Tag: Clinical-Nursing

This Nursing theories CLC Assignment – NRS-430V Professional Dynamics is a Collaborative Learning Community (CLC) assignment.

Nursing theories are tested and systematic ways to implement nursing practice. Select a nursing theory and its conceptual model. Prepare a 10-15 slide PowerPoint in which you describe the nursing theory and its conceptual model and demonstrate its application in nursing practice. Include the following:

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Present an overview of the nursing theory. Provide evidence that demonstrates support for the model’s efficacy in nursing practice. Explain how the theory proves the conceptual model.

Explain how the nursing theory incorporates the four metaparadigm concepts.

Provide three evidence-based examples that demonstrate how the nursing theory supports nursing practice. Provide support and rationale for each.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Since you will not actually be presenting to the class, well written, detailed speakers notes that include in-text citations are expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Nursing theories CLC Assignment – NRS-430V Professional Dynamics

Gastrointestinal (GI) and hepatobiliary disorders

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan. Gastrointestinal (GI) and hepatobiliary disorders

CASE STUDY

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

• Synthroid 100 mcg daily

Gastrointestinal (GI) and hepatobiliary disorders

• Nifedipine 30 mg daily

• Prednisone 10 mg daily

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To Prepare

• Review the case study assigned by your Instructor for this Assignment

• Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

• Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder. Gastrointestinal (GI) and hepatobiliary disorders

• Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

By Day 7 of Week 4

Write a 1-page paper that addresses the following:

• Explain your diagnosis for the patient, including your rationale for the diagnosis.

• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Gastrointestinal (GI) and hepatobiliary disorders

• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. Gastrointestinal (GI) and hepatobiliary disorders.

Natural Disaster And The Role Of Public Health Nurse PowerPoint

Create a power point with the intended audience to be a community health department.

· Focus on a real or fictional disaster that has or could affect your area. For example, if you live on the Florida coast you might choose potential hurricane.

Topic for the assignment is hurricane

· Discuss the role of the Community Health Nurse in each stage of disaster. You should include a few slides on each stage of disaster: preparedness, response, recovery with specific activities and resources that the public health nurse would use in each stage.(Please refer to Chapter 25 for the stages Page 722)

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· Identify other agencies that might be involved.

(Such as the, Police and emergency response team, organizations such the     American Red Cross, Department of Health and Human Services (HHS) ,The HHS National Disaster Medical System (NDMS), HHS Office of Emergency Preparedness (OEP)

Other organization involved may be: salvation army, Community Emergency Response Team (CERT), The Humane Society of the United States, The World Vision)

The assignment should be submitted in Power Point format, with at least 15 content slides (in addition to a title slide and reference slide) and include at least two scholarly sources(less than 5 years old) other than provided materials.

Clark, M. J. (2015). 
Population and community health      nursing
 (6th ed.). Boston, MA: Pearson Chapter 25

http://www.redcross.org/get-help/prepare-for-emergencies/be-red-cross-ready

Natural Disaster And The Role Of Public Health Nurse PowerPoint

Practicum Decision Tree – young girl with difficulties in school case study

Decision Tree

Introduction

The focus of this assignment is to make decisions regarding the diagnosis and treatment of the 8-year-old with school difficulties. The first decision is about the client’s diagnosis while the other two decisions will be on the client’s treatment. The paper will also discuss ethical issues that may impact the client’s treatment plan. Practicum Decision Tree – young girl with difficulties in school case study

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Decision #1: Differential Diagnosis

The first decision is that the client’s diagnosis is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. The reason for selecting this decision is because Katie is manifesting inattention symptoms for ADHD. DSM-5 criteria delineate symptoms of ADHD inattention to include: inattention to details; making mistakes during classwork or at workplace; lack of attention when carrying out duties or during play; inability to actively or directly listen during conversations; not being able o follow instructions; leaving schoolwork or work duties unfinished; inability to organize activities and duties; avoiding activities that require mental concentration; misplacing important things; being forgetful; and being easily distracted (Emser et al, 2018) Similarly, Katie manifests majority of these symptoms and hence the diagnosis of 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation is appropriate (Tong et al, 2016). There are other instruments that can be used to further confirm the client’s ADHD diagnosis and they include the Child Behavior Checklist and Vanderbilt Assessment Scale, ACTeRS.

By selecting this decision, the aim was that the…

Assignment 1: Practicum: Decision Tree

For this Assignment, you examine the client case study in this week’s Learning Resources. Consider how you might assess and treat pediatric clients presenting with symptoms noted in the case.

Note: This Assignment is the first of three assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

Evaluate clients for treatment of mental health disorders

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

The Assignment:

Examine Case 1. 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 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.

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.

 

Case #1

A young girl with difficulties in school

BACKGROUND

In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features.

When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

Child Behavior Check List

Conners’ Teacher Rating Scale

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” 
(Available at: https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 )
. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

SUBJECTIVE

You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.”

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

MENTAL STATUS EXAM

The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

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.

299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/03/mm/decision_tree/index.html

 

Decision Tree

Introduction

The focus of this assignment is to make decisions regarding the diagnosis and treatment of the 8-year-old with school difficulties. The first decision is about the client’s diagnosis while the other two decisions will be on the client’s treatment. The paper will also discuss ethical issues that may impact the client’s treatment plan.

