logics can lead to immoral consequences. For example, logically a person has to keep a promise and that not breaking a promise could result in someone being seriously injured or even killed. (Thiroux, 2014)

·    No room for mercy. Kant believed in “eye for an eye”

·    Open to interpretation

·    Similar to Kantianism, the consequences of a duty could result in an immoral outcome

·    Intuitionism is viewed as a “hunch” (Thiroux, 2014)

·    Incomplete list of duties

hu245 unit 2 assignment ethical theories comparison chart examples

 

 

 

Virtue Theory

Virtue Theory

How is “Good” Determined

·    “Virtue ethics are character based ethics” (Thiroux, 2014)

·    Requires both moral judgement and understanding of law and order

Most Noted Philosopher(s)

·    Aristotle

·    Kongzi or “Confucius”

Major Strengths

·    “Acts that are objectively virtuous, without a knowledge that the acts are good and without actively or rationally choosing them ourselves” (Thiroux, 2014)

·    Utilizes the “mean” between excess and defect which keeps people content and/or peaceful – Moderation

·    Seeks to develop the moral person from within and from without

Major Weaknesses

·    Unknown if virtue is taught and learned or natural. Virtuous people are usually identified in older age instead of youth

·    Human flourishing and well-being are undefined

·    Relies on having someone to model after that is already virtuous. If there is no one to model after, then it is left to interpretation

 

 

 

References

Austin, M. W. (n.d.) Internet encyclopedia of philosophy. Retrieved October 1, 2016, from http://www.iep.utm.edu/divine-c/

Thiroux, J. P., Krasemann, K. W. (2014-12-01). 
Ethics: Theory and Practice (Updated Edition), 11th Edition
. [VitalSource Bookshelf Online]. Retrieved from https://kaplan.vitalsource.com/#/books/9781323130162/ hu245 unit 2 assignment ethical theories comparison chart examples

 

 

HU245 Unit 2 Assignment

Ethical Theories Comparison Chart

Utilitarianism

Ethical Egoism

Ethics of Care

Kantianism

Prima Facie
Duties

Divine Command Theory

Virtue Theory

How is “good” Determined

An act is moral if it brings a desirable end, for the majority.

An act that is in one’s own best interest is good.

-An act is good if it can be made into a rule for all human beings

Nothing is good in itself except good will, consequences should not affect morality

-Adhering to the Prima Facie is our moral obligation, and is good.

-An act is considered good if it is commanded by a “higher” power

-By honoring virtuous habit, the right or good choice will be made.

Most Noted Philosopher(s)

-Jeremy Bentham

-John Stuart Mill

-Ann Rand

-Jesse Kalin

-John Hospers

-Carol Gilligan

– Immanuel Kant

– Sir William David Ross

-St Augustine

-John Calvin

-Duns Scotus

-Aristotle

Major Strengths

-Attractive to the majority

-Fairness is easily determined because of its basic principles

-Ensures personal needs will be met

-Encourages individual freedom and responsibility

-Everyone deserves care mindset

-Recognizes weakness in moral theories

-Provides a basis for human rights

-Aims to treat everyone fairly

hu245 unit 2 assignment ethical theories comparison chart examples

 

-Provides guidelines to morality

-Easy to follow rules

-Commands are given by the ultimate authority, making the reliable and trustworthy

-Human begins can follow commands without fear of consequences or anything else

– Following virtues makes for better individuals

-motivates personal relationship and the sense of community

Major Weaknesses

-Results depend on the prediction of an action

-Impersonal and overlooks the individual to serve the “greater good”.

-Inconsistent

-requires everyone to participate in its philosophy to be successful

-Disrupts the philosophy of gender equality

-Women’s values are held higher then men’s values

– “Eye for an eye” mindset does not allow for mercy

-Universal rules do not help when each situation is different

-Hard to determine which obligations take precedence

-Lacks rational foundation of the existence of said “higher” powers

-Can these “higher” powers be proven trustworthy?

– Lacks a distinction between was acts are morally acceptable and which acts are not.

-It is limited to helping individuals and not the population.

hu245 unit 2 assignment ethical theories comparison chart examples

Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

Research Critique on B-type natriuretic peptide-guided treatment for heart failure

Working most of my years of nursing in the home health field, one of the goals was to help decrease the readmission rate of patients that have Congestive Heart Failure (CHF). In doing so, we worked closely with the CHF clinic to help monitor and teach these patients on the disease process and early signs and symptoms to monitor for exacerbation of CHF. This is an area that has peaked this writer’s interest. Patients that have CHF require monitoring such as detailed clinical assessment and a review of their medications.  This will also include “the need for titration and optimization in line with guidelines and to pick up possible side effects. The pharmacological treatment options for patients with left ventricular systolic function (LVSD) include diuretics, angiotensin-converting enzyme (ACE) inhibitors (angiotensin receptor blockers if ACE inhibitors are not tolerated), beta-blockers and mineralocorticoid receptor antagonists (MRA)” (CHF is a serious problem and result in a big financial burden to hospital Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure.  “Because excessive readmissions tend to indicate suboptimal care, government and commercial payers are focusing on 30-day readmission rates as a new quality measure for hospitals. The intent behind the measures is for the hospitals to provide better care by following evidence-based practice guidelines, which in turn, will reduce heart failure readmission rates” (Merkley, 2019, para. 4).

