Tag: Clinical-Nursing

Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree

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. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

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

o Which Decision did you select?

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

o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

o 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

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

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

o 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

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

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

o 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.

Below is a sample paper for this assignment, use it as a guide.

Clinical Judgement on Katie’s Disorder

One of the vital roles of nurse practitioners is formulating the appropriate diagnosis whenever they encounter clients with symptoms that resemble different disorders. When such situations arise, it becomes imperative for the practitioners to develop the right diagnosis by utilization of the standardize diagnostic tools to rule out other differential diagnoses which will assist practitioners in the initiation of the treatment plan that will lead to a favorable outcome as well as increase patient satisfaction. The focus in this paper is about an eight-year-old girl Katie that was brought to the clinic by her parents due to the child is suspected of suffering from attention deficit hyperactive disorder (ADHD) from the assessment her teacher performed with the assessment tool called Conners’ Teacher Rating Scale. While inside the practitioner’s office, Katie was exhibiting some behavior that aligns with ADHD for example, inability to pay attention or sit still, continually interrupting the parents and the practitioner. She also revealed that she has difficulty paying attention in class or complete her school work. It is the responsibility of the mental health nurse practitioner that is managing this client to perform further diagnostic evaluations to establish the appropriate diagnosis and treatment plan. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Decision Point One

After evaluating all the information provided including the independent and objective evidence, the carefully chosen judgement for Katia is 314.00 Attention Deficit Hyperactivity Disorder, predominantly inattentive presentation. An additional diagnostic evaluation tool to use to assess the Katia and her parents are the Child Behavior Check List (CBCL) since the teacher has already evaluated the child with Conners’ Teacher Rating Scale. CBCL is a user-friendly, cost-effective, reliable, and valid standardized assessment tool that is generally used in mental health services, schools, medical settings, child and family services, public health agencies, child guidance, and training programs for assessing children’s behavioral/emotional problems from the perspectives of multiple informants including parents, caregivers, and teachers (Mazefsky, Anderson, Conner, & Minshew, 2014).

The reason for choosing the above diagnosis is due to the symptoms the client exhibited in concurrent with the criteria for the selected diagnosis as listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: (DSM-5). The requirements to make the determination is when the client meets up to six or more of the rules, for example, exhibits concentration difficulty, inability to complete a task promptly, difficulty retaining simple instructions, avoids activities that require cognition, and paying attention to unnecessary distractions (American Psychiatric Association [APA], 2013). The target outcome is to link the symptoms to the right diagnostic criteria in DSM-5 before establishing the appropriate treatment plan, and that matches with the expected result.

Decision Point Two

The initial pharmacological agent to use for the client is Adderall XR 10mg by mouth every day. The medication is also known as Amphetamine is an approved medication to treat kids from six to 17 years with ADHD and it belongs to the group of drugs called stimulants that functions by improving the chemical irregularity in the brain which is prompting the symptoms (Stahl, 2014). The basis behind this judgment is that it reduces the symptoms of inattentiveness, motor hyperactivity, and impulsiveness that interrupt social, school, and occupational functioning which is the goal of treatment for this client. The common side effects of Adderall XR to explain to the parents of the client includes; insomnia, shivering, vertigo, dehydrated mouth, constipation, diarrhea, reduced appetite, and weight loss (Felt, Biermann, Christner, Kochhar, & Harrison, 2014). The effectiveness of the medication can be apparent right after the first dose while in some patients, it can take several weeks to achieve the most therapeutic effect.

After four weeks of initiating this choice of medication, the parents of the client and the teacher noted some positive changes in the morning but not so much improvement in the afternoon and also complained of reduced appetite. The updates from the parents and teacher are the regular occurrence that is associated with medication which was explained to the parents at the initial visit, and the full effect of the drug takes several weeks in some individuals. Therefore, the result at hand is not different from what the practitioner expected. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Decision Point Three

Although the client has shown some improvement in the morning, modification in her attentiveness in the afternoon is yet to be achieved. Therefore, the next action is to supplement Adderall XR with a minute dose of instant release Adderall for the client to take in the afternoon that will sustain the client in the afternoon to complete her homework as well. The reason is that the overall result for initiating treatment is to improve the client’s attentiveness and concentration in school work including homework. At this point, the practitioner will schedule a follow-up visit in four weeks to assess for the effectiveness of the instant release on the client’s symptoms. American Academy of Pediatrics (2017), recommends that Continuous monitoring of the client’s behavior and medications are necessary to assess if the treatment strategy is functioning and one of the ways to achieve it is by follow-up visits.

Ethical Consideration

The dominant interest of mental health practitioner that is managing the mental health of children and adolescents is the safety of the child while upholding the moral principle of doing no harm and also address the rights and privileges of both children and their parents/legal caregivers, interpret consent as well as confidentiality (Jackson, Burns, & Richter, 2014). Therefore, mental health practitioners to should be watchful of different forces that could play roles in the diagnostic method while preserving the knowledge that their attempts will significantly reshape the near- and likely longer-term expectations of their child patients. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Conclusion

When practitioners encounter a patient with symptoms that resemble other conditions, establishing the appropriate diagnosis by ruling out other possible conditions becomes imperative like the case of Katie who was accompanied to the clinic by her parents. Therefore, it is the sole obligation of the mental health practitioner that is managing this client to perform further diagnostic evaluations to establish the appropriate diagnosis and treatment plan. They should also remember the importance of maintaining confidentiality and ensuring that the authorized person signs the treatment consent before initiating treatment.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

American Academy of Pediatrics. (2017). Treatment & Target Outcomes for Children with

ADHD. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Treatment-of-ADHD-and-Related-Disorders.aspx

Felt, B. T, Biermann, B., Christner, J. G., Kochhar, P. & Harrison, R. V. (2014). Diagnosis and

management of ADHD in children. American Family Physician, 90(7), 456-464.Retrieved from https://www.aafp.org/afp/2014/1001/p456.html

Jackson, M. K., Burns, K. K., & Richter, M. S. (2014). Confidentiality and treatment decisions

of minor clients: a health professional’s dilemma & policy makers challenge. Springer Plus, 3, 320. https://10.1186/2193-1801-3-320 Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Mazefsky, C. A., Anderson, R., Conner, C. M., & Minshew, N. (2014). Child Behavior Checklist

Scores for School-Aged Children with Autism: Preliminary Evidence of Patterns Suggesting the Need for Referral. Journal of psychopathology and behavioral assessment, 33(1), 31-37. https://doi.org/10.1007/s10862-010-9198-1

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New

York, NY: Cambridge University Press.

Practicum: Decision Tree

Introduction

Nurse practitioners have the role of making a suitable diagnosis for the clients and prescribing the appropriate treatment regimen. The diagnosis should be performed using suitable diagnostic tools in order to exclude other differential diagnoses in order to facilitate appropriate treatment and ensure better health outcomes for the patient/client. This case study presents an 8-year-old female client, who presented after being suspected of having ADHD. The “Conner’s Teacher Rating Scale-Revised” showed that the client was forgetful, inattentive, distractible easily, and poor in reading, spelling, and math. The teacher further reported that the client had short attention span, did not have interest in schoolwork, left school work uncompleted, and did not follow instruction.  After the mental status exam, her mood was euthymic while the clinical interview indicated that her concentration and attention were fairly limited. Accordingly, this paper will present three decisions made about the diagnosis and treatment choices for this client and the rationale behind the selected decisions. The paper will conclude by discussing ethical considerations during the client’s treatment. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Decision Point One

From the provided information and the findings of the mental status exam, the diagnosis of the client is attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. The Child Behavior Check List (CBCL) can be used to further evaluate the client and her parents because the reliability and validity of the tool in evaluating mental health issues in children have been verified. The rationale for selecting the diagnosis, attention deficit hyperactivity disorder (ADHD) is because the client manifests symptoms consistent with clinical symptoms listed within the DSM-5 diagnostic criteria. As per the DSM-5 criteria for ADHD, individuals with ADHD manifest hyperactivity-impulsivity or/and inattention that affect an individual’s development or functioning (American Psychiatric Association, 2013). For inattention, children should manifest 6 or more inattention symptoms for a minimum of 6 months and the symptoms include: lack of attention to details and mistakes in classwork and other activities; lack of attention during play/tasks; inability to listen directly; inability to follow instructions; failure to finish classwork or assigned chores; disorganization; avoiding activities needing mental effort; losing essential things such as books; forgetfulness; and being easily distracted (Tong et al, 2016). On the other hand, hyperactivity/impulsivity is characterized by fidgeting; running/climbing inappropriately; inability to play quietly; excessive talking; blurting out answers prior to question completion; problem waiting for ones turn, and interrupting/intruding others. The client manifests more than six symptoms of inattention and hence fits the diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation American Psychiatric Association, 2013). Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

With this decision, the hope was that the appropriate diagnosis would lead to the appropriate treatment for this client, and hence ensure better health outcomes.

Decision Point Two

The first treatment choice is for the client to start Adderall XR 10 mg orally every day. The reason for choosing Adderall is because evidence shows the efficacy of the pharmacological agent in the treatment of ADHD. Adderall is FDA approved for treatment of children aged from 6-17 years. The medication is a stimulant and works by improving stimulation within the prefrontal cortex; specifically, Adderall is a competitive inhibitor of dopamine and hence acts on the dopamine and norepinephrine transporters and hence boosts neurotransmission of both dopamine and norepinephrine within the prefrontal cortex, improving the symptoms of ADHD such as inattentiveness, impulsivity, and hyperactivity (Brown et al, 2018).  Side effects that have been reported in Adderall include increased aggressiveness, appetite suppression, sleeplessness, weight loss, mouth dryness, diarrhea, vertigo and constipation (Weyandt et al,2018).

The expected outcome was that there will be significant symptom improvement because the pharmacological agent has been demonstrated to be effective in improving ADHD symptoms. It was also hoped that she would not experience side effects after initiation of the medication. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

Comparable with the expected outcome, after four weeks of starting Adderall, there was significant symptom improvement for the client in the morning. However, there was no significant improvement during the afternoon hours because the client was unable to maintain attention in the afternoon. This is attributable to the Adderall being
an immediate release amphetamine pharmacological agent and thus the medication was short-acting, leading to decreased effectiveness to last for the whole day (
Weyandt et al, 2018)
. In addition, the client reported appetite loss which is a major side effect in amphetamines.

Decision Point Three

The third decision is the addition of a slight dose of Adderall during the early afternoon. The reason for this decision is to make sure that the client will be able to maintain attention even during the afternoon because, with the previous decision, the client was not able to achieve attention in the afternoon (Huss et al, 2017).

By adding a small dose in the afternoon, it is hoped that the client will maintain attention throughout the day and thus she will concentrate on her school work and other activities (Huss et al, 2017). The client will be monitored by a PMHNP after every four weeks in order to have her progress assessed. In addition, the assessment will be able to inform the ability of the client to tolerate the additional dose.

Ethical Considerations

Medications such as stimulants like Adderall have various side effects and hence the PHHNP should ensure no harm to the client. In addition, informed consent is an important ethical aspect during the treatment of this client. Therefore, it is the duty of the PMHNP to explain to the parents of Katie regarding the available treatment options, including the side effects associated with stimulants such as Adderall (Committee on Bioethics, 2016). This will ensure that the parents of the client make an informed decision prior to selecting any treatment option.

BUY A PLAGIARISM-FREE PAPER HERE

Conclusion

According to the presented symptoms, the diagnosis for this client was attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. The first pharmacological agent for the client was Adderall XR 10 mg because Adderall is approved for treatment of the pediatric population and its efficacy in treating ADHD has been demonstrated. Even though, the symptoms improved, the client was not able to maintain attention in the afternoon. Accordingly, the third decision was addition of a slight dose of Adderall during the early afternoon in order to ensure that she was able to maintain attention even in the afternoon hours. In conclusion, it is important for the PMHNP to ensure that the selected treatment regimen does not cause harm to the client and also seek informed consent from the parents of Katie prior to starting any treatment. This will ensure the parents make an informed choice, regarding their daughter’s treatment. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

References

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders, 5th edition
. Arlington: American Psychiatric Publishing.

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

Committee on Bioethics. (2016). Informed Consent in Decision-Making in Pediatric Practice.
American Academy of Pediatrics
.
96(5):981
.

Huss M, Duhan P, Gadhi P, Chen C, Carsten S & Kumar V. (2017). Methylphenidate dose optimization for ADHD treatment: a review of safety, efficacy, and clinical necessity.
Neuropsychiatr Dis Treat
. 1(13), 1741–1751.

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

Weyandt L, White T, Gyda B, Adam N, Leon K & Bjorn S. (2018). Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students.
Pharmacy (Basel)
. 6(3): 58. Katie’s attention deficit hyperactive disorder (ADHD) Practicum: Decision Tree.

NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

NURS6051. Transforming Nursing and Healthcare through Technology. The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

NURS-6051N,Transforming Nursing & HC

Week 3 Assignment: 
The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined? NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

BUY A PLAGIARISM-FREE PAPER HERE

Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency.

To Prepare:

Review the concepts of technology application as presented in the Resources.

Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies.

The Assignment: (4-5 pages)

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

Describe the project you propose.

Identify the stakeholders impacted by this project.

Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.

Identify the technologies required to implement this project and explain why.

Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

 

NURS_5051_Module02_Week03_Assignment_Rubric

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient care efficiency. Your project proposal should include the following:

Describe the project you propose.

Identify the stakeholders impacted by this project.

Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving, and explain how this improvement would occur. Be specific and provide examples.

Identify the technologies required to implement this project and explain why.

Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.–

The response accurately and thoroughly describes in detail the project proposed.

The response accurately and clearly identifies the stakeholders impacted by the project proposed.

The response accurately and thoroughly explains in detail the patient outcome(s) or patient-care efficiencies that the project proposed is aimed at improving, including an accurate and detailed explanation, with sufficient supporting evidence of how this improvement would occur.

The response accurately and clearly identifies the technologies required to implement the project proposed with a detailed explanation why.

The response accurately and clearly identifies the project team (by roles) and thoroughly explains in detail how to incorporate the nurse informaticist in the project team.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.–

Written Expression and Formatting
– English writing standards:

Correct grammar, mechanics, and proper punctuation–

Uses correct APA format with no errors..

Name: NURS_5051_Module02_Week03_Assignment_Rubric

Possible Resources

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05.

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

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019.

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

 

Nursing Informatics Project Proposal

 

Background

In today’s world, there is nothing worrying than the deaths that are recorded on a daily basis emanating from the so-called lifestyle diseases. Thousands of new patients are diagnosed each day with a large number being unaware of being victims of these silent killer conditions. Among the top-rated lifestyle diseases/conditions are diabetes, hypertension, as well as obesity (Moghani Lankarani & Assari, 2017). One in every four Americans suffers from either hypertension or is diabetic. These statistics are alarming and have placed the two conditions among the 10 leading causes of death in the US. Diabetes is ranked number 1 cause of opportunistic diseases such as kidney failure, stroke and heart attack globally (The Observatory. Diabetes in America, 2017). NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

This calls for improved efforts in fighting this menace of lifestyle disease right through the creation of the public awareness, proper follow-up, as well as quality medical services to reduce the cases of diagnosis and the number of deaths associated with the same through proper data and information management (Thew, 2016). This paper will propose a nursing informatics project that will observe application of technology in the advocacy to improve the patient-care efficiency within the health facilities across the US.

The Project Proposal

The project that is proposed will be referred to as “Clinic alert follow-up system” (CAFS). This project will provide alert services to the involved nurses to identify or acquire updates concerning clinic follow-ups for those previously diagnosed with either hypertension, diabetes or obesity. Upon the first or subsequent visit to a health facility, and with the initial patient examination in the triage, the patient will undergo a routine checkup which must include the three crucial checkups of the diabetes, hypertension as well as BMI. If the patient is diagnosed with one or more of the conditions, the nurse will log in into the “Clinic alert follow-up system” (CAFS) and enter the patient medical code to perform a search. NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

If the patient details are not found, that means the patient is either visiting the facility for the first time or in the previous visits, they had not been diagnosed with either of the conditions. The nurse will key in the checkup results and recommend a further doctor examination and a possible clinic booking for the new patient (Glassman, 2017). This will alert the doctor during the patient session and if the doctor recommends a clinic or therapy session booking, the system will select a date and time upon the availability of the doctor, as well as the matter of treatment urgency. For a regular patient who had been previously diagnosed, the nurse will be able to get alert of the previous clinic follow-ups on whether the patient has been attending clinic/therapy sessions, as well as the treatment progress. This is the most important point of having the CAFS system in place as most diagnosed patients worsen their conditions due to lack of follow-up, especially with the doctor’s recommendation. With the CAFS assistance, the nurse and the doctor can establish the patient progress as every visit to the clinic or therapy session is also recorded and updated within the CAFS system NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

The Stakeholders Impacted by This Project

Clinic alert follow-up system (CAFS) will impact various stakeholders who include the patient, nurses, doctors, therapists, specialists, IT department team as well as the nurse informaticists. The main aim of having CAFS in place is to identify the trend of the three identified lifestyle conditions through diagnosis, clinical and therapy sessions, follow-up, as well as treatment progress (Wang, Kung & Byrd, 2018). With the normal routine checkups, most of the patients who get diagnosed with either hypertension, diabetes or obesity does not get proper follow-up, especially if their intended visit was concerning a different complication away from the tree. This situation has led to increased cases of these conditions as well as other opportunistic diseases such as heart attack, kidney failure and lower limb amputations that are all associated with uncontrolled hypertension, diabetes or overweight. The CAFS system is expected to solve this situation

Patient-Care Efficiencies This Project Is Aimed at Improving

For the patient-care efficiencies, CAFS is aimed at making follow-up from the initial visit of a diagnosed patient and ensure that they adhere to the recommended actions and treatment journey whenever possible. Assistance will also be ensured in terms of availing of the necessary medicine, as well as counseling sessions for those who may be in need. The nurse work will be made easier as the follow-up process will be availed by the system and various informatics within the systems will be alerted on specific actions to undertake within the patient’s treatment journey (Macieria, et al., 2017). It will also be easier to identify the rate of diagnosis among the patients and even in a specific period e.g. Yearly, quarterly or in a month (Glassman, 2017). In the process of follow-up, the patient will be more informed, take care of themselves in terms of diet watch and exercises, as well as adhere to the medication. This will bring an overall positive change and improvement of the condition to the diagnosed patients.

The Technologies Required to Implement This Project

The CAFS will require a standard server to integrate with the rest of the health facility system. The existing computers will be used in the same system, but will need to be upgraded with the latest operating system. For compatibility issues, CAFS will be compatible with both windows and OS. Some orientation will be conducted by the IT experts to familiarize the various stakeholders on the operations of the system and the various processes that will be required during each stage NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay.

The Project Team (By Roles) and the Incorporation of The Nurse Informaticist In the Project Team

The project team will involve the senior nurse, nurse informatics, IT experts, system developers, a representative from the doctor, therapist and nutritionist representatives. The reason to have everyone on the board is to incorporate all the features that involves the various stages and departments right from the patient visit to the last stage of the treatment processes. The representatives have been carefully and specifically selected from the departments that are deemed to deal with the three critical conditions of hypertension, diabetes as well as obesity/Overweight. The nurse informaticist is of great importance as they will be liable to gather and interpret the complicated patient data and disseminate to the various concerned stakeholders within the CAFS system. Nurse informatics are also important as they are the ones who should initiate the system changes and upgrade in collaboration with the IT department experts, for improved service delivery (McGonigle & Mastrian, 2017). NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

 

 

References

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12 (11), 45–47.

Retrieved from
https://www.americannursetoday.com/wp-
content/uploads/2017/11/ant11-Data-1030.pdf

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G.

(2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Moghani Lankarani, M., & Assari, S. (2017). Diabetes, hypertension, obesity, and long-term risk

of renal disease mortality: Racial and socioeconomic differences.
Journal of Diabetes Investigation
,
8
(4), 590–599. https://doi.org/10.1111/jdi.12618 NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge

(4th ed.). Burlington, MA: Jones & Bartlett Learning.

The Observatory. Diabetes in America. (2017).
MLO: Medical Laboratory Observer
,
49
(2), 6.

Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=120942250&site=ehost-live

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved

from
https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-
challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and

potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126 (1), 3–13. doi:10.1016/j.techfore.2015.12.019. NURS 6051 Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies Essay

Counseling Essay

Using the case study you will identify key patient problems, stages of change for each identified problem, criteria that supports specific DSM 5 substance use diagnosis, and develop questions about items you would wish to understand in more depth.

BUY A PLAGIARISM-FREE PAPER HERE

Case Study –

Johanne, is 30-year-old woman and has been drinking alcohol for at least 9 years. At first her drinking modest (1-2 standard drinks) once or twice per week, and at social events with her partner and friends. She reports there were occasional periods of heavy drinking (4 or 5 drinks per event) about 2-3 times per year. When she divorced 4 years ago, she started drinking more frequently, almost every night and most often after her two school-age children and preschool age child had gone to bed Counseling Essay. About 3 years ago, she noticed that she was feeling more anxious and felt stress from efforts to get the children to daycare and school, doing day to daycare, not having enough money, hassling with her ex-husband over child support, and getting to work on time. She received a prescription for benzodiazepine Zanax from her family doctor and after about 6 to 7 more months noticed her frequency of use increased, along with her alcohol use. She began using up the medication 1-2 weeks before her next prescription was due and when she was out of medicine, she felt very anxious. When this occurred, she used alcohol to control her anxiety and feelings of stress. She also began to try to seek out other prescribers for this medication, when her health care provider declined to fill her prescription earlier than planned Counseling Essay.

Johanne grew up in a household she describes a “tense and chaotic”. She describes her mother as being verbally abusive and who has continued to struggle with excess alcohol use most of her life. Johanne recounts drinking alcohol two or three times during high school, yet not liking the taste or effects of alcohol. She then began to smoke cannabis around age 16 and enjoyed that more. Johanne went through a period of smoking cannabis regularly after ending her relationship with her first high school boyfriend. After she began another relationship, she reduced her cannabis use, decided she was becoming too reliant on marijuana stating, “I was afraid I was getting addicted to it”, and quit using entirely. She has been smoking cigarettes for at least 12 years and uses about 15-20 a day, but will smoke even more when “I am anxious”.

Johanne has been drinking regularly (she reports at least 1-2 times a week for about seven years) for at least ten years. After her divorce, her drinking increased to almost daily, and her use of benzodiazepines began three years ago. Johanne started “prescription shopping” like her need for the benzodiazepine increased. She reports feeling a sense of shame, feels regret about her divorce, reports low motivation, little belief in her own ability and low confidence. She reports little social interaction with others outside of teachers at her children’s school and her immediate family. She also reports that she feels like an ineffective parent but insists she has never neglected her children.

On admission, Johanne reports she has felt depressed: feeling sad about the loss of her husband through divorce, guilty about not taking good enough care of her children, anxious, lethargic, and unmotivated. Sometimes she sleeps for hours at a time, and when asked how long, she reports 10-12 hours or more. At other times, she wakes up in the middle of the night, then has trouble falling back to sleep and at other times cannot get to sleep. Her physical complaints include frequent headaches, a chronic cough, and an irregular menstrual cycle. She reports feeling “stressed out,” yet has trouble taking steps to reduce her sense of stress. Prior to entering the detox program, she had not had a physical exam in 4 years. While in the detoxification program, her restlessness, anxiety, and depressive symptoms seemed to increase. She reports feeling overwhelmed with issues of finances, childcare, and isolation.

Her doctor recognized her withdrawal risks and referred her to a psychiatrist trained in substance use disorder. The psychiatrist recommended inpatient treatment. After being monitored in a detoxification program for several days, and referred to an 8-week intensive outpatient treatment program, she is now ready to develop her treatment plan.

Instructions:

– Clearly identifies, defines, and explains key criteria, symptoms, issues, counseling strategies, risk reduction methods, etc.

– Demonstrated ability to effectively apply concepts, techniques, and related learning from case studies, and research.

– Paper must have a logical flow with complete ideas presented, clarity of argument and explanations, and the writing engages the reader.

 

Counseling

Key patient problems

Frequent drinking almost every night with the drinking intensity increasing since the divorce four years ago.

Increasing anxiety and stress from taking care of children, financial issues, dealing with ex-husband, and work responsibilities.

Heavy smoker (smoked for at least 12 years) using 15 to 20 cigarettes every day.

Antisocial behavior by keeping away from social relationships with friends and family.

Depression since the divorce.

Increasing use of benzodiazepine (Zanax) prescribed for the anxiety and stress.

Indications of prescription medication abuse and addiction with benzodiazepine not used as prescribed and alternative sources of medication sourced apart from prescribers.

Has history of child abuse (verbal abuse by mother).

Family history of alcohol abuse by mother.

Has history of cannabis use as a teenager.

Detoxification program was not helpful with her anxiety and depression increasing.

Withdrawal risks identified (disturbed sleep, irritability, anxiety, and tension) and client referred to counseling.

Stages of change for overcoming the alcohol and prescription Zanax addiction

The stages of change are suitable for describing the case details. These stages help in understanding the range of behaviors that the client exhibits as she wants to reverse her addiction but has difficulty in doing so. Through understanding the stages of change that apply to the client, it is possible to present an effective recovery plan that applies person-centered and motivational approaches rather than pathological and confrontational approaches. The client began at the pre-contemplation stage when she ignored the negative effects of the addiction and only focuses on what she perceives as the positive effects. At this stage, she was not ready to change the addictive behavior. This is seen when she drank alcohol after her children had gone to bed, and used alcohol to supplement Zanax. At this stage, the client viewed the Zanax and alcohol addiction as a pleasant and positive experience. However, the negative effects were apparent although she ignored them (such as prescription shopping that could land her in jail and depression), choosing to use more alcohol and prescription Zanax (Hartney, 2019b).

The client moved into the second stage (contemplation) when she became aware of the negative consequences of the addiction and started thinking about changing through quitting, moderating and cutting down on the addictive behaviors. At this point, she was considering changing the addictive behavior, open to listening to information about the negative consequences of the addictive behavior, and learning strategies for addressing the addictive behavior. The contemplation stage concluded when she made the decision to seek treatment for the addictive behavior (Hartney, 2019b).

The client moved into the third stage (preparation) when she started planning and preparing for the treatment for addictive behavior, and carrying out the changes she contemplated. At this point, she planned about the change to be made: cutting down on the alcohol and Zanax, and reducing the harm. Also, she planned on how to make the change: seeking professional treatment to guide her through the treatment process. Besides that, she put support in place by booking a place in a detoxification program. In addition, she sought help from a social worker/counselor to help with the preparation. Once the preparation for treatment was complete, the client moved on to the next stage (Hartney, 2019b) Counseling Essay.

The client moved into the fourth stage (action) when she attempted to overcome the addictive behavior and actively sought to control the behavior. At this stage, she began the real change when she entered the detoxification program where trained professional personnel were on site to support her through the treatment and make informed decisions for therapy when necessary. However, this stage turned out to be more challenging than the client had anticipated, causing her to develop withdrawal symptoms that complicated the treatment effort. Her restlessness, anxiety and depressive symptoms increased, causing the medical personnel to be concerned (Hartney, 2019b).

The trained professional personnel at the detoxification program deemed the withdrawal symptoms dangerous and though it prudent to refer the patient to an intensive outpatient treatment program for additional monitoring. This caused the client to move back into the preparation stage where new treatment options were explored before moving back into the action stage with a new treatment plan being applied with a focus on minimizing the withdrawal symptoms, and addressing the issues that overwhelmed her (Hartney, 2019b) Counseling Essay.

Criteria that supports specific DSM 5 substance use diagnosis

DSM 5 identifies addictive behavior as substance use disorder, noting that the client qualifies for such a diagnosis since she uses alcohol and prescription Zanax in excessive amounts that cause her significant health and life issues to include having difficulties in meeting her home and work responsibilities. In fact, she is diagnosed with severe substance use disorder since she meets eight of the criteria for diagnosis within a 12-month period as presented in DSM 5. Firstly, she has used Zanax and alcohol in a hazardous manner when she was taking care of her children after the divorce thus placing them in a dangerous situation. Secondly, the alcohol and prescription medication use has caused her to experience social problems as she keeps away from social interactions and opts to be on her own. Third, the substance use has caused her to neglect major roles as she fails to meet home and work responsibilities owing to the substance use Counseling Essay. Fourthly, she experienced withdrawal symptoms when she stopped using alcohol and Zanax in the detoxification program. Fifthly, she had built up a tolerance causing her to require more of the substances to get the same effect. Sixthly, she uses larger amounts of the substance for longer periods of time. Seventhly, she spends a lot of her time using the two substances. Eighthly, she had developed psychological issues related to the use to include anxiety and depression (Hartney, 2019a; Sperry, 2016). As a result, the criteria presented in DSM 5 supports the client’s diagnosis as suffering from substance use disorder Counseling Essay.

In addition to the presented criteria, the client’s age of onset of substance use would also be considered since it has implications for the diagnosis. That is because it is significantly associated with psychological problems. To be more precise, the client began drinking alcohol at 21 years of age and Zanax at 24 years of age. This identifies her as a late onset substance user thereby reducing her risk for psychosocial problems in different life areas (when compared to early onset substance use) to include work adjustment, recreation/leisure, peer relationships, family system, psychiatric disorders, and behavior patterns (Poudel & Gautam, 2017).

Questions to ask for in-depth understanding before diagnosis conclusion

What are the patterns of the substances use? Should include longest periods of abstinence from the substances, duration of sobriety, and date of last substance use.

Have you had any legal consequences and/or complications from using the substances? Such as trafficking, selling, arrests and convictions.

Have you had any cravings? As manifested in desires, thoughts and dreams.

Do your parents, siblings, friends, ex-husband use the same substances? Probes for the types of substances use since this could be an important problem indicator Counseling Essay.

Have you had any interruptions in social (home) and professional (work) history from substance use? Explanation required.

What is your work/occupational history? Probes for source of finances linked to the substances use, such as stealing, skimming from family accounts, and participating in the commercial sex industry.

Do you have a citation/arrest history caused by substance use? Such as probation, incarceration, and legal infraction.

Conclusion

One must accept that psychotherapy offers an opportunity for understanding and intervening in psychiatric issues. In addition, one must acknowledge that substance use disorder is a generalized diagnostic term that characterizes the excessive and uncontrollable use of chemical substances to include prescription medication and alcohol. Besides that, it is clear that persons with substance use disorder go through different stages of change that include pre-contemplation, contemplation, preparation and action stages. Still, there is a need for DSM 5 criteria to be applied to ensure that the correct diagnosis is presented. Also, age should be considered as it has implications for associated psychological problems and eventual diagnosis. Additionally, leading questions should be asked to understand patterns of use, relevant family history, and professional and social effects as they have implications for the implications. These issues have been discussed in the present case to show the complexities of diagnosis substance use disorder Counseling Essay.

References

Hartney, E. (2019a).
The 11 official criteria for addiction/substance use disorder
. Retrieved from https://www.verywellmind.com/what-are-the-official-criteria-for-addiction-22493 Counseling Essay

Hartney, E. (2019b).
The stages of change model of overcoming addiction
. Retrieved from https://www.verywellmind.com/the-stages-of-change-model-of-overcoming-addiction-21961

Poudel, A. & Gautam, S. (2017). Age of onset of substance use and psychosocial problems among individuals with substance use disorders.
BMC Psychiatry
, 17, 10. Retrieved from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1191-0

Sperry, L. (2016).
Handbook of diagnosis and treatment of DSM-5 personality disorders:
assessment, case conceptualization, and treatment
(3
rd
ed.). New York, NY: Routledge Counseling Essay.

Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay

Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

BUY A PLAGIARISM-FREE PAPER HERE

Students will:

• Analyze salient ethical issues in psychiatric mental health practice

• Compare ethical dilemmas with state health laws and regulations

• Analyze ethical decision-making processes

To prepare:

• 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.

Write a 2-page paper in which you do the following:

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

• Describe the moral and ethical dilemmas surrounding the issue Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

• 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.

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

 

Summary of the Moral/Ethical Issue

Confidentiality is key to maintaining the therapeutic relationship that exists between patients and mental health practitioners. It is for this reason that as healthcare providers, they are required to value privacy and confidentiality as a patient’s basic right by not sharing a patient’s medical data to unauthorized persons or without a client’s consent. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay Except for legal situations, while the law considers confidentiality to be absolute, there are unavoidable yet ethical clinical scenarios where confidentiality may be breached. In mental health practice, confidentiality as an ethical principle is defined as only availing patient information to authorized persons with a patient’s informed consent.

The Ethical/Moral Dilemma Surrounding The Issue

The case scenario as presented by Jie (2015) involved a 57-year-old male patient who was diagnosed with aggressive end-stage prostate cancer. The shared with a nursing staff his attempt to commit suicide and requested the nursing staff not to share with other healthcare providers. This positioned the nursing staff in a difficult scenario where she had to decide between mutually exclusive options. The nursing staff had two morally upright choices to make: to remain silent as requested by the patient or to share the information with staff and prevent a suicide attempt. If she decides to remain silent as requested by the client, the patient’s decision will be respected. However, this decision may result to harm as the patient may commit suicide without any interventions. On the other hand, should the nursing staff share this information with other healthcare providers, through teamwork, the patient would be closely monitored to prevent suicide? However, his confidentiality and autonomy would be violated. The major ethical dilemma is if or not the nurse should share with colleague staff members on the client’s suicide attempt without his consent.

Ethical Issue In Comparison to State Health Laws And Regulations

The state health laws and regulations require all healthcare providers to focus on decisions and actions which benefit patients. This implies that healthcare professionals are only obligated to take positive actions which promote the wellbeing and health of patients. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay Despite being required to maintain confidentiality, there are specific exceptions which are considered ethical and acceptable to breach patient confidentiality by the law (Barnhorst, Wintemute & Betz, 2018). Most of these exceptions involve circumstances which can easily result in personal harm, harm to society or another person. The HIPAA law allows healthcare providers to disclose protected health information (PHI) when it can help to either reduce or prevent an immediate threat to themselves, a family member or anyone in the public. Similarly, the state law requires that confidentiality can be broken and mandatory reporting done in cases that involve self-harm or harm to the public to safeguard individuals (Barnhorst, Wintemute & Betz, 2018).  Therefore, based on state laws, the nursing staff had to do take steps that would promote and maintain the patient’s health. Mandatory reporting to the relevant authority or sharing with staff would be the best choice Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

Process of Ethical Decision Making To Address This Ethical Dilemma

Mental health practitioners have an ethical, legal and professional role of safeguarding patient privacy and confidentiality except for specific legal situations or when found incompetent by a judge. When comparing the two choices that the nurse staff had to make based on a nurse’s ethical-legal roles and the state laws, the choice to maintain confidentiality would be of no essence and the patient could have probably committed suicide (Hiriscau et al., 2014). This decision only benefits the patient and satisfies his desire to die. On the other hand, it could negatively impact healthcare staff and family members. However, the decision to share with third parties such as staff as required by law could promote avoidance and prevention. This could be of significance to the patient, his family and healthcare providers. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

References

Barnhorst, A., Wintemute, G., & Betz, M. E. (2018). How should physicians make decisions about mandatory reporting when a patient might become violent?. 
AMA journal of ethics
, 
20
(1), 29-35.

Elger, B. S., Handtke, V., & Wangmo, T. (2015). Informing patients about limits to confidentiality: a qualitative study in prisons. 
International journal of law and psychiatry
, 
41
, 50-57 Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

Hiriscau, I. E., Stingelin-Giles, N., Stadler, C., Schmeck, K., & Reiter-Theil, S. (2014). A right to confidentiality or a duty to disclose? Ethical guidance for conducting prevention research with children and adolescents. 
European child & adolescent psychiatry
, 
23
(6), 409-416.

Jie, L. (2015). The patient suicide attempt–An ethical dilemma case study. 
International Journal of Nursing Sciences
, 
2
(4), 408-413. Practicum Journal Entry: Analyzing an Ethical Decision Case study Essay.

Relationship between the clinical nurse educator and the clinical environment Essay

What is the relationship between the clinical nurse educator and the clinical learning environment? What strategies will enhance the relationship? What factors might detract from the relationship?

What are the clinical educator’s responsibilities to the clinical agency:

1. regarding students?

2. regarding patients?

3. regarding staff (professional and support staff)?

4. regarding administration?

What factors must be considered in selecting clinical experiences? How do these factors relate to planning your practicum experiences with your own clinical faculty preceptor and their students?

Please see the attachment of the article in the file and textbook to use for this class Relationship between the clinical nurse educator and the clinical environment Essay

BUY A PLAGIARISM-FREE PAPER HERE

Nurse education

What is the relationship between the clinical nurse educator and the clinical learning environment?

Clinical nurse educators have the responsibility of enhancing the clinical learning environment to present efficient and competent graduates. This occurs through making good preparation of the environment so that students’ anxiety and fear is reduced thus enabling them to make fewer mistakes within the environment (Farzi, S., Shahriari & Farzi, S., 2018). Additionally, educators are responsible for creating a positive environment that helps students to visualize future success, tailoring the teaching relationship to the learner, being curious about the student and his/her interests, using anecdotes to form closer relationships, creating safe settings to discuss occurrences that include mistakes, and offering clarity concerning mistakes and expectations (Koharchik & Redding, 2016).

What strategies will enhance the relationship?

Strategies to enhance the relationship include ensuring that the clinical nurse educators have adequate clinical expertise, reasonable clinical evaluation is applied, and the environment offers a proportional balance between the number of faculty facilities, educators and students. Besides that, a pleasant atmosphere should be created to include appropriate behavior of educators with students, and ensuring that the students are not neglected so that participants’ willingness to learn and teach is enhanced (Farzi, S., Shahriari & Farzi, S., 2018).

What factors might detract from the relationship?

There are five factors that could detract from the relationship. Firstly, fear of failure and criticism can cause clinical nurse educators to be stressed and make mistakes. Secondly, insufficient readiness of the educators (inadequate mastery of teaching skills and cognitive components of learning, and insufficient self-confidence) that disturb the environment. Thirdly, unpleasant atmosphere of clinical environment from inappropriate behavior of educators as they neglect the environment resulting in reduced willingness to learn and teach (Farzi, S., Shahriari & Farzi, S., 2018).

What are the clinical educator’s responsibilities to the clinical agency:

regarding students?

They have the responsibility to train students in nursing skills, prepare nursing students for successful change out of academia, empower students to thrive in the nurse profession once they graduate, and improve the systems intended to uphold nursing education. In addition, educators determine educational standards and curriculum applicable to the students to include assessing educational outcomes, advising and teaching students, coordinating clinical placements, and curriculum building and improvement Relationship between the clinical nurse educator and the clinical environment Essay. Also, the tailor the teaching relationship to the learner to ensure that the learner is offered the best opportunity to acquire knowledge. Overall, educators uphold and improve structure and systems upon which nursing education rests through continuously creating new and innovative ways to approach the education process (Billings & Halstead, 2016).

regarding patients?

They ensure that the nursing workforce taking care of the patients has current and accurate attitudes, skills and information required to offer efficient and effective care for patients across their entire lifespan. Also, they teach patients how to navigate the health landscape and assist in life-care planning. Besides that, they provide patient care.

regarding staff (professional and support staff)?

They coach other medical personnel on how to offer services that support patient care and recovery efforts. Also, they consult in expert capacities to ensure that the appropriate care is provided. Besides that, they coordinate continuing education, coordinate clinical placement and offer mentoring services (Billings & Halstead, 2016) Relationship between the clinical nurse educator and the clinical environment Essay.

regarding administration?

They consult in forensic and legal capacities. Also, they work towards policy improvement within the institution that making change recommendations supported by current evidence. Besides that, they create new and innovative way to manage health care, and streamline processes. In addition, they uphold and improve administrative structures and systems (Billings & Halstead, 2016).

What factors must be considered in selecting clinical experiences?

There are five factors that must be considered in selecting clinical experiences. The first factor is role acceptance that emanates from socialization with the intention of helping the student to gain a professional identity with regards to coping with organizational and professional commitment, and professional roles. The second factor is clinical supervision that centers on the workload of medical personnel and how it affects their attitudes towards students’ supervision and clinical learning. The third factor is organizational support and resources, with a focus on communication, equipment, procedures, and materials. The fourth factor is teaching and guiding support as offered by preceptors and lecturers. The final factor is clinical stress and anxiety, a psycho-social issue that affects wellbeing and educational process (Gaberson, Oermann & Shellenbarger, 2015). Relationship between the clinical nurse educator and the clinical environment Essay.

How do these factors relate to planning your practicum experiences with your own clinical faculty preceptor and their students?

The identified factors relate to planning practicum experiences since the practicum experience is an on-going systematic process. Through creating a favorable environment with regards to the identified factors, a student is able to receive encouragement and support in professional practice. In fact, the factors help students in identifying what they want so that they engage the clinical faculty preceptor in an ideal and supportive mentorship that helps with educational preparation and positive attitude. This helps the student in being matched to the best practicum site while increasing professional independence, socialization and self-confidence (Gaberson, Oermann & Shellenbarger, 2015) Relationship between the clinical nurse educator and the clinical environment Essay.

 

References

Billings, D. M. & Halstead, J. A. (2016).
Teaching in nursing: a guide for faculty
(5
th
ed.). St. Louis, MO: Elsevier.

Farzi, S., Shahriari, M. & Farzi, S. (2018). Exploring the challenges of clinical education in nursing and strategies to improve it: A qualitative study.
Journal of Education and Health Promotion
, 7, 115. DOI: 10.4103/jehp.jehp_169_17

Gaberson, K., Oermann, M. & Shellenbarger, T. (2015).
Clinical teaching strategies in nursing
(4
th
ed.). New York, NY: Springer Publishing Company.

Koharchik, L. & Redding, S. (2016). Strategies for successful clinical teaching.
American Journal of Nursing
, 116(7), 62-65. Relationship between the clinical nurse educator and the clinical environment Essay.

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

Legal and ethical considerations

How legal and ethical considerations for group and family therapy differ from those for individual therapy.

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Therapy is typically dependent on the description of the clients and their expectations. In fact, this difference can be noted for individual and group/family therapies owing to the distinctions of their position level in community structures. All therapies apply professional psychotherapeutic principles to solve existing psychiatric and mental problems. However, unique differences exist with regards to their legal and ethical considerations (Sadock, B., Sadock, V. & Ruiz, 2014). In this respect, differences exist between individual and group/family therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

There are three notable ethical differences between the two types of therapies. The first ethical difference is the professional qualifications of therapists who provide their services. On one hand, individual therapy is a general expectation for all therapists. On the other hand, group/family therapy requires that the therapist first undergo training to provide individual therapy before undergoing additional training to provide group and family therapy. This means that the therapists providing services for the two types of therapies are ethical expected to meet the different qualification expectations for practice (Wheeler, 2014). The second ethical difference is that for individual therapy, an informed consent can be expected to express the client’s true sentiments in terms of voluntarily attending the therapy. The same cannot be said for family/group therapy where the realities of social structures create the possibility of some of the members being coerced into attending the therapy. This implies that therapists providing family/group therapy must consider the possibility that some of the members may have been coerced into attending the therapy and would not participate fully or support the therapy exercises. This is particularly an issue of consideration where there are glaring power and authority differences such as children being coerced into attending family therapy by their parents (Whitaker & Cosgrove, 2015). The third ethical difference is that confidentiality would not be much of a concern in individual therapy, but that may not be the case with family/group therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment. That is because the members are not obligated to keep any disclosures made in the therapy sessions confidential. This is an ethical concern that therapists must consider when dealing with group/family therapies since they cannot offer any guarantees that the information that any member discloses will not be exposed outside the group (Cautin, & Lilienfeld, 2015).

In addition to the three ethical concerns that have been discussed, legal difference also exist between the two types of therapies. Firstly, therapists providing psychiatric services must be licensed and certified to provide these services. This would define their scope of practice and geographical area of operation that would typically be defined in terms of states. These licenses and certifications are periodically issued by recognized organizations after ascertaining that the individual is qualified to offer the services (Cautin, & Lilienfeld, 2015). Secondly, therapists are expected to keep all information confidential as indicated by HIPAA legislation. This means that the information can only be used under express permission of the client and for therapy purposes. Therapists who breach the legislation risk facing legal sanctions that could range from their licenses being withdrawn to fines and incarceration (Wheeler, 2014). As a result, therapists should be aware of the legal and ethical considerations when providing their services. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

How the differences might impact your therapeutic approaches for clients in group and family therapy.

The differences noted in the legal and ethical considerations can influence therapeutic approaches for group/family therapies in a number of ways. Firstly, the therapist should meet the licensure and certification requirements to practice, while ensuring that all documentation is current. Secondly, the therapist should consider the possibility that some group/family members could be coerced to attend therapy thus influencing their participation and therapy outcomes. Finally, information security measures should be implemented on how to handle client information in terms of secure storage and use to conform to HIPAA requirements.

References

Cautin, R. & Lilienfeld, S. (2015).
The encyclopedia of clinical psychology, volume II Cli-E
. Hoboken, NJ: John Wiley & Sons.

Sadock, B., Sadock, V. & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatr
y (11
th
ed.). Philadelphia, PA: Wolters Kluwer. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

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

Whitaker, R. & Cosgrove, L. (2015).
Psychiatry under the influence: institutional corruption, social injury, and prescriptions for reform
. New York, NY: Palgrave Macmillan.

 

 

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Considering the Health Insurance Portability and Accountability Act (HIPPA), the idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential. For this Discussion, consider how limited confidentiality and other legal and ethical considerations might impact therapeutic approaches for clients in group and family therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Learning Objectives

Students will:

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

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

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

To prepare:

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

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

By Day 3

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

 

The Group Psychologist
|
April 2011

Group Psychotherapy Column

Procedures and guidelines for group therapy

Detailed procedures and rules members of group therapy must adhere to.

By
John Breeskin, PhD, ABPP

Confidentiality

Anything said between any two or more group members at any time is part of the group and is confidential.
I understand that everything said in group is confidential. I agree to keep secret the names of other members of the group and what is said in the group. I agree to keep secret anything which occurs between or among group members. I understand that there is an exception to this confidentiality which applies to the group leader. If the group leader believes that someone is in danger, the leader has a professional obligation to take direct action in order to keep everyone safe.

I agree not to keep secret from the group anything which occurs within the group. Anything which occurs between or among any members is part of the group is kept secret from anyone outside of the group but is not kept secret from the group. This also applies to any individual meetings you may have with a group leader. I understand that if I violate this confidentiality I could be removed from the group. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Privacy (The Stop Rule)

No group member is ever required to answer any question, to participate in any activity, or to tell anything. If I am asked questions or asked to participate in an activity which makes me feel uncomfortable, I understand that I have the right to pass, that is, the right to refuse. I agree that will never pressure other group members to participate in any discussion or activity after the member has passed or refused. I understand that the group leader is obliged to protect this right. I also understand that I will benefit more from group the more I am able to take risks in sharing and participating.

Dignity

No group member is ever humiliated, hazed, or abused in any way. I agree to avoid this destructive behavior.

Violence or intimidation

Violence or intimidation toward other group members is never tolerated. I understand that I must never be violent or intimidating toward other group members and that if I threaten to harm persons or property I will be asked to leave the group. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Alcohol and Other Drugs

Group members cannot participate in the group under the influence of alcohol or other mind altering drugs. When under the influence of chemicals, persons do not have access to their emotions and have less control over their behavior. I understand that if the leader believes that I am under the influence of alcohol or other drugs, I will be asked to leave the group.

Exclusive relationships

Dating and other exclusive relationships between or among group members are not a good idea. The relationships can make other group members feel left out. When a couple breaks up, for example, this can be most painful and may make it impossible for these people to continue in the group. Since anything which occurs between or among group members is part of the group, members who are dating or in very exclusive relationships may be embarrassed when their intimate moments are discussed in the group.

Gossip

Gossip and secret grudges can be very destructive in a group. I agree that if I have something to say to another group member, I will try to say it to the member directly rather than talk about him/ her behind his/her back.

Attendance

I agree that I will attend every meeting unless an emergency arises. If an emergency should arise I will notify the group leader prior to the meeting to tell him or her that I will be unable to attend. I understand that the group leader will tell the group what has happened. I understand that if I have three unexcused absences, my continued group membership will be discussed. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Internet Connectivity

I feel very strongly that the members of the group should form and participate in an online group limited to the group members. Of course, the same cautionary notes apply to the internet communications in terms of both confidentiality and inter-group sharing. (I have used this model very successfully, and it significantly enhances a healthy form of interconnection.)

Responsibilities

I understand that it is the group leader’s responsibility to enforce these procedures and guidelines. The group may, when it wishes, propose other procedures and guidelines which will be up to the group to monitor.

Termination

Usually, group members decide, within the group, with the leader, when it is time to leave the group. Sometimes it is necessary for a group member to leave the group unexpectedly. This can cause group members to wonder if they have harmed the leaving member. I promise that if I must leave the group unexpectedly, I will come to a last group meeting and tell the members that I am leaving and say goodbye. I agree to announce this at the beginning of the last meeting so that the group has time to ask questions and say goodbye. If I decide to leave the group the group members may express their concerns but also respect the decision of the person wishing to leave. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

I have read the procedures and guidelines for group and agree to be bound by them while I am a member of the group

_____________________         ____________

Group Member                         Date

I promise to faithfully enforce procedures and guidelines for this group.

____________

Date

JB

Group Leader

 

Discussion: Legal and Ethical Considerations for Group and Family Therapy

Comparison of legal and ethical considerations for group and family therapy to legal and ethical considerations for individual therapy

In individual therapy, informed consent involves explaining to the client about the treatment and all for the client to decide whether to take part in the therapy or not. On the other hand, in group therapy and family therapy informed consent involves presenting essential information regarding the group treatment to individuals to ensure that they are in a position to rationally decide whether to take part in the group and how to participate (Cooper et al, 2017).  This indicates that informed consent in group/family therapy is relatively different when compared to informed consent in individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

In individual therapy confidentiality and privacy are not a major issue because only the client and the therapist are involved. However, in both group and family therapy, confidentiality and privacy issues become a challenge. For example, in group therapy, there is more than one client and during the therapy group members may discuss and reveal their diagnosis, treatment and other issues. The confidentiality and privacy of such information is hence disclosed to all group members (McClanahan, 2014). Similarly, in family therapy, the therapist may be forced to keep quite on some issues, due to the promises the therapist made in good faith. One family member may reveal some vital information, that they may not want the other party to know (Breeskin, 2011). This brings in confidentiality and privacy issues not present in individual therapy. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

The aspect of neutrality and dual relationships is common in family therapy (Laureate Education, 2015). While in individual therapy the therapist is only handling a single client, during a family therapy the therapist handles more than one party and hence the issue of neutrality and dual relationships may arise (Bellesheim, 2016). For example, family members may be having conflicting issues they want addressed. Therapists may hence find themselves in an ethical dilemma regarding their role on conflicting issues of family members.

Impact of the Differences on Therapeutic Approaches

These differences render therapeutic approach more complex and challenging. For example, obtaining an informed consent in group therapy and family therapy is more complex and comprehensive and hence consumes a lot of time (Cooper et al, 2017). In addition, some parties may refuse to take part in the therapy, for instance in family therapy and this leaves the therapist in an uncomfortable situation regarding what to do.  Secondly, confidentiality may be difficult to maintain in family and group therapy because there are more parties involved (Bellesheim, 2016). At times confidentiality and privacy may be breached by one of the group or family member, which eventually impacts the therapeutic approach; for instance, some members may become very affected due to confidentiality breach while some may even terminate treatment. Finally, since maintaining neutrality may be challenging in a family therapy, often the therapist may face a dilemma on the action to take which may slow and even hinder the therapy (Bellesheim, 2016). NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment.

Strategies to address the Legal and Ethical Considerations

Always have the group members read, understand and sign a document detailing procedures and rules for members of group therapy (Breeskin, 2011).

The therapist should always set and maintain group therapy rules

Any client who attempts to or actually breaches the set rules should have an appropriate action taken such as being referred for individual therapy

The group members need to be educated regarding confidentiality and privacy to ensure they are well versed and minimize the risk of breaching confidentiality

Zero tolerance to rule violation NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

The therapist should model the required behaviors, for instance by maintaining the confidentiality of the client’s information (Riva & Erickson, 2018).

References

Bellesheim K. (2016). Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals with Serious Mental Illness.
Ethics & Behavior .
26(7), 607-620.

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

Cooper E, Hudson J, Marti K & Lise M. (2017). The Future of Group Therapy: Current and Future Challenges in Group Therapy. International Journal of Group Psychotherapy . 47(1), S219-S239.

Laureate Education. (2015).
Microskills: Family counseling techniques 2 [Video file]
. Baltimore, MD: Laureate Education. NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-

Riva, M & Erickson J. (2018).
Ethical Considerations in Group Psychotherapy
. In M. Leach & E. Welfel (Eds.),
The Cambridge Handbook of Applied Psychological Ethics
(Cambridge Handbooks in Psychology, pp. 218-238). Cambridge: Cambridge University NURS 6650 Week 1: Legal and Ethical Considerations for Group and Family Therapy Discussion Essay Assignment

Cognitive Versus Rational Emotive Behavioral Theory

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.

Explain at least three differences between CBT and REBT. Include how these differences might impact your practice as a mental health counselor.

Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature. Cognitive Versus Rational Emotive Behavioral Theory.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

ORDER A PLAGIARISM-FREE PAPER HERE

Similarities and Differences between CBT and REBT

Introduction

           
In psychotherapy, the term Cognitive Behavioral Therapy (CBT) has almost become a generic term for Rational Emotive Behavioral Therapy (REBT) and Cognitive Therapy (CT). According to Ellis (2003), “it is almost impossible to describe accurately … [as] it has now become much more eclectic and integrative ….” (p. 225). Corey (2017) confirms this inclusive nature of CBT by stating that “One of the most common CBT group approaches is based on REBT principles and techniques” (p. 279). Cognitive Versus Rational Emotive Behavioral Theory For this reason, some authorities seem to use the terms CBT and CT synonymously and interchangeably (Corey, 2017). This paper looks at the similarities and differences between REBT and Cognitive Behavioral Therapy (CBT/CT). The former was independently developed by Albert Ellis in the same period that the latter was being developed by Aaron T. Beck (Corey, 2017).

Similarities between CBT and REBT

CBT and REBT as psychotherapy options share quite a number of similarities. Both are types of behavior therapy that encourage patients to work on their thoughts between therapy sessions, at home. This makes both REBT and CBT use “specific homework assignments” that are given to the patient/ client to go work on and accomplish (Ellis, 2003, p. 229). Both therapies also hold that the way people express their behavior outwardly is the consequence of their own perceptions and beliefs. Furthermore, they also both require the patient or client to identify their problem themselves (Corey, 2017). CBT and REBT both focus on educating the patient and enabling them to work on prevention of presently held negative thoughts influencing future behavior and emotions (Ellis, 2003; Corey, 2017). CBT and REBT also both stress the significance of “irrational or dysfunctional beliefs in the creation of emotional disturbance ….” (Ellis, 1999, p. 5; Iftene et al., 2015). In all, both REBT and CBT advocate for a healthy and “friendly, caring therapist-client relationship” (Ellis, 2003, p. 228). Cognitive Versus Rational Emotive Behavioral Theory.

Three Differences Between CBT and REBT

According to Ellis (2003), CT takes “a collaborative stance” between therapists and clients. REBT, on the other hand, emphasizes more on the therapist teaching the client and the latter absorbing and implementing what they are taught. The major underpinning hypothesis of REBT is that “people contribute to their own psychological problems … [and] specific symptoms” because of what they hold to be true in their own minds (Corey, 2017, p. 271). CBT/ CT on the other hand, is “based on empirical research” and uses evidence-based and tested methods (Corey, 2017, p. 281) Cognitive Versus Rational Emotive Behavioral Theory. The third difference between the two is that on the one hand, REBT aims to make the patient or client identify long-held beliefs and thereafter systematically disabuse them of the same through education. On the other hand, CBT does not consider the client’s negative beliefs as the only cause of symptoms; but also “genetic, neurological, or environmental changes” (Corey, 2017, p. 282). These differences, therefore, may impact my practice as a mental health counsellor in that I’ll have to make an informed choice of behavior therapy to use between the two on a case-by-case basis Cognitive Versus Rational Emotive Behavioral Theory.

Preference for Cognitive Therapy (CT)

Although both psychotherapy modalities are effective and widely accepted, my preference would be CBT. This is because it is based on tested practical evidence that is scientific and can be quantified and replicated (Corey, 2017). Evidence-based therapies (EBT) are currently the gold standard across all levels of medical practice.

Summary

           
REBT and CBT/ CT are alternative forms of behavior therapy that were developed independently at approximately the same time. The former uses philosophical tenets while that latter takes an empirical evidence-based approach. Both are however similar in many ways and significantly impact the practice of the mental health counselor.  

References

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

Ellis, A. (1999). Rational emotive behavior therapy and cognitive behavior therapy for elderly people.
Journal of Rational-Emotive & Cognitive-Behavior Therapy, 17(1)
, 5-18. DOI: 10.1023/a:1023017013225

Ellis, A. (2003). Similarities and differences between rational emotive behavior therapy and cognitive therapy.
Journal of Cognitive Psychotherapy: An International Quarterly, 17(3)
, 225-240. DOI: 10.1891/jcop.17.3.225.52535

Iftene, F., Predescu, E., Stefan, S., & David, D. (2015). Rational-emotive and cognitive-behavior therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy in the treatment of major depressive disorder in youth: A randomized clinical trial.
Psychiatry Research, 225
, 687–694. DOI: 10.1016/j.psychres.2014.11.021 Cognitive Versus Rational Emotive Behavioral Theory

Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Introduction

A psychiatric emergency is a disturbance of behaviour, mood, or thought which may lead to harm to the individual or others if untreated (Sadock, Sadock, & Ruiz, 2014).  In both pediatric and adult psychiatric emergencies, the clinician must ensure the safety of everyone involved.  A complete assessment should be performed.  Goals of the psychiatric emergency assessment are to determine whether client poses a risk of harm to self or others, confirm the presence of a psychiatric disorder, and determine factors that may have lead to the issue. It is also essential to determine how the illness has impaired the client’s normal level of functioning, identify the client’s strengths, target the problems for treatment, and determine the level of care the client requires (Carandang, Gray, Marval-Ospino, &MacPhee, 2012). Suicidal behaviours are one of the most common pediatric psychiatric emergencies. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Description of Adult Psychiatric Emergency Case

Working and doing my practicum in an acute psychiatric hospital, I have cared for many adults with psychiatric emergencies.  In my last rotation, a 30-year-old Caucasian female with suicidal ideations with a plan to overdose presented to the facility for evaluation.  She reported feeling overwhelmed due to (a) a recent separation from her husband, (b) becoming a single mother, and (c) struggling financially.  The client used a wheelchair due to a motor vehicle accident and felt she was a burden to her family.  A therapist assessed her, and the psychiatrist on call admitted the client with a diagnosis of major depressive disorder. Laboratory testing included a complete blood count, comprehensive metabolic panel, thyroid stimulating hormone level, magnesium level, phosphorous level, urine drug screen, urine pregnancy test, and pharmacogenetic testing for psychiatric medications.  After less than an hour on the adult unit, the client stated she wanted to go home and filled out paperwork requesting release. The client was placed on a 72-hour hold. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.  An initial psychiatric evaluation was performed by the psychiatric mental health nurse practitioner later in the day, and the client was started on an antidepressant.  The client’s level of observation was downgraded to the line of sight after 24 hours then to every 15-minute checks the following day.  She received daily group psychotherapy, weekly individual psychotherapy, and evaluated by either a psychiatric mental health nurse practitioner or a psychiatrist daily.  Appointments for follow-up care were made, and the client was discharged home after 16 days in the facility. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

How a Child or Adolescent Would Be Treated Differently

If a pediatric client were to present with suicidal ideations with a plan, information would be gathered from both the parent or guardian and the child to form the diagnosis.  Laboratory testing would be the same as for the adult client except pregnancy testing; males and females below childbearing age would not require pregnancy testing (Lewandowski et al., 2013).  The psychiatric evaluation would be the same but may require the clinician to use simple words.  Children and adolescents would be asked about bullying at school or on social media and academic difficulties.  The child or adolescent would take part in family therapy sessions as a successful treatment of suicidality in the pediatric population is more likely to involve a family component (Lewandowski et al., 2013).  Selective serotonin reuptake inhibitors are the first-line medication for pediatric clients with moderate to severe depression. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

Ethical Issues

The treatment of children and adolescents requires the consent of their parents or guardians.  Each time a medication is changed, increased, or decreased consent from a parent or guardian must be obtained (Sadock, Sadock, & Ruiz, 2014).  Ethically, the clinician must recognize that children and adolescents must play a part in their treatment and obtain the assent of the minor whenever possible.

References

Carandang, C., Gray, C., Marval-Ospino, H., MacPhee, S. (2012). Child and adolescent psychiatric emergencies. In J. M. Rey (Ed.), 
IACAPAP e-textbook of child and adolescent mental health 
(pp.1-31). Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/J.1-EMERGENCIES-072012.pdf

Lewandowski, R. E., Acri, M. C., Hoagwood, K. E., Olfson, M., Clarke, G., Gardner, W., …& Frank, S. (2013). Evidence for the management of adolescent depression. 
Pediatrics
, 
132
(4), e996-e1009. doi:10.1542/peds.2013-0600

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. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay.

 

Week 6: Emergency Psychiatric Care in Childhood and Adolescence

”I can’t believe I am not dead. I want to be dead, but those pills did not work as fast as I expected. Dad found me and called 911. I cannot go on living after what they said about me on the Internet. My life is ruined and I cannot go back to school or even show my face around here. They all think I am that way, but I am not. Dad thinks this was a mistake, but he is wrong. When I get out of here, I am going to try something different, and this time it will work.”

Jessica, age 13

When psychiatric emergencies arise, they can present many challenges to the PMHNP. While there are many approaches to emergencies that are similar, there are also significant differences when dealing with children and adolescents versus adults. This is particularly true with coordination of care, availability of resources, and legal implications of the psychiatric emergency. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

This week, you examine psychiatric emergencies that arise during childhood and adolescence and compare how those emergencies are assessed and treated to those of adult clients.

Photo Credit: ijubaphoto / iStock / Getty Images Plus

Learning Resources

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

Required Readings

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.

Chapter 23, “Emergency Psychiatric Medicine” (pp. 785–790)

Chapter 31, “Child Psychiatry” (pp. 1226–1253)

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

“Bipolar and Related Disorders”

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

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Reversal of benzodiazepine effects

flumazenil

Aggression

Behavioral problems

Cataplexy syndrome

clozapine

propranolol

zuclopenthixol

aripiprazole

asenapine

chlorpromazine

haloperidol

iloperidone

lurasidone

olanzapine

paliperidone

quetiapine

risperidone

ziprasidone

clomipramine

imipramine

sodium oxybate

Catatonia

Extrapyramidal side effects

Mania

alprazolam

chlordiazepoxide

clonazepam

clorazepate

diazepam

estazolam

flunitrazepam

flurazepam

loflazepate

lorazepam

midazolam

oxazepam

quazepam

temazepam

triazolam

benztropine

diphenhydramine

trihexyphenidyl

alprazolam (adjunct)

aripiprazole

asenapine

carbamazepine

chlorpromazine

clonazepam (adjunct)

iloperidone

lamotrigine

levetiracetam

lithium

lorazepam (adjunct)

lurasidone

olanzapine

quetiapine

risperidone

sertindole

valproate (divalproex)

ziprasidone

zotepine

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.” Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Optional Resources

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)

Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)

Discussion: Treatment of Psychiatric Emergencies in Children Versus Adults

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations.

In this week’s Discussion, you compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients.

Learning Objectives

Students will:

Compare treatment of adult psychiatric emergency clients to child or adolescent psychiatric emergency clients

Analyze legal and ethical issues concerning treatment of child or adolescent psychiatric emergency clients

To Prepare:

Review the Learning Resources concerning emergency psychiatric medicine.

Consider a case where your adult client had a psychiatric emergency. (Note: If you have not had an adult client with a psychiatric emergency, ask your preceptor to describe one of their clients with a psychiatric emergency to use as an example for this Discussion.) Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

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

By Day 3

Post:

Briefly describe the case you selected.

Explain how you would treat the client differently if he or she were a child or adolescent.

Explain any legal or ethical issues you would have to consider when working with a child or adolescent emergency case. Treatment of Psychiatric Emergencies in Children Versus Adults Discussion Essay

Case Study: An African American Child Suffering From Depression

Therapy for Pediatric Clients with Mood Disorders

Introduction

Pediatric Mental health problems ranging from depression to bipolar disorder are known as mood disorders, or affective disorders.    Recent studies have shown a correlation between  affective disorders in children, and depression or anxiety disorders in the adult years. It is suggestive that the onset of adult psychopathologic disorders can be linked to behavioral or emotional symptoms displayed as  a child or adolescent.(Medscape, 2018). Case Study: An African American Child Suffering From Depression.

ORDER A PLAGIARISM-FREE PAPER HERE

Mood disorders in children remain one of the most under diagnosed health problems. Mood disorders that go undiagnosed can put kids at risk for other conditions, like disruptive behavior and substance use disorders, that remain after the mood disorder is treated. Children and teens with a mood disorder don’t always show the same symptoms as adults. So it can be difficult for parents to recognize a problem in their child, especially since he or she may not easily express his or her thoughts or feelings.(chop,2018).  Treatments vary depending on the symptoms of the depression. Treatment is aimed at decreasing the signs of the illness. In order to properly treat a patient, there needs to be a complete assessment , past mental health history, psychological therapies and pharmacological interventions should be part of the treatment plan.

The purpose of this assignment is to discuss mood disorders and its effect on children and treatment options available.

Summary of patient

The patient is an 8 year old African American male with chief complaints of feeling “sad, withdrawn, decreased appetite and occasional irritation. Upon assessment the child is alert and oriented x 3, overall mood is sad. He denies visual or auditory hallucinations, however, admits to thinking about himself being dead. The Children’s Depression rating scale is 30, translates to significant depression. The CDRS was devised by Poznanski, Cook, and Carroll in 1979, to diagnose depression in 6- to 12-year-olds.(Poznanski,1986). Case Study: An African American Child Suffering From Depression.

Decision 1

Options:  Sertraline 25mg by mouth daily, Paxil 10 mg by mouth daily and Wellbutrin 75mg by mouth 2x/daily

I chose Sertraline 25 mg by mouth daily. Studies have shown that Sertaline is appropriate for treating depression in young children.”(SSRIs) have a relatively good response rate (40-70%)”(p.7). Paxil   is contraindicated for children younger than 18 and Wellbutrin is contraindicated as well. Wellbutrin has other risks for anorexia and seizures (p.16). The initial goal of treatment of mood disorders is a decrease in symptoms. The outcome of treatment was not as I expected , I expected a minimal reduction in symptoms. However, the client reported no change in symptoms.

Decision 2

Options: Prozac 10 mg by mouth daily, Sertraline 37.5 mg by mouth daily, Sertraline 50 mg by mouth daily

I chose to increase the Sertraline to 50 mg  by mouth daily. Sertraline is appropriate for treating children and the dosage can be titrated to up 200 mgs (p.18). The 25 mg dose might not be the right therapeutic dose and  to give it more time to become effective. I did not pick Sertraline 37.5 because it is below the therapeutic  dose suggestion. The reason for not choosing Prozac 10 mg by mouth daily, is to stay with the current medication and titrate up till symptoms decrease and client does not report depression symptoms. The goal of treatment is  to have a reduction in symptoms. The results were some of what I expected, I did not expect a 50% reduction in depressive symptoms. Case Study: An African American Child Suffering From Depression.

Decision 3

Options:  Maintain current dose, change to SNRI, or Increase to Sertraline 75 mg by mouth daily

My choice is to maintain the current dose. Stahl (2013) has mentioned that a 50% reduction in symptoms after treatment with an antidepressant is a “response”. If there is a positive response to a medication it is best to maintain that current treatment. There reason I did not chose the other two options was because the client had a 50% reduction in symptoms without any further symptoms. The goal is for the client to respond positively to medication leading to complete reduction of symptoms. The outcome was as I expected. The goal of titrating a medication that has shown positive results .After a 50% reduction, there should be more reduction after the next 4 weeks, leading to a complete remission of symptoms.

Conclusion with Ethical considerations

Children, including adolescents can display disruptive or irritability as a normal part of this stage in development. But key signs to watch for include irritability and not getting along with other children, stating other children do not like them, the feeling of rejection, these are “bridge symptoms” that can be early signs of risk for a anxiety or affective disorder. Parents, teachers, and care givers need to be aware of what is typical teen behavior and what is atypical to help prevent future mental health disorders.

The ethics and responsibility of prescribing medication falls in the hands of the provider. The provider is responsible for educating the client and the parents in this case of the risk. Children that are younger than 14 are not able to consent to treatment.” They cannot give legal permission for treatment, which must come from their parents. It is the responsibility of the prescribing clinician to inform the parents of the expected benefits and risks of the medication” (Vitiello, 2012, p.12).  The clinician has the responsibility  to monitor the clients  response to medication and compliance . Involving the parents in the plan of care can help monitor the effectiveness of the treatment. Case Study: An African American Child Suffering From Depression.

References

Children’s Hospital of Philadelphia.(2018) Retrieved from https://www.chop.edu/conditions-    diseases/mood-disorders-children-and-adolescents

Laurate Education (2016e).
Case study. An African American Child Suffering From Depression
[Interactive             media file]. Baltimore, MD: Author.

Medscape (2018).  Retrieved from https://www.medscape.com

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

Vitiello B. (2012). Principles in using psychotropic medication in children and adolescents. In Rey JM (ed),              IACAPAP
e-Textbook of Child and Adolescent Mental Health. Geneva: International Association       for Child and Adolescent Psychiatry and Allied Professions.
Retrieved from http://iacapap.org/wp-content/uploads/A.7-

 

 

Case Study: An African American Child Suffering From Depression NURS 6630 – Week 2

To prepare for this Assignment:

 

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

 

The Assignment

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

 

At each decision point stop to complete the following:

 

Decision #1

Which decision did you select?

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

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

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

 

Decision #2

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

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

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

 

Decision #3

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

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

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

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

 

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

 

Therapy for Pediatric Clients with Mood Disorders – Case Study: An African American Child Suffering From Depression

Decision #1

Which decision did you select?

Begin Zoloft 25 mg orally daily.

Why did you select this decision?

Zoloft is a selective serotonin reuptake inhibitor (SSRI) that functions by restoring serotonin balance in the brain to improve mood, particularly the client’s depression. Besides that, it is highly effective in treating mood disorders and depression among children. In addition, starting at the lower dose of 25 mg since antidepressants tend to increase anxiety when first used Stahl, 2014) Case Study: An African American Child Suffering From Depression.

What were you hoping to achieve by making this decision?

The prescribed medication was intended to improve the client’s mood and address the depression by restoring the serotonin balance in the brain (Stahl, 2014).

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

The prescription and its dosage was intended to improve the client’s mood and address the depression (Stahl, 2014). But, this objective was not achieved. Instead, the client returned to the clinic after four weeks reporting that she had not experienced any changes to her depressive symptoms. The lack of response is likely the result of the low medication dosage with a higher dose anticipated to further improve the serotonin balance in the brain to alleviate the depressive symptoms (Stahl, 2013). Case Study: An African American Child Suffering From Depression

Decision #2

Increase Zoloft dose to 50 mg orally daily.

Why did you select this decision?

The dosage was increased since the initial dose did not achieve the desired outcome of reducing the depressive symptoms. The increased dose is anticipated to further improve serotonin balance in the brain thereby reducing the depressive symptoms (Stahl, 2014).

What were you hoping to achieve by making this decision?

The decision to increase the prescribed medication dose was intended to reduce the client’s depressive symptoms by improving serotonin balance in the brain (Stahl, 2014).

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

The expected result from increasing the dosage to 50 mg was to reduce the depressive symptoms. This was achieved since the client visited the clinic four weeks later with the depressive symptoms reduced by 50% and client reporting that he was tolerating well (Stahl, 2014).

Decision #3

Maintain the current dose of Zoloft at 50 mg orally daily.

Why did you select this decision?

The decision to maintain the current dose was made for two reasons. Firstly, the client was responding well to the current dosage with clear symptoms reduction. Secondly, the client had adjusted well to the current dosage to imply that it was an optimum dosage for reducing the symptoms without presenting adverse effects (Stahl, 2014).

What were you hoping to achieve by making this decision?

The decision to maintain the current dosage was made with the intention of building on the current positive results. The dosage is already working in relieving the depressive symptoms, and maintaining it is expected to continue the current trend of relieving the symptoms (Stahl, 2014) Case Study: An African American Child Suffering From Depression.

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

It was expected that additional symptoms reduction would be reported beyond the current 50%. But this was not the case with no further reduction in symptoms reported after four weeks. Given that the 50% reduction in symptoms was not full remission, the client was responding to the medication so that a change in drugs was not warranted, then the next step would be to recommend the use of psychotherapy as an additive therapy to complement the prescription medication. This decision is informed by ethical justifications that the client is already responding to medication whose dosage cannot be increased so that psychotherapy is recommended as a complement that would provide additional benefits (Stahl, 2013; Stahl, 2014). Besides that, the standard safe Zoloft dose for children is 50 mg daily for mood disorders and depression. Increasing the dose beyond 50 mg daily is likely to reduce the symptoms further but also result in client intolerance and adverse side effects that include suicide tendencies (Gordon & Melvin, 2014; Magellan Health, Inc., 2013; Vitiello, 2012).

 

 

References

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal?
Journal of Pediatrics and Child Health
, 50(11), 847-854. doi:10.1111/jpc.12655 Case Study: An African American Child Suffering From Depression

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

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

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

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.),
IACAPAP e-textbook of child and adolescent mental health
. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf Case Study: An African American Child Suffering From Depression

Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Analyzing an Ethical Decision

Article: “Zhang S, Graham M, Brink J & Wang X. (2015). Involuntary admission and treatment of patients with mental disorder.
Neurosci Bull
. 31(1), 99–112”.

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

Ethical Issue in the Article

Ethics involving involuntary treatment for people with mental illness revolve about protecting patients and other people and the ethical and legal aspects of balancing the autonomy and rights of the patient with the public rights (Sadock et al, 2014). Sometimes psychiatric patients do not consider themselves to be ill while other times they refuse to undergo treatment and therefore they may end up being forced to undergo treatment against their will (Zhang et al, 2015). Moreover, majority of voluntary psychiatric patients are coerced into accepting treatment maybe by the family, employer, friends or medical personnel. Accordingly, the involuntary treatment of psychiatric people brings in ethical issues in regard to autonomy and informed consent (Zhang et al, 2015). This is because involuntary treatment may be viewed to be violating the autonomy of the patient as well as the principle of informed consent. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Moral and Ethical Dilemmas Surrounding the Issue

The moral and ethical dilemma surrounding the issue of voluntary vs. involuntary treatment occurs when the healthcare provider is forced to honor the autonomy of the patient and seek informed consent, and at the same time ensure that the patient gets the suitable treatment (Opsal et al, 2016). Mental illness can impair the patient’s judgment and their decision-making ability and hence such patients may not be able to make decisions regarding their treatment. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment. Accordingly, the healthcare provider has to make a decision between respecting the autonomy of the patient and being beneficent by providing treatment to be patient (Hustoft et al, 2018). The line separating the respect for the patient autonomy and beneficent care brings in moral and ethical dilemmas especially when handling individuals with severe mental illness. A healthcare provider should be able to justify and be heedful of any removal of the patient’s right and learn the responsibility of stripping a patient their freedom in order to provide the appropriate care (Hustoft et al, 2018).

Comparison to State Health Laws and Regulations in Missouri

Missouri has civil commitment laws that set out the procedure to determine when involuntary treatment is suitable for people with severe mental illness. Laws of Missouri permit the use of court-ordered treatment which is referred to as assisted outpatient treatment (AOT). For a person to be provided with the court-ordered treatment, the person must demonstrate probability of serious harm to self and other people, and show significant risk of physical harm that may result due to the inability of the individual to make treatment decisions because of the mental impairment (Lebenbaum et al, 2018) Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment. Missouri laws also list the designated facilities acknowledged by the Department of Mental Health to offer involuntary detention services. Similarly, the principle of beneficence supports treatment for the best interests of the patient and if the patient is perceived to pose danger to self or other people, and is unwilling to get treatment (Lebenbaum et al, 2018). Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Process of Ethical Decision Making

The first step would be to recognize the ethical dilemma and gather the relevant factors about the dilemma. The second step would be to examine for the right-versus-wrong issues and test for right-versus-right paradigms. Finally, the organization policies regarding ethics and Missouri laws about involuntary treatment would be analyzed in order to make the appropriate ethical decisions (Brayley et al, 2015). Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

References

Brayley J, Alston A & Rogers K. (2015). Legal criteria for involuntary mental health admission: clinician performance in recording grounds for decision.
Med J Aust
. 203 (8): 334.

Hustoft K, Larsen K et al. (2018). Voluntary or involuntary acute psychiatric hospitalization in Norway:A 24 h follow up study.
International Journal of Law and Psychiatry
. 56 (2018), 27-34

Lebenbaum M, Chiu M, Vigod S & Paul K. (2018). Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study.
BJPsych Open
. 4(2), 31–38. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

Opsal A, Kare J & Clausen T. (2016). Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders.
BMC Health Serv Res
. 16(656).

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.

 

Learning Resources

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

Required Readings

American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment.

•Standard 5D “Prescriptive Authority and Treatment” (page 58)

Note: Throughout the program you will be reading excerpts from the ANA’s Scope & Standards of Practice for Psychiatric-Mental Health Nursing. It is essential to your success on the ANCC board certification exam for Psychiatric/Mental Health Nurse Practitioners that you know the scope of practice of the advanced practice psychiatric/mental health nurse. You should also be able to differentiate between the generalist RN role in psychiatric/mental health nursing and the advanced practice nurse role.

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.

•Chapter 5, “Examination and Diagnosis of the Psychiatric Patient” (pp. 192–289)

•Chapter 31, “Child Psychiatry” (pp. 1082–1107)

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

•“Introduction”

•“Use of the Manual”

•“Cultural Formulation”

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

Kaplan, C. (2017). Ethical dilemmas. Advanced Healthcare Network. Retrieved from https://web.archive.org/web/20160416180027/http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Ethical-Dilemmas-2.aspx Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Pumariega, A. J., Rothe, E., Mian, A., Carlisle, L., Toppelberg, C., Harris, T., . . . Smith, J. (2013). Practice parameter for cultural competence in child and adolescent psychiatric practice. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1101–1115. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00479-6/pdf

American Academy of Child & Adolescent Psychiatry (AACAP). (2012a). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 541–557. Retrieved from http://www.jaacap.com/article/S0890-8567(12)00141-4/pdf

American Psychological Association. (2017). Code of Ethics. Retrieved from http://www.apa.org/ethics/code/

Document: Child and Adolescent Diagnostic Assessment Worksheet (Word document)

Document: Practicum Journal Template (Word document) Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Required Media

Gajbhare, P. (2014, March 8). Mental status examination [Video file]. Retrieved from https://www.youtube.com/watch?v=VjWVYgf2UcU

Note: The approximate length of this media piece is 36 minutes.

YMH Boston. (2013a, May 22). Vignette 1 – Introduction to a preventive services visit [Video file]. Retrieved from https://www.youtube.com/watch?v=pQy-jwiu7gM

Note: The approximate length of this media piece is 3 minutes.

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

Note: The approximate length of this media piece is 4 minutes. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

Optional Resources

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.

•Chapter 1, “Neural Sciences” (pp. 1–92)

•Chapter 31.2, “Assessment, Examination, and Psychological testing” (pp. 1107–1118)

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

In your role as a PMHNP, you will encounter several situations that will require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidenced-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their socio-demographic and ethnic/racial background. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action. For this Assignment, you review the literature and discover the various ethical dilemmas PMHNPs encounter and how these issues are typically addressed in your state.

Learning Objectives

Students will:

•Analyze salient ethical issues in psychiatric mental health practice

•Compare ethical dilemmas with state health laws and regulations

•Analyze ethical decision-making processes Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment

To prepare:

•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.

Write a 2-page paper in which you do the following:

•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. Analyzing an Ethical Decision Practicum Journal Entry Essay Assignment