Decision #1: Differential Diagnosis

The first decision is that the client’s diagnosis is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. The reason for selecting this decision is because Katie is manifesting inattention symptoms for ADHD. DSM-5 criteria delineate symptoms of ADHD inattention to include: inattention to details; making mistakes during classwork or at workplace; lack of attention when carrying out duties or during play; inability to actively or directly listen during conversations; not being able o follow instructions; leaving schoolwork or work duties unfinished; inability to organize activities and duties; avoiding activities that require mental concentration; misplacing important things; being forgetful; and being easily distracted (Emser et al, 2018) Similarly, Katie manifests majority of these symptoms and hence the diagnosis of 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation is appropriate (Tong et al, 2016). There are other instruments that can be used to further confirm the client’s ADHD diagnosis and they include the Child Behavior Checklist and
Vanderbilt
Assessment Scale, ACTeRS. Practicum Decision Tree – young girl with difficulties in school case study

By selecting this decision, the aim was that the correct diagnosis for this client would be made in order to ensure the client received the appropriate treatment.

 

Decision #2: Treatment Plan for Psychotherapy

The second decision is for Katie to start Adderall XR 10 mg orally daily. The reason behind selection of this decision is due to the fact that Adderall XR is approved by FDA to treat ADHD. The medication has been demonstrated to be effective to treat symptoms of ADHD. According to Brown et al (2018) Adderall has been demonstrated to have efficacy in improving attention span and focus, as well as in improving memory and concentration. Another reason for choosing the drug is because it has few side effects and its effect wears-off gradually.

By selecting Adderall for this client, the expectation was the symptoms of ADHD would improve since the medication’s efficacy has been shown in regard to improving ADHD symptoms (Brown et al, 2018). It was expected that the client will maintain attention and focus in the classroom and that she will have minimal or no side effects after taking the medication. Practicum Decision Tree – young girl with difficulties in school case study

As it was expected, the ADHD symptoms improved as depicted by the client’s attention in class improving where she maintained attention in the class during morning hours. Nonetheless, there are some notable variations from the expected outcome. One, the client was only able to maintain concentration during morning hours as indicated by her day-dreaming in afternoon classes. The reason for this is because inattention symptoms surfaced following the wearing off of the drug’s effect. Secondly, the client reported appetite loss after she started taking Adderall. Loss of appetite is among the main side effects of Adderall. (Briars & Todd, 2016).

Decision #3: Treatment Plan for Psychopharmacology

The selected decision third decision is for the client to be added a small dose of immediate-release of Adderall during the early afternoon. This decision was chosen because the first medication is wearing off and thus the client is not able to maintain attention in the afternoon. Therefore, addition of small dose of Adderall during afternoon will assist the client to be attentive even in the afternoon (Briars & Todd, 2016). The other alternative decisions would not be useful in addressing the inattention evident in the client during afternoon hours.

Ethical Considerations

The most important ethical consideration in this client is the addition associated with medications used to treat ADHD. It is important to explain to the client’s family regarding the potential side effects and addictive aspect (Keilow et al, 2018). In addition, during the client’s treatment, close monitoring should be done and only the prescribed dose should be released to the client. Moreover, the care provider should seek informed consent from the client’s parents and explain comprehensively regarding the available treatment choices so that they can make an informed decision. Finally, it is important to maintain confidentiality and ensure the client’s information is not disclosed to the third parties (Keilow et al, 2018) Practicum Decision Tree – young girl with difficulties in school case study.

Conclusion

The first decision is that Katie’s diagnosis is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. This is because Katie is manifesting symptoms consistent with symptoms of (inattention) ADHD, according to the DSM-5 criteria for.  The second decision that was chosen is for the client to start Adderall XR 10 mg orally daily. This decision was chosen because the efficacy of Adderall in the treatment of ADHD symptoms has been demonstrated. Since the client is still manifesting inattention in the afternoon, the subsequent decision is addition of small dose of immediate-release of Adderall in the early afternoon. This will ensure the client maintains attention in the afternoon. Ethical considerations include being attentive of addiction associated with ADHD medications, educating the clients family about the side effects of the medications, seeking informed consent, and ensuring confidentiality throughout Katie’s treatment.

 

References

Brown K, Samuel S & Patel D. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners.
Transl Pediatr
. 7(1), 36–47.

Briars L & Todd T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder.
J Pediatr Pharmacol Ther
. 21(3), 192–206. Practicum Decision Tree – young girl with difficulties in school case study

Emser T, Johnston B, Steele D, Sandra K, Lisa T & Hanna C. (2018). Assessing ADHD symptoms in children and adults: evaluating the role of objective measures.
Behav Brain Funct
. 14(11).

Keilow M, Holm A & Fallesen P. (2018). Medical treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and children’s academic performance.
PLoS ONE
. 13(11), e0207905.

Tong L, Xiong X &Tan H. (2016). Attention-Deficit/Hyperactivity Disorder and Lifestyle-Related Behaviors in Children.
PLoS ONE
. 11(9), e0163434.

 

Review of Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

Introduction

           
Katie is a female 8 year-old Caucasian child who is brought to the clinic by her parents. She has a previous provisional diagnosis of attention deficit hyperactivity disorder or ADHD. Katie is having difficulties in school with concentration and performance. She is also not socializing well with her peers and likes to keep to herself. Her attention span is also short. Katie was born to mature parents (47 and 49 years old respectively) and had notable low wellness scores at birth. The parents bring with them the Connor’s Teacher Rating Scale form which had been filled by her teacher at school. This is helpful in assessing her condition and arriving at the correct diagnosis. Practicum Decision Tree – young girl with difficulties in school case study

Decision Point Number 1

In using the available assessment tools and based on what the parents and the teacher had reported, the diagnosis of ADHD with predominantly inattentive presentation was made as stated above. According to the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
, inattention such as Katie’s must meet criterion A. 1 (a)-(i) for this diagnosis to be reached (APA, 2013). This was met by Katie because her Conner’s Teacher Rating Scale shows that she is easily distracted at school and has the habit of only paying attention to what she has interest in. She is also quite forgetful of what she has been taught in school, attributable too to her inattention. The hope in arriving at this diagnosis was that Katie would be started on ADHD treatment at the right time; a fact that would place her in a better position to be free of her symptoms in the shortest time possible (Wender & Tomb, 2017). However, on close assessment during the revisit session, subjective evidence showed clearly that Katie was also evidently hyperactive as she could not stay in one place during the interview with the psychiatric-mental health nurse practitioner or PMHNP. Apart from the fact that her answers were short, it was also revealed that she also wonders in thought while in class. Practicum Decision Tree – young girl with difficulties in school case study. Her mental status examination was however largely unremarkable.  She was oriented in all aspects and was dressed appropriately for both the time of the day and the weather. The only thing that stood out was that she had an imaginary friend by the name “Audrey.” Because of these findings, the presentation of the diagnosis had to be reviewed from predominantly inattentive to combined presentation (APA, 2013; Wender & Tomb, 2017). This is because her symptoms largely agreed also with criterion A. 2 (a)-(i) on hyperactivity and impulsivity. Moreover, she also fitted in with the rest f the criteria B, C, D, and E (APA, 2013). Thus the summary of her definitive diagnosis is ADHD with inattention, hyperactivity, and impulsivity. There wasn’t much difference in the initial decision and the revised one in terms of the results as the diagnosis itself has not changed but only the presentation. The fact that she had not started to show any significant response to treatment is to be expected because ADHD response to pharmacologic treatment typically takes weeks (Stahl, 2014; Katzung, 2018). Practicum Decision Tree – young girl with difficulties in school case study.

Decision Point Number 2

           
On the return visit the girl was put on wellbutrin (bupropion) 75 mg daily to be taken by mouth. This decision was taken because this s a major norepinephrine dopamine reuptake inhibitor or NDRI approved by the Food and Drug Administration (FDA) for the treatment of ADHD (Stahl, 2014; Katzung, 2018; Nursingworld.org, n.d.). The other reason for choosing wellbutrin is that it continues to work for several years later and in the process deters the recurrence of symptoms (Stahl, 2014). This long term remission is what was intended to be achieved by this choice. Wellbutrin is one of the best pharmacotherapeutic agents available for treating ADHD. However, its effects are normally not felt immediately and its full therapeutic action may be evident from up to four weeks later (Stahl, 2014). The results of this decision to start wellbutrin and what was expected are not significantly different for two reasons. First is that as stated it takes weeks for the full impact of the drug to be felt (this patient returned after four weeks). Two is that the questions that Katie is asking are not part of the known side effects of the drug (Stahl, 2014).

Decision Point Number 3

As stated above, wellbutrin (bupropion) does not cause the patient to ask the type of questions that Katie is asking as a side effect (Stahl, 2014). Therefore, the decision taken in this instance is to reassure the patients that those questions she is asking are just part of her normal developmental progress given her age. They have got nothing to do with the treatment which is evidence-based. Practicum Decision Tree – young girl with difficulties in school case study As at now, there is no evidence to suggest that the drug may cause such behavior. Therefore, because the overall response is so far promising (the teacher says the girl has started being more attentive and is doing her academic work), the dose of bupropion will be doubled to 150 mg daily. By making this decision, the hope is to augment the noted effect of the drug and ensure long-lasting remission. One consideration though is that the questions about death by Katie may persist. This would mean she is having some sort of suicidal ideation which may be caused by the wellbutrin (Stahl, 2014; Wender & Tomb, 2017). If this occurs, it would mean the results of the intervention and the expectations would be different, due to the fact that antidepressants generally may at times cause suicidal ideation. In that case, the drug would be changed from wellbutrin to concerta 18 mg
mane
per day. this would also be supported by psychotherapy in terms of training in social skills to improve her engagement with her peers and take her mind away from suicidal thoughts (Corey, 2017). In doing all this, the ethical principle of nonmaleficence (not causing harm) has to be remembered as continuing a drug that may result in her committing suicide will be immoral. Also the decision of the parents on treatment options has to be respected – ethical principle of autonomy (Haswell, 2019).

References

American Psychiatric Association [APA] (2013).
Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
5
th
ed. Arlington, VA: APA.

Corey, G. (2017).
Theory and practice of counselling and psychotherapy,
10
th
ed. Boston, MA: Cengage Learning.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing
, 8(4), 177-179. Doi: 10.12968/joan.2019.8.4.177

Katzung, B.G. (Ed) (2018).
Basic and clinical pharmacology, 14
th
ed
. New York, NY: McGraw-Hill Education.

Nursingworld.org (n.d.).
Pharmacological Principles
. Retrieved 14 June 2019 from
https://www.nursingworld.org/~4ae124/globalassets/catalog/sample-chapters/pmhnpsamplechapter.pdf

Stahl, S.M. (2014).
Stahl’s essential psychopharmacology: Prescriber’s guide
, 5
th
ed. New York, NY: Cambridge University Press.

Wender, P.H. & Tomb, D.A. (2017). ADHD:
A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults
, 5
th
ed. New York, NY: Oxford University Press. Practicum Decision Tree – young girl with difficulties in school case study

Change Implementation And Management Plan

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

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To Prepare:

Review the Resources and identify one change that you believe is called for in your organization/workplace.

This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.

Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.

Your presentation should be 5–6 minutes in length and should include a video with you as presenter. Change Implementation And Management Plan

Your Change Implementation and Management Plan should include the following:

An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)

A description of the change being proposed

Justifications for the change, including why addressing it will have a positive impact on your organization/workplace

Details about the type and scope of the proposed change

Identification of the stakeholders impacted by the change

Identification of a change management team (by title/role)

A plan for communicating the change you propose

A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose

APA citation 3 to 5 reference within the 5 years

Change Implementation And Management Plan

Intellectual Developmental Disorder Treatment options Essay

Intellectual development disorder is associated with deficits an individual’s intellect characterized by experiential learning, academic learning, abstract thinking, planning, judgment and reasoning (Zheng & Chen, 2016). The treatment of this disorder involves the alleviation of symptoms and multiple options are available for the management of this disease. Each treatment intervention is uniquely tailored for specific individual to meet their personal needs.

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Behavioral Intervention is effective in the treatment of intellectual developmental disorder. It involves the use of techniques and behavioral changes. Behavioral interventions seek to teach the functional alternative behaviors and reduce the associated symptoms. The techniques used include modelling, fading, prompting and reinforcements. Another intervention is applied behavior analysis (ABA) that utilizes the learning theory principles to bring about positive and meaningful change of behavior in the patient (Schuengel et al., 2019). These changes develop self-control, social, communication and self-monitoring skills. They are also applicable in the daily and structured settings as well as group and individual instruction Intellectual Developmental Disorder Treatment options Essay. Peer-Mediated treatment also engages children with disabilities in activities that boost their competency in communication.

Notably, pharmacological therapy is also effective in treating intellectual developmental disorder. It entails the use of medication to treat children for early developmental delays. Psychological therapy involving psychiatrists, geneticist, special education therapist, physical therapist or occupational and speech therapist is also necessary in treatment. Environmental arrangement organizes the surrounding to promote communication. The aim is to set the communication occasion and increase the environmental interest. The patient comments and expresses desires to understand and enquire about the environment thus improving the communication and learning skills. Moreover, Functional communication training (FCT) replaces challenging behavior with the appropriate communication and behavioral alternatives that improve their cognitive levels. On the other hand, Incidental teaching teaches elaborate communication attempts and interesting opportunities using prompt questions Intellectual Developmental Disorder Treatment options Essay.

References

Schuengel, C., van Rest, M. M., Stanford, C. E., & Hastings, R. P. (2019). Impact of Research About the Early Development of Children With Intellectual Disability: A Science Mapping Analysis. In 
Frontiers in Education
 (Vol. 4, p. 41). Frontiers.

Zheng, X. F., & Chen, J. J. (2016). Evaluation of intellectual development level of 300 children with language disorder. 
Zhongguo dang dai er ke za zhi= Chinese journal of contemporary pediatrics
, 
18
(11), 1115-1118 Intellectual Developmental Disorder Treatment options Essay.

Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

Examine Case 1. 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.

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https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6660/03/mm/decision_tree/index.html

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. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

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 Resources. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

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.

Review of Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

Introduction

           
Katie is a female 8 year-old Caucasian child who is brought to the clinic by her parents. She has a previous provisional diagnosis of attention deficit hyperactivity disorder or ADHD. Katie is having difficulties in school with concentration and performance. She is also not socializing well with her peers and likes to keep to herself. Her attention span is also short. Katie was born to mature parents (47 and 49 years old respectively) and had notable low wellness scores at birth. The parents bring with them the Connor’s Teacher Rating Scale form which had been filled by her teacher at school. This is helpful in assessing her condition and arriving at the correct diagnosis.

Decision Point Number 1

In using the available assessment tools and based on what the parents and the teacher had reported, the diagnosis of ADHD with predominantly inattentive presentation was made as stated above. According to the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
, inattention such as Katie’s must meet criterion A. 1 (a)-(i) for this diagnosis to be reached (APA, 2013). This was met by Katie because her Conner’s Teacher Rating Scale shows that she is easily distracted at school and has the habit of only paying attention to what she has interest in. She is also quite forgetful of what she has been taught in school, attributable too to her inattention. The hope in arriving at this diagnosis was that Katie would be started on ADHD treatment at the right time; a fact that would place her in a better position to be free of her symptoms in the shortest time possible (Wender & Tomb, 2017). However, on close assessment during the revisit session, subjective evidence showed clearly that Katie was also evidently hyperactive as she could not stay in one place during the interview with the psychiatric-mental health nurse practitioner or PMHNP. Apart from the fact that her answers were short, it was also revealed that she also wonders in thought while in class Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie. Her mental status examination was however largely unremarkable.  She was oriented in all aspects and was dressed appropriately for both the time of the day and the weather. The only thing that stood out was that she had an imaginary friend by the name “Audrey.” Because of these findings, the presentation of the diagnosis had to be reviewed from predominantly inattentive to combined presentation (APA, 2013; Wender & Tomb, 2017). This is because her symptoms largely agreed also with criterion A. 2 (a)-(i) on hyperactivity and impulsivity. Moreover, she also fitted in with the rest f the criteria B, C, D, and E (APA, 2013). Thus the summary of her definitive diagnosis is ADHD with inattention, hyperactivity, and impulsivity. There wasn’t much difference in the initial decision and the revised one in terms of the results as the diagnosis itself has not changed but only the presentation. The fact that she had not started to show any significant response to treatment is to be expected because ADHD response to pharmacologic treatment typically takes weeks (Stahl, 2014; Katzung, 2018).

Decision Point Number 2

           
On the return visit the girl was put on wellbutrin (bupropion) 75 mg daily to be taken by mouth. This decision was taken because this s a major norepinephrine dopamine reuptake inhibitor or NDRI approved by the Food and Drug Administration (FDA) for the treatment of ADHD (Stahl, 2014; Katzung, 2018; Nursingworld.org, n.d.). The other reason for choosing wellbutrin is that it continues to work for several years later and in the process deters the recurrence of symptoms (Stahl, 2014). This long term remission is what was intended to be achieved by this choice. Wellbutrin is one of the best pharmacotherapeutic agents available for treating ADHD. However, its effects are normally not felt immediately and its full therapeutic action may be evident from up to four weeks later (Stahl, 2014). The results of this decision to start wellbutrin and what was expected are not significantly different for two reasons. First is that as stated it takes weeks for the full impact of the drug to be felt (this patient returned after four weeks). Two is that the questions that Katie is asking are not part of the known side effects of the drug (Stahl, 2014). Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

Case #1

A young girl with difficulties in school

BACKGROUND

In psychopharmacology you met Katie, an 8-year-old Caucasian female, who was brought to your office by her mother (age 47) and father (age 49). You worked through the case by recommending possible ADHD medications. As you progress in your PMHNP program, the cases will involve more information for you to sort through.

For this case, you see Katie and her parents again. The parents have reported that the medication given to Katie does not seem to be helping. This has prompted you to reconsider the diagnosis of ADHD. You will consider other differential diagnoses and determine what information you need to accurately assess the DSM-5 criteria to make the diagnosis of ADHD or another disorder with similar diagnostic features Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

When parents bring their child to your office, they may have read symptoms on the internet or they may have been told by the school “your child has ADHD”. Your diagnosis will either confirm or refute that diagnosis.

Katie’s parents reported that their PCP felt that she should be evaluated by psychiatry to determine a differential diagnosis and to begin medication, if indicated. The PMHNP makes this diagnostic decision based on interviews and observations of the child, her parents, and the assessment of the parents and teacher.

To start, consider what assessment tools you might need to evaluate Katie.

Child Behavior Check List

Conners’ Teacher Rating Scale

The parents give the PMHNP a copy of a form titled “Conner’s Teacher Rating Scale-Revised” 
(Available at: https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/GetPdf.cgi?id=phd000099.1 )
. This scale was filled out by Katie’s teacher and sent home to the parents so that they could share it with their provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, makes careless mistakes in her schoolwork, forgets things she already learned, is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. She has difficulty interacting with peers in the classroom and likes to play by herself at recess. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

When interviewing Katie’s parents, you ask about pre- and post-natal history and you note that Katie is the first born with parents who were close to 40 years old when she was born. She had a low 5 minute Apgar score. The parents say that she met normal developmental milestones and possibly had some difficulty with sleep during the pre-school years. They notice that Katie has difficulty socializing with peers, she is quiet at home and spends a lot of time watching TV.

SUBJECTIVE

You observe Katie in the office and she is not able to sit still during the interview. She is constantly interrupting both you and her parents. Katie reports that school is “OK”- her favorite subjects are “art” and “recess.” She states that she finds some subjects boring or too difficult, and sometimes hard because she feels “lost”. She admits that her mind does wander during class. “Sometimes” Katie reports “I will just be thinking about something else and not looking at the teacher or other students in the class.” Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

Katie reports that her home life is just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse, denies bullying at school. She offers no other concerns at this time.

Katie’s parents appear somewhat anxious about their daughter’s problems. You notice the mother is fidgeting with her rings and watch while you are talking. The father is tapping his foot. Other than that, they seem attentive and straight forward in the interview process.

MENTAL STATUS EXAM

The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is neutral. Katie says that she doesn’t hear any ‘voices’ in her head but does admit to having an imaginary friend, ‘Audrey’. No reports of delusional or paranoid thought processes. Attention and concentration are somewhat limited based on Katie’s short answers to your questions. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHAT IS YOUR DIAGNOSIS FOR KATIE?

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.

 
299.00 Autism Spectrum Disorder (ASD), mild and co-occurring; 300.23 Social Anxiety Disorder

 
315.0 Specific Learning Disorder with Impairment in Reading and 315.1 Impairment in Mathematics

 
314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation

Decision Point Number 3

As stated above, wellbutrin (bupropion) does not cause the patient to ask the type of questions that Katie is asking as a side effect (Stahl, 2014). Therefore, the decision taken in this instance is to reassure the patients that those questions she is asking are just part of her normal developmental progress given her age. They have got nothing to do with the treatment which is evidence-based. As at now, there is no evidence to suggest that the drug may cause such behavior. Therefore, because the overall response is so far promising (the teacher says the girl has started being more attentive and is doing her academic work), the dose of bupropion will be doubled to 150 mg daily. By making this decision, the hope is to augment the noted effect of the drug and ensure long-lasting remission. One consideration though is that the questions about death by Katie may persist. This would mean she is having some sort of suicidal ideation which may be caused by the wellbutrin (Stahl, 2014; Wender & Tomb, 2017). If this occurs, it would mean the results of the intervention and the expectations would be different, due to the fact that antidepressants generally may at times cause suicidal ideation. In that case, the drug would be changed from wellbutrin to concerta 18 mg
mane
per day. this would also be supported by psychotherapy in terms of training in social skills to improve her engagement with her peers and take her mind away from suicidal thoughts (Corey, 2017). In doing all this, the ethical principle of nonmaleficence (not causing harm) has to be remembered as continuing a drug that may result in her committing suicide will be immoral. Also the decision of the parents on treatment options has to be respected – ethical principle of autonomy (Haswell, 2019).

References

American Psychiatric Association [APA] (2013).
Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
5
th
ed. Arlington, VA: APA.

Corey, G. (2017).
Theory and practice of counselling and psychotherapy,
10
th
ed. Boston, MA: Cengage Learning.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice.
Journal of Aesthetic Nursing
, 8(4), 177-179. Doi: 10.12968/joan.2019.8.4.177 Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

Katzung, B.G. (Ed) (2018).
Basic and clinical pharmacology, 14
th
ed
. New York, NY: McGraw-Hill Education.

Nursingworld.org (n.d.).
Pharmacological Principles
. Retrieved 14 June 2019 from
https://www.nursingworld.org/~4ae124/globalassets/catalog/sample-chapters/pmhnpsamplechapter.pdf

Stahl, S.M. (2014).
Stahl’s essential psychopharmacology: Prescriber’s guide
, 5
th
ed. New York, NY: Cambridge University Press.

Wender, P.H. & Tomb, D.A. (2017). ADHD:
A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults
, 5
th
ed. New York, NY: Oxford University Press. Diagnosis in Attention Deficit Hyperactivity Disorder (ADHD): The Case of 8 Year-Old Caucasian Girl Katie

NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay

Post an explanation of how the use of CBT in families compares to CBT in individual settings. Provide specific examples from your own practicum experiences. Then, explain challenges counselors might encounter when using CBT in the family setting. Support your position with specific examples from this week’s media. (references need to be since 2013 and from creditable resources)

Walden University NURS 6650 Week 5: Group and Family Psychotherapy

Introduction

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Cognitive behavioral therapy (CBT) trains individuals to recognize their maladaptive thinking patents and to be aware of the situations, thoughts, and feelings that induce negative automatic thoughts. After this step, CBT focuses on confirming if the individual would want to change their current problems (David et al, 2018). CBT is based on the premise that a person can be susceptible to negative thinking regarding self, future and generally the world. According to David et al (2018) thinking is reinforced by attitudes that are based on childhood experiences and other life events and this can lead to negative thinking. Therefore, CBT aims to change the negative thinking perspective into a positive thinking perspective through cognitive restructuring (Mohamadian et al, 2018). This discussion will focus on how the use of CBT in a family setting compared to CBT within individual settings NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

Individual CBT has a generally well-defined framework that emphasizes on reducing harm, especially with individuals who have substance abuse disorders or anxiety disorders (Wheeler, 2014). Individual CBT is a collaborative process that occurs between the therapist and the client; the process integrates physiology and schemas when developing the treatment plan (Wheeler, 2014).

On the other hand, CBT for the family is solution-focused and also brief. The focus of family CBT is on providing support to the family members to ensure they think and act in a more adaptive way, and learn to make better decisions and develop a more friendly and calmer family atmosphere. In family CBT therapy, feelings, cognitions, and behaviors are perceived as mutually influencing all individuals involved (Patterson, 2014).

An example of a client I experienced during practicum is a 32-year-old male client named B.G who participated in individual CBT once weekly and family CBT once weekly. The client had an alcohol abuse disorder NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

The client presented to the individual CBT after his employer along with the spouse complained that he was not able to manage his alcoholism. The client reported that he took alcohol almost every day of the week but he was trying to cut down the intake. During the individual CBT, open-ended questions were used to help to obtain situational and cognitive information from the client. The client would get angry and upset; this implied that he was not being honest about his alcohol intake. The client would give different information every time he was questioned. The client attended three individual CBT sessions and a recommendation was made to start family CBT with his wife (EB) because “the house was full of stress”.

During the family CBT therapy, the client was open about his alcohol use. However, the wife would interrupt him. The wife insisted that the client was not making efforts to cut down alcohol intake. However, during the session, B.G kept contradicting himself and while EB gave a seeming reliable account. This informed the therapist that BG was not making noticeable efforts to reduce alcohol intake. NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

According to B.G thinking, his alcohol intake did not in any way present a problem to his marriage, life or career. CBT views substance use disorder as a situation where individuals use such substances to reinforce the behavior. With time, such negative and positive reinforcing agent becomes a part of everyday activities. CBT attempts to reduce such effects by improving incidents allied to abstinence or by developing skills to help in reducing substance use (Wheeler, 2014). NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

During the family therapy, it became clear that B.G would give a different account when alone but when the wife was present, he tried to give an accurate account. Accordingly, the therapist proposed to the client to continue with the individual therapy and also attend family CBT once weekly.

Evidence shows that when individuals with substance use disorder try to maintain sobriety or lower substance use, there is a likelihood of relapse (Ringle et al, 2015). As a result, ready for change meeting were proposed for the client. This was based on this week’s media that indicated that clients are positively influenced to change when they encounter other individuals experiencing similar situations.

The example of this client shows some of the challenges encountered during psychotherapy and that in some situations it would be necessary to have clients undergo both family and individual therapies to ensure the therapy goals are met. NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay.

Some of the challenges that a therapist may encounter when using CBT in a family setting is trying to restructure the thinking pattern of different people at the same time. In addition, the therapist may be unsure if the structure of the session was appropriate for diverse family members and if the CBT techniques were effective for every individual (Ringle et al, 2015).

 

References

David D, Cristea J & Hofmann S. (2018). Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy.
Front Psychiatry
. 9(4).

Mohamadian F, Bagheri M, Sadat M & sani H. (2018). The Effects of Cognitive Behavioral Therapy on Depression and Anxiety among Patients with Thalassemia: a Randomized Controlled Trial.
J Caring Sci
. 7(4),219–224.

Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. 
Journal of Family Psychotherapy
, 
25
(2), 132–144.

Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. 
Psychiatric services (Washington, D.C.)
, 
66
(9), 938-45.

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to

       guide for evidence-based practice
. New York, NY: Springer. NURS 6650 Week 5 – How CBT in families compares to CBT in individual settings Essay

NURS 6650 Working With Children and Adolescents Versus Adults Essay

Explain why a developmental assessment of children and adolescents is important.

Describe two assessment instruments and explain why they are used for children and adolescents but not adults.

Describe two treatment options for children and adolescents that may not be used when treating adults.

Explain the role parents play in assessment and treatment

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Importance Of Developmental Assessments Of Children And Adolescents

Developmental assessments of pediatric clients form a vital part of holistic care which is a major goal of psychiatric nursing. When conducting psychiatric evaluations, developmental assessments are used to gauge the likelihood of any deviations from normal development physically, psycho-sexually, socially or emotionally (American Psychiatric Association, 2013).  Based on the outcomes of an assessment, mental health practitioners can institute early interventions for any deviations noted. Developmental assessments are also essential since some adolescents and children can present in clinical settings with behaviors consistent with disabilities in development (American Psychiatric Association, 2013). By using these assessments, mental health practitioners can determine whether such disability is as a result of trauma, environmental factors or genetics. When identified early, the right referrals can be made to promote a child’s development and well-being NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Assessment Instruments For Adolescents and Children

           
The use of assessments instruments in adult and pediatric populations is vital in ensuring that the criterion for a specific diagnosis has been met. Generally, the most commonly used instruments for diagnoses are questionnaires and interviews (Sadock, Sadock & Ruiz, 2014). However, there exists a huge difference between the assessment instruments used for adults and pediatric clients. This is attributed to the fact that the details captured in pediatric assessments are obtained from additional sources such as caregivers, parents, and teachers other than just the pediatric client. Assessment instruments used for pediatric clients should be simple, brief, specific and sensitive. Assessment instruments that are specifically used for pediatric clients and cannot be used for adult patients are the National Institute of Mental Health Interview Schedule for Children Version IV and Dominic-R (Hargrave & Arthur, 2015). The former can be used in clinical settings with children between 6-17 years in either a parent or child format. The child format is suitable for children aged 9-17 years of age which the parental format can be used for pediatric clients aged 6-17 years old(Sadock, Sadock & Ruiz, 2014). On the other hand, the Dominic-R assessment instrument uses the images of a child named Dominic to depict several symptoms and can be used for children aged 6-11 years. Even though the behavioral and emotional content it illustrates is based on DSM-III-R, these details can be incorporated with the clinical details of the DSM-IV NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Treatment Options For Adolescents and Children

           
Play therapy has proven to be a highly effective and successful treatment option among pediatric patients with ADHD, depression, and PTSD. This form of therapy utilizes a play model that is nondirective to promote an environment that is safe and enhances the growth of a child (Blanco et al., 2015). The other treatment option used for children and adolescents is trauma-focused cognitive behavioral therapy. According to de Arellano, et al., (2014), trauma-focused CBT is a preferred empiric treatment model for pediatric clients who have undergone some form of trauma. NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Parent’s Role In Assessment and Treatment

           
Adolescents and children are heavily reliant on the participation of direct caregivers and parents in care for more successful health outcomes. Parents are relied on by clinicians to obtain exact information on the symptoms that a child presents with, past medical, surgical, psychosocial and family history (American Psychiatric Association, 2013). It is also worth mentioning that, rarely do children or adolescents initiate psychiatric evaluations. Therefore, to comprehensively understand the reasons for evaluation, clinicians can only collect information through interviews with caregivers or parent. However, information shared by children or adolescents should not be ignored since they tend to understand their concerns, thoughts, and feelings better.

 

References

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

Blanco, P. J., Muro, J. H., Holliman, R., Stickley, V. K., & Carter, K. (2015). Effect of child-centered play therapy on performance anxiety and academic achievement.
Journal of Child and Adolescent Counseling
,
1
(2), 66-80.

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60-72 NURS 6650 Working With Children and Adolescents Versus Adults Essay.

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.

de Arellano, M. A. R., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., & Delphin-Rittmon, M. E. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence.
Psychiatric Services
,
65
(5), 591-602. NURS 6650 Working With Children and Adolescents Versus Adults Essay.

Psychiatric Mental Health Practices Ethics and Dilemmas

Review literature for moral/ethical issues encountered by a PMHNP.

Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment

Summarize the moral/ethical issue in the article (no more than 1 paragraph).

Describe the moral and ethical dilemmas surrounding the issue.

Analyze the ethical issue and compare them to the state health laws and regulations in your state.

Outline the process of ethical decision making you would use to address this ethical dilemma.

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Psychiatric Mental Health Practices Ethics and Dilemmas

A summary of an ethical issue in the article

“Hem, M., Molewijk, B., Gjerberg, E., Lillemoen, L., & Pedersen, R. (2018). The significance of ethics reflection groups in mental health care: a focus group study among health care professionals.
BMC Medical Ethics
, 19 (1):54”.

Coercive treatment is a prominent ethical issue that professions in psychiatric mental health practices face. Over the past years, the utilization of coercion in psychiatric services has gained increasing attention and raised some of the utmost hard ethical issues. The usage of coercion threatens the autonomy of the patient. It can cause both physical and psychological harm and it as well threatens the perception of healthcare professionals of what entails good treatment and care. Generally, coercion is used to assist the patient. Nevertheless, it might also be utilized to safeguard others or be misapplied by healthcare professionals. Thus, the usage of coercion is an intricate ethical enterprise Psychiatric Mental Health Practices Ethics and Dilemmas.

Ethical and moral issues surrounding the use of coercion

There are several different ethical challenges connected to the usage of coercion.  As Norvoll et al (2018) indicate, coercion entails professionals overriding apparent autonomy of patients, with resultant ethical implications. The serious impacts of coercion on a patient’s liberty and autonomy make coercion an innately value-laden action.  The most significant justification for coercion is that it is aimed at promoting the well-being and best interest of the patient. As Hem et al (2018) allege, the usual argument is that coercive care and treatment might improve the health of the patient or that failure of not doing what is viewed as safe or good can cause impairment. Psychiatric Mental Health Practices Ethics and Dilemmas. This line of thinking presumes that a patient’s best inters is thoroughly evaluated and carefully considered when applying coercion.

How to balance between nonmaleficence and beneficence when using coercion is a major ethical dilemma because it entails balancing between inflicting harm(nonmaleficence) and promoting good. For instance, restraints lessen the risk of physical harm to the patient but they have an adverse effect resulting in humiliation, fear, anger, embarrassment, and powerlessness. Practitioners are also faced with the ethical dilemma of balancing between the patient’s best interest and the safety of hospital staff and other patients (Hem et al, 2018). According to Steinert (2017), if practices that restrict liberty, like involuntary detention and inpatient treatment or seclusion becomes essential due to dangerous behavior, there is a likelihood of severe deterioration of psychosocial health. Averting such an outcome may be regarded as acting in the best interest of the patient’s well-being. Therefore, treating a patient against her or his will is justifiable as being beneficent to the patient if the aim is to avert long-term constraint of his freedom and if this restriction isn’t merely a hypothetical possibility Psychiatric Mental Health Practices Ethics and Dilemmas.

An analysis of the ethical issue and its comparison to Indiana state laws and regulations

Legislation exists in the majority of states to allow for coercion and involuntary treatment of individuals who are considered to be ill and at danger. The civil commitment laws are a mechanism to coerce a person to undergo outpatient treatment of psychiatric hospitalization. AS Cautin and Lilienfeld (2015) assert, civil commitment might transpire only after a court determines that a person is suffering from a statutorily needed level of mental condition and probably associated conditions.  Typically, a court orders civil commitment when the involved person is unable to voluntarily consent to treatment. Psychiatric Mental Health Practices Ethics and Dilemmas. Like other states, Indiana has civil commitment laws that determine the criterion establishing when involuntary care or treatment is suitable severely mentally ill patients who cannot voluntarily seek care. Indiana state laws permit for inpatient treatment and assisted outpatient treatment.

Ethical decision process

As a PMHNP, I might address the ethical dilemma of the use of coercion by evaluating the patient’s decisional capacity and the best interest of the patient. If the capacity of the patient to make rational choices is hindered, I may respect the autonomy of the patient by involving his relatives to make decisions on behalf of the patient or offer any pertinent information that they possess about the possible preferences of the patient. As Baruth and Lapid (2017) allege, discussions with healthcare team and family are key in making a determination of patient values that apprise medical decision making. Information from other healthcare professionals and family are useful in supporting conclusions when establishing capacity, and can also be valuable to a proxy or surrogate decisionmaker when the patient is considered to not to have decisional capacity. Psychiatric Mental Health Practices Ethics and Dilemmas.

 

References

Baruth, J., & Lapid, N. (2017) Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal.
AMA Journal of Ethics,
19(5): 416-425.

Cautin, R., & Lilienfeld, S.  (2015). The Encyclopedia of Clinical Psychology, 5Volume Set. New York:  John Wiley &  Sons

Hem, M., Gjerberg, E., Husum, T., & Pedersen, R. (2018). Ethical Challenges when using coercion in mental healthcare: a systematic literature review.
Nursing Ethics
, 25(1): 92-110.

Norvoll, R., & Hem, M., Pedersen, R. (2016). The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care.
HEC Forum
, 29(1): 59-74.

Steinert, T.  (2017). Ethics of Coercive Treatment and Misuse of Psychiatry.
Psychiatric Services,
68(3): 291-294. Psychiatric Mental Health Practices Ethics and Dilemmas.