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Background of Study

CHF occurs when the heart muscle does not pump blood as well as it should.  Therefore, it cannot meet all the needs of the body. “Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however, on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalization care. B-type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure but could offer to clinicians a possible tool to guide drug treatment. This could optimize drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance” (McLennan et al., 2016, para. 1). The objective of this study was to see if CHF guided by serial BNP or N-terminal pro b-type natriuretic peptide (NT-proBNP) monitoring improves outcomes compared to treatment guided by clinical assessment alone.

Method of Study

Numerous search methods were used in this study such as the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluations Database in Cochrane Library.  The study “included randomized controlled trial of NT-proBNP guided treatment guided by clinical assessment alone with no restriction on follow-up. Adults treated for heart failure, in both in-hospital and out-of-hospital settings, and trials reporting a clinical outcome were included” (McLennan et al., 2016, para. 3). The authors of this study also contacted the authors of relevant studies and experts in the relevant fields that pertained to this study. Out of 3379 references that were screened, 3044 were removed due to not being relevant to this study.  The remaining 335 references were then examined and from these 18 studies were included for this study. In these 18 studies, 3,660 patients with heart failure took part.  The ages of these patients were between 62 and 80 years old.  All areas were cited and references where current.  The author of this study also evaluated the strengths and weaknesses of the available studies. Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

Results of Study

The findings of this study showed “that patients with CHF low-quality evidence showed a reduction in heart failure admission with NP-guided treatment while low-quality evidence showed uncertainty in the effect of NP-guided treatment for all-cause mortality, heart failure mortality, and all-cause admission. Uncertainty in the effect was further shown by very low-quality evidence for patient’s quality of life. The evidence for adverse events and cost of treatment was low quality, and we were unable to pool results” (McLennan et al., 2016, para. 10).  These findings indicated that hospital admissions due to CHF may be reduced when monitoring the BNP compared to clinical assessment only, but that the evidence was unclear on if there were fewer deaths from CHF being monitored with the BNP versus clinical assessment only groups.  The study will help to contribute to the nursing knowledge by shedding light on the education of BNP-guided treatment to these patients to reduce the number of hospital admissions/re-admissions due to CHF.

Ethical Considerations

The study was not approved by an Institutional Review Board (IRB) as it was a research of 18 research studies that had previously been performed to see if BNP-guided treatment would help with managing CHF. IRB is required only on research that involves human subjects. Being that this study did not actually perform its own trial studies, patient privacy was not an issue to consider. Some of the studies used in this study were partly or fully funded by a pharmaceutical company.  This might show some risk for bias in their results.  No ethical considerations were noted in these studies regarding the treatment or lack of treatment on patients.

Conclusion

By researching 18 randomized controlled trials with 3660 participants, the study was able to compare BNP-guided treatment with clinical assessment alone on patients that have CHF to see if hospital admission/re-admission rates would decrease.  Now that hospitals must comply with new quality measures or face financial penalties due to hospital re-admissions due to CHF, it is important to try to keep these patients at home and stable. Evidence of this study did show that BNP-guided treatment in patients with CHF had a reduction in hospital re-admission rate. However, the evidence did not show an improvement in the quality of life. The evidence found in this study did suggest that CHF admission rates were reduced by BNP-guided treatment (26%) versus clinical assessment alone (38%). What does this mean for the nursing practice?  It means that more follow-up is needed once these patients are released from the hospital.  This would include the use of more frequent visits to the physician, the use of CHF clinics, and home follow-up by using home care nurses. Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure.

 

References

McLennan, J., Heneghan, C.J., Perera, R., Clements, A. M., Glasziou, P. P., Kearley, K. E.,          Pidduck, N., Roberts, N.W., Tyndel, S., Wright, F.L., & Bankhead, C., (2016)

Merkley, K., (2019). Reduce heart failure readmission rates.
Health Catalyst.
Retrieved from           
https://www.healthcatalyst.com/reduce-heart-failure-readmissions-with-healthcare-            analytics/

Direct quotations that are 40 words or longer are placed in a free-standing block of typewritten lines and omit quotation marks and is indented 1/2 inch from the left margin,

See Perdue Owl at this link to help clarify this.

https://www.ufv.ca/media/assets/academic-success-centre/handouts/Summarizing-A-Scholarly-Journal-Article-2009.pdf

 

http://blog.efpsa.org/2013/02/28/how-to-read-and-get-the-most-out-of-a-journal-article/

 

http://www.donnavandergrift.com/uploads/1/3/3/4/13345738/writingsummary.pdf

 

My #AcWri Strategies: Write reflective memos

McLennan, J., Heneghan, C.J., Perera, R., Clements, A. M., Glasziou, P. P., Kearley, K. E., Pidduck, N., Roberts, N.W., Tyndel, S., Wright, F.L., & Bankhead, C., (2016) B-type Natriuretic Peptide-guided treatment for Heart Failure.
The Cochrane Database of Systematic Reviews
(Dec. 22, 2016) Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449577/
 Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure