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NRS-433V-RS3: Quantitative Studies

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Quantitative Studies

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

SAMPLE ANSWER

NRS-433V-RS3: Quantitative Studies

Quantitative Research Article 1

Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. https://www.ncbi.nlm.nih.gov/pubmed/26718414

  1. Problem

The DASH diet emphasizes the consumption of vegetables, fruits, whole grains, and low-fat dairy foods to reduce blood pressure and the risks of cardiovascular diseases(Chiu et al.2016). According to the reports on the nursing studies, high-fat dairy products, fewer vegetables, and fruits are associated with a high risk of stroke, blood pressure, and diseases of the coronary artery.

NRS-433V-RS3: Quantitative Studies

  1. Significance to nursing

The extent of adherence to diet determines the effectiveness of the intervention of the DASH diet. Most people with the problem of following prescribed diets have difficulty if adhering to DASH diet. It is the responsibility of the nurses to create awareness and advice patients on how to follow prescribed diets to increase the effectiveness of DASH intervention. According to Chiu, et al. 2016, it is essential to include a variation in the composition of the macronutrients in the DASH diet while still enhancing the preservation to the benefits of lipid and blood pressure risk factors.

NRS-433V-RS3: Quantitative Studies

  • Purpose of the study

The main objective of the study was to assess the possible effects of switching to low-fat dairy foods contained in the DASH diet from full-fat foods. This was accompanied by a corresponding addition in fat and a decrease in sugar intake on plasma lipids, blood pressure, and lipoproteins.

  1. Research question

Does the DASH diet effectively lower blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol?

How the article answers the PICOT question

The article analysis the effects of the DASH diet, that is, the substitution of full-fat for low-fat dairy foods in the DASH diet with a reduction of sugar intake on the blood pressure, lipoproteins and plasma lipids.

How the intervention and comparison group in the article compares with those in the PICOT question

The report considers the DASH diet as a primary intervention to lower high blood pressure. The randomized trial takes place for three weeks. Similarly, the PICOT question includes the DASH diet as one of the responses in lowering blood pressure within the first five months.

 

Quantitative Research Article 2

Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship.  Hypertension, 42(1), 8-13. https://www.ncbi.nlm.nih.gov/pubmed/12756219

  1. Research problem

Blood pressure has become one of the leading causes of mortality rates across the globe. The Dietary Approaches to Stop Hypertension can act aa primary mechanism for lowering blood pressure through consumption of a diet with vegetables, fruits, and low-fat dairy foods.

NRS-433V-RS3: Quantitative Studies

  1. Significance to nursing

Nurses should consider Dietary Approaches to Stop Hypertension as one of the primary nonpharmacological approaches to stop high blood pressure.  The authors of the article theoretically describe that the blood pressure-lowering action can be analyzed on the pressure curve that is drawn through the use of data from the DASH-sodium trail.

  • The purpose of the study

The main objective of the study was to assess the effects of the DASH diet on the pressure-natriuresis relationship to identify its mechanisms of lowering blood pressure.

  1. Research question

What is the effect of the DASH diet on the pressure-natriuresis relationship in blood pressure lowering mechanism?

How the article answers the PICOT question

The report provides proof on whether the DASH diet lowers blood pressure within the first five months if intervention by testing its effects on pressure-natriuresis.

How the intervention and comparison group in the article compare to identified in the PICOT question

The article describes the effects of the DASH diet on the relationship of pressure-natriuresis to give clarity of its mechanism of lowering blood pressure. Similarly, the intervention in the PICOT question focuses on the blood pressure-lowering effect of the DASH diet.

Methods of the Two Studies

The report by Chiu, et al., 2016 used a randomized controlled trial where health men and women consumed a standard DASH diet, lower-fat and high fat carbohydrate modification of the DASH diet known as the HF-DASH diet for three weeks each separated by two weeks for washouts. The measurement in the laboratory included the concentration of lipoproteins articles which were determined by the mobility of ions. Statistical analysis for treatment differences was conducted through the use of ANOVA (Stata version 11) for a three-treatment cross over design.NRS-433V-RS3: Quantitative Studies

Similarly, the article on the Effects of the DASH diet on the Pressure-Natriuresis Relationship used a controlled trial method where DASH sodium trial and randomized feeding trial were used. However, the research design differed from the one conducted by Chiu et al. 2016 because it used a sample size of 412 who were 22 years and above(Akita, Sacks, Svetkey, Conlin & Kimura, 2003). Also, the participants were not healthy individuals as they had systolic blood pressure (SBP) ranging between 120 to 159 and Diastolic blood pressure ranging between 80-95 without blood pressure-lowering medication. Statistical analysis was conducted by comparing the x-intercept and the steepness of the curve of the pressure-natriuresis between DASH diets and the control diet as well as the subgroups and testing them by the use of Student t-test for the non-paired samples.

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Benefits and limitations of the methods used in the two research articles

Both articles used controlled trial methods. One benefits of the technique were that it was easy to produce accurate results which clearly showed the effects of the DASH diet on Blood pressure levels.

One limitation of the controlled trial methods used in the research articles was that it was difficult for the participants to strictly follow the prescribed diets, which made the research process tiresome.

Results of the two research studies and their implications to the nursing practice

Chiu et al. (2016) found that urinary potassium excretion was higher with the HF-DASH and DASH diets compared to control diets. The results of the DAH and H-F DASH DIETS did not differ where the mean for the DASH diet was 83.5, HF-DASH was 81.5, and that of the control diet was 50.5. The HF DASH and the DASH diets significantly lowered blood pressure as compared to the control diet. The implication of the study is that Nurses should emphasize the application of the DASH diet as a significant treatment of high blood pressure and create awareness among patients and members of the community. This would help effectively implement the use of the DASH diet as a nonpharmacological treatment of blood pressure.

NRS-433V-RS3: Quantitative Studies

Evaluation of the data obtained from the DASH-Sodium Trial through the use of pressure-natriuresis curve, the DASH increased the slope of the relationship (Akita, Sacks, Svetkey, Conlin & Kimura, 2003). This indicates that the DASH diet effectively lowered blood pressure groups though a diuretic action with high sensitivity of sodium. The implication of the study is that the DASH diet should be used as a primary nonpharmacological treatment of blood pressure. It also helps nurses understand the mechanism of the DASH diet in lowering BP, which makes it possible for them to speculate on patients and those situations it can be beneficial.

Outcomes comparison

The outcomes of the PICOT question included the lowering of blood pressure within the first five months of DASH diet intervention. The findings of the two articles showed a reduction of the blood pressure within less than five months as expected in the PICOT question.

 

References

Akita, S., Sacks, F. M., Svetkey, L. P., Conlin, P. R., & Kimura, G. (2003). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet on the pressure-natriuresis relationship.  Hypertension, 42(1), 8-13. https://www.ncbi.nlm.nih.gov/pubmed/12756219

Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. https://www.ncbi.nlm.nih.gov/pubmed/26718414

 

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Steps on Becoming a Grassroots Lobbyist

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Steps on Becoming a Grassroots Lobbyist

  1. Imagine that you are going to make a visit to your representative in Congress. Develop a one-page document that supports your position on the AHCA that you would leave with your representative or his or her aide when you make your visit. This one-pager, also called a “leave behind,” should state your position clearly in bullet points and give your reasons why your position is preferred. This “leave behind” should have 1 inch margins and utilize 14-point font throughout. If you were making this visit in person, you would present your “leave behind” to the person with whom you speak during your visit. Include a second page that describes your rationale for the position in your “leave behind” page supported by at least two journal articles.
  2. Write a two-page brief to describe the scenario surrounding your legislative visit. Understanding the political affiliation of your representative, include answers to the following:
    • Was your member in support or in opposition to the AHCA?
    • State three points that you would cover in support or opposition to your representative’s position.
    • How does your nursing experience influence the advocacy position that you take on the AHCA?

 

SAMPLE ANSWER

Steps on Becoming a Grassroots Lobbyist

Part 1

The AHCA may introduce many changes and enhance the American healthcare system. The country has changed drastically during the last decade. As such, the health care policies that may have worked during the past may not be the most effective during the current period. The American Health Care Act of 2017 (AHCA), therefore, may be the solution that is needed to address some of the key challenges associated with the current healthcare system in the country.

Steps on Becoming a Grassroots Lobbyist

Enacting the bill would result in better healthcare services since it will be addressing some of the challenges related to healthcare that the American people face. AHCA would be better relative to AHA for some reasons, which include:

  • Increased flexibility since not having health insurance would not attract a federal penalty, thus making AHCA more flexible.
  • Tax credits to aid in the payment of tax premiums, which tends to be particularly important for low-income earners. Furthermore, these credits phase out as incomes rise, which in turn increases equality.
  • The introduction of a maximum subsidy or tax credit the government can pay. Such ensures that public resources are utilized in the best way possible.
  • People can buy plans that do not cover benefits that they may not want. Such increases the flexibility, which in turn may lead to increased insurance coverage in the country (Fielder et al., 2017).

For the above reasons, therefore, it is my believe that enacting AHCA and repealing ACA would be more beneficial to the American people considering the former addresses new healthcare challenges, increases flexibility, and results in a better use of public resources relative to the latter.

Steps on Becoming a Grassroots Lobbyist

The rationale for the position that I take in the letter is that AHCA offers a better opportunity to improve healthcare in the United States compared to using the current Obama Care are system. One of the reasons for supporting AHCA is that it will lead to a repeal of AHA, which is associated with multiple problems and it does not fulfill on the promises that it made.

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One of the reasons why I support AHCA is that it will increase flexibility in taking insurance cover in the country since not having an insurance cover would not attract penalties. With AHA, failing to take an insurance cover attracts some penalties. By removing such penalties and introducing incentives, more people would take insurance cover. Furthermore, citizens would have the option to select the benefits that they would like to be covered for, unlike the AHA, which has mandatory areas that need to be covered. Such may lead to lower insurance premium, thus attracting more people to take insurance cover (Rice et al., 2018).

Moreover, enacting AHCA would lead to better use of resources, which includes having a cap on the amount of tax credits and subsidies that the government can pay. Such would result in better uses of resources for other critical elements, such as making healthcare affordable for all people, and not only those who have insurance cover. Moreover, the cost of healthcare in the country may decrease because of introducing maximum credits, and paying them based on the income of families, which would contribute to equality (Thompson et al., 2018). For instance, when family or individual incomes exceed certain amounts, they do not qualify for the tax credits or subsidies.

Part 2

The member was in opposition of AHCA in congress. He was strongly opposed to the bill and strongly campaigned against it. However, such may have been caused by his party affiliation, but not an analysis of the bill fully to understand how it would affect healthcare in the United States. As such, it would have been prudent for the representative to support the bill since it would have been more beneficial to the American people compared to AHA.

Steps on Becoming a Grassroots Lobbyist

One of the reasons for the need for supporting is increased cost of health insurance. While AHA promised to save around $2,500 per family each year, it has not. In fact, the Department of Health and Human Services notes that since 2013, insurance premiums have more than doubled. However, the family incomes have only risen by around 19%, which shows that the rise in premiums is not because of an improving economy (Fielder et al., 2017). Therefore, introducing AHCA may control the increasing cost of insurance premiums, while at the same time offering individuals with more flexibility since they can choose whether to be covered or not, or the benefits that they would like to be covered for.

Furthermore, there is an urgent need to repeal AHA because entitlement spending has increased drastically during the last few years. AHA has caused entitlement spending to increase more than it had been expected. For instance, the projected costs of Medicaid and AHA subsidies are expected to be $4.8 trillion, with both being responsible for an estimated 44% of the anticipated increase in entitlement spending in the future (Williamson & Singe, 2017). Therefore, enacting AHCA would ensure that such costs spending are controlled, which will be beneficial to the economy.

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Furthermore, AHCA presents a new opportunity for lowering the costs of healthcare in the United States. With the enactment of AHA, it was hoped that healthcare in the country would become more affordable. However, with the enactment, healthcare costs have continued rising. Before the implementation of AHA, healthcare costs amounted to an estimated 17.2% of the GDP. However, in the year that followed, it rose to 18.3%, which represented an increased or around $200 billion on healthcare spending (Fielder et al., 2017). Forecasts indicate that medical by 2025; medical expenses will make around 20% of the country’s GDP (Rice et al., 2018). Therefore, there is a need to enact a bill that would lower and control the increasing costs of health care in the country since AHA has not been addressing the issue. Enacting AHCA may be the ideal solution for addressing the problem in the country.

Steps on Becoming a Grassroots Lobbyist

My nursing experience has considerably influenced the advocacy position that I have taken with regard to AHCA. The experience has introduced me to some of the critical elements that need to be considered in the healthcare sector. For instance, medical expenses and healthcare costs are some of the key considerations that influence the quality of healthcare in a country. At the same time, nursing experience has enabled me to gain the relevant research skills, which means that I can be able to search for the right resources to support or opposes elements related to the healthcare sector. The research findings, coupled with my experience, inform the decisions that I make regarding whether to support a healthcare issue or not.

 

References

 Fiedler, M., Aaron, H. J., Adler, L., & Ginsburg, P. B. (2017). Moving in the wrong direction—health care under the AHCA. New England Journal of Medicine, 376(25), 2405-2407.

Rice, T., Unruh, L. Y., van Ginneken, E., Rosenau, P., & Barnes, A. J. (2018). Universal coverage reforms in the USA: From Obamacare through Trump. Health Policy, 122(7), 698-702.

Thompson, F. J., Gusmano, M. K., & Shinohara, S. (2018). Trump and the Affordable Care Act: Congressional repeal efforts, executive federalism, and program durability. Publius: The Journal of Federalism, 48(3), 396-424.

Willison, C. E., & Singer, P. M. (2017). Repealing the affordable care act essential health benefits: Threats and obstacles. American journal of public health, 107(8), 1225.

 

 

 

 

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Ethnicity and Pharmacotherapy for Cardiovascular Diseases

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Ethnicity and Pharmacotherapy for Cardiovascular Diseases

examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular disorders.  You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

 

When writing your Week 2 Assignment, consider the following scenario:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

  • Atenolol 12.5 mg daily
  • Doxazosin 8 mg daily
  • Hydralazine 10 mg qid
  • Sertraline 25 mg daily
  • Simvastatin 80 mg daily

o Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

 

Write a 2- to 3-page paper that addresses the following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

 

SAMPLE ANSWER

Ethnicity and Pharmacotherapy for Cardiovascular Diseases

Introduction

Drug prescription is considered to an essential aspect in patient care. When done properly, it leads to effective control of diseases and other health conditions, thereby improving the health of patients. Contrarily, poor prescriptions of drugs may lead to health problems. In some cases, it may lead to death. To achieve the aim of this process, practitioners need to adhere to suitable drug concentrations basing on different health factors (Ladd & Hoyt, 2016). One of the issues that may affect the effectiveness of drug dosages is ethnicity. This factor refers to the state of being in a social setting with common traditions. This paper tries to establish the impact of ethnicity on cardiovascular pharmacotherapy of a patient. The patient’s initials are AO and he is viewed to have had obesity in his life. He is diagnosed with hypertension and hyperlipidemia.

Ethnicity and Pharmacotherapy for Cardiovascular Diseases

Effect of Ethnicity on PD and PK Processes

There is a higher prevalence of cardiovascular diseases in African Americans than in other ethnic groups in the country. African Americans are depicted to have the highest prevalence of hypertension in the world. In addition, hypertension also develops earlier in blacks than in any other ethnic group. It is suggested that African Americans may carry a gene that increases their sensitivity to salt, thereby increasing their risk of attaining hypertension (Diaz et al., 2017). This group is also viewed to experience a high burden of morbid factors such as hyperdilipidemia, diabetes, heart disease, and obesity. These issues lead to elevated blood pressures in the ethnic group. The factors also increase the body’s resistance to drugs’ effects.  Assuming that AO is African American, he tends to have a lower control of hypertension than patients from other ethnic groups (Arcangelo et al., 2017).

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Changes in the Pharmacotherapy

Research shows that African American respond well to beta blockers in the treatment of hypertension. Therefore, Atenolol intake is suitable for AO. However, its dosage should start at 50 mg due to the patient having obesity. Doxazosin is viewed to be an essential add-on to calcium-channel blockers. However, it is discouraged in a monotherapy. Therefore, its 8mg dosage is suitable for the patient during a combinative therapy. Hydralazine is a vasodilator which is essential for relaxing the patient’s blood vessels. The drug may not be suitable for the patient when diuretics are involved (Sessoms et al., 2015). Simvastatin is suitable in the treatment of hyperlipidemia in African Americans. However, since the patient is obese, the starting dosage should 40mg. Sertraline is a suitable antidepressant whose intake is recommended to start between 50mg and 100mg. However, its interaction with simvastatin may lead to liver damage. Therefore, its 25mg dosage is safe for AO (Arcangelo et al., 2017).

Improving AO’s Therapy

Treatment of hyperlipidemia and hypertension for a patient with obesity also needs the use of physical exercises. In addition, the patient needs to have a healthy diet. Both approaches are considered suitable in reducing the patient’s weight (Diaz et al., 2017). In addition, control the amount of salt in the body, thereby making the patient to reduce effects of salt sensitivity. The practitioner also needs to engage in effective follow-ups to ensure that the patient’s liver is not affected by the interaction between simvastatin and sertraline. If its functionality is within the normal range, sertraline’s intake level may be increased to improve on the patient’s activeness (Whelton et al., 2016).

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Conclusion

Pharmacotherapy for hypertension and hyperlipidemia is depicted to be affected by ethnicity of the patient. The paper focuses on treatment basing on an African American ethnicity. The ethnic choice is essential for the disease because African Americans have a higher prevalence of hypertension than other ethnic groups. From the paper, it can be shown that proper consideration of changes in pharmacodynamic and pharmacokinetic processes leads to a safe prescription for the patient. Additional therapeutic measures such as exercises and a suitable diet are considered to improve the patient’s pharmacotherapy.

 

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).

Pharmacotherapeutics for advanced practice: A practical approach (4thed.). Ambler, PA: Lippincott Williams & Wilkins.

Diaz, K. M., Booth III, J. N., Seals, S. R., Abdalla, M., Dubbert, P. M., Sims, M., … & Shimbo,

  1. (2017). Physical activity and incident hypertension in African Americans: the Jackson Heart Study. Hypertension, 69(3), 421-427.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for

            Nurse Practitioners, 12(3), 166-173.

Sessoms, J., Reid, K., Williams, I., & Hinton, I. (2015). Provider adherence to national

guidelines for managing hypertension in African Americans. International Journal of Hypertension, 1-7. Doi:10.1155/2015/498074.

Whelton, P. K., Einhorn, P. T., Muntner, P., Appel, L. J., Cushman, W. C., Diez Roux, A. V., …

& Arnett, D. K. (2016). Research needs to improve hypertension treatment and control in African Americans. Hypertension, 68(5), 1066-1072.

 

 

 

 

 

 

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Reviewing the Classical Argument

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Reviewing the Classical Argument

Please answer them thoroughly and in the order they are given. This type of journal should be at least 300 words or more.

 

FYI: Enclosed files might help to answer the assigment

 

How is the classical argument structure different from what you think of as a normal argument you might encounter in a conversation with somebody or an argument you might see on TV? Talk about the classical argument sections you feel you understand and do not understand.

 

SAMPLE ANSWER

Reviewing the Classical Argument

The classical argument differs from normal arguments as it strictly focuses on different sections. This type of argument aims at making inquiries, convictions, negotiations and persuasions. In normal conversations, these sections may not be present because there are no rules on how a person may approach a concept or subject. Therefore, there are different ways in which people argue or converse in a television setting. From another perspective, it can be seen that a classical argument does not involve more than one party (Winthrop, n.d.).

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In my understanding, all the different sections of a classical argument are necessary. In my view, the introductory section is easy to understand because it brings about the general information of the argument. I find the narration part to be tedious due to one’s involvement with various developments to create a position on an issue. In addition, it is difficult to understand because it restricts one from developing specific claims yet it requires one to state facts. The first reason and claim section is easy to develop because it involves developing one’s support of an argument basing on what they think to be strongest reasons (Winthrop, n.d.).

In addition, I find the second and third reason and claim sections to be well elaborated. They do not need much development a s long one brings about a suitable reason. Moreover, the rules involved in these sections are easy to follow. For instance, one needs to analyze a source and to support his or her position with suitable elaboration. The acknowledgement and refutation section is well-defined. However, it needs suitable techniques for writer to refute his position and come up with a better way to depict his position as the most relevant. In that regard, I find it to be difficult because it may make one to lose his direction when he acknowledges the opposing views without refuting it with the same rigor (Winthrop, n.d.).

 

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References

Winthrop (n.d.). The classical argument. Retrieved from

https://www.winthrop.edu › centerHandoutClassicalArgument

 

 

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Strategic Objectives Response Paper

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Strategic Objectives Response Paper

Need a peer respond to the selected posts.

 

Peer Post 1- Cornel Bedward

For this discussion I chose to discuss the strategic objectives of the Olympic Medical Center. The Olympic Medical Center is a public hospital district on the North Olympic Peninsula located in Port Angeles and Sequim, Washington. “Olympic Medical Center is responsible for proactively planning for the community’s health care need” (OMC, n.d.). Their strategic plan focuses on three areas:  quality, patient safety and satisfaction, Olympic Medical Center and community relationships, and organizational performance.

The first strategic objective Olympic Medical Center (OMC) has revolves around ensuring that they offer the safest, highest-quality health care with compassion. They will do so by continuing to standardize their care processes and fortify their systems in order to amplify patient safety and quality, and perfect their ability to deliver positive patient experiences (OMC, 2018-2020, p. 5).  OMC strategies include following evidence-based best practices through national quality initiatives, being a leader in adopting national patient safety initiatives, and encouraging a culture of service that constantly acknowledges the expectations and fulfills the needs of our patients, their families and our community in the services they provide (OMC, 2018-2020, p. 8). In order to implement these strategies OMC will continue to foster a culture of quality, patient safety and experience for their patients and staff. They will concentrate on explicit quality goals that will prevent unnecessary readmissions, and improve emergency department wait times. Lastly, OMC will ensure their Quality Management System will effectively sustain compliance with International Organization for Standardization (ISO) 9001: 2015 standards (OMC, 2018-2020, p. 8).

Strategic Objectives Response Paper

The second strategic objective Olympic Medical Center (OMC) has is to continue to work with their community partners and representatives and maintain recruitment and retention of the best doctors, advanced practice clinicians, clinical staff and employees to continue to achieve excellence in health care (OMC, 2018-2020, p. 5). The strategy OMC wants to achieve is to promote and inform the community about the services OMC provides. They will support public health, and promote health and wellness by discussing appropriate lifestyle choices, addressing social factors that negatively affect their community’s health and educating the community on chronic disease management. A third strategy they aim to achieve is to assist community partners to help support community development by “promoting health care access, advocacy and disaster preparation” (OMC, 2018-2020, p. 9). The goals they will implement to achieve this are: continue to meet with elected federal and state officials and their healthcare aides to further meet the needs of their healthcare system, organize annual goals and operating plans for the Swedish affiliation, to further enhance community health over time OMC will participate in agreed-upon Olympic Community of Health (OCH) programs and align with OCH-identified Medicaid measures with a focus on primary care access, continue to develop of wellness initiatives, and lastly preserve positive relationships with funding partners and donors (OMC, 2018-2020, p. 9).

Strategic Objectives Response Paper

The last strategic objective Olympic Medical Center (OMC) has is maintaining their organizational performance by sustaining financial solvency by achieving a positive net income (OMC, 2018-2020, p. 5). In order to do this OMC will maintain open communication within the organization and promote creative ideas from all staff. By sustaining prolific and respectful working relationships, OMC can encourage teamwork between employees, management, physicians and commissioners. They will contribute to employee development and education to advance quality, patient safety and experience, and financial stewardship. Lastly, OMC will continue to create a culture that reflects their Mission, Vision and Values (OMC, 2018-2020, p 10). OMC plans to “ implement “OMC Operational Excellence” across all divisions, prioritizing process improvements that result in improved operational efficiency, patient access, wait times, patient experience, and employee experience and engagement” (OMC, 2018-2020, p 10). They will put forth changes based on their 2015 employee survey and conduct a follow-up employee survey to further improve employee engagement. They will imbue a culture initiative to align

Their employees with the Mission and Values they have. OMC will also execute Workforce Development Plan (OMC, 2018-2020, p 10).

References

Olympic Medical Center (OMC). (n.d.). Strategic Plan. Retrieved August 31, 2019 from http://www.olympicmedical.org/default.aspx?ID=11

Olympic Medical Center (OMC). (2018 -2020). Strategic Plan. Retrieved August 31, 2019 from http://www.olympicmedical.org/pdfs/Strategic%20Plan%202018-2020.pdf

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning, implementation, and evaluation processes in hospital systems: A survey from Iran. Global Journal of Health Science, 7(2), 56–65. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/38626/22539

Walston, S. L. (2014). Strategic healthcare management: Planning and execution. Chicago, IL: Health Administration Press.

 

Peer Post 2 – Mackenzie Rodriquez

Tampa General Hospital is a very well-known health care facility located in Tampa, Florida. Some of the strategic objectives of Tampa General Hospital are to ensure quality health care services for all patients, create a safe environment, as well as ensure all staff members are equipped with the needed skills (TGH, 2019). First, TGH wants to make sure that all patients that visit the hospital will receive the best quality care regardless of the patient’s race, religion, economic background, etc… (TGH, 2019). Secondly, the safety of all patients and staff members is extremely important. Offering a safe environment for all patients and staff members allows patients to feel comfortable and allows employees to work more efficiently. Lastly, the hospital wants to ensure that all staff members are equipped with the needed skills in order to provide quality services to all of their patients.

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Some of the tactical objectives that will help Tampa General Hospital to achieve each of the strategic objectives are to make constant improvements to the technology equipment, increase security services, as well as create an overall efficient training program for all staff members (Chron, 2019). First, by frequently updating all technology every year, helps to ensure that all machines and equipment are efficient and functioning properly in order to help ensure the quality of services that are provided to patients. Secondly, increasing the number of security members over a period of time, will help keep the hospital safe and secure. Lastly, by making improvements to the training program for staff members every single year helps to ensure that they will have a better understanding of what is expected of them and what skills are required by the hospital. In addition, some of the operational objectives that can be used in order to help TGH achieve their strategic objectives is to fix the day to day issues (Chron, 2019). For example, any technology glitches should be fix immediately in order to prevent any of the machines from shutting down. Also, if any patients or staff members feel that a particular person makes them feel unsafe, it should be addressed immediately, and action needs to be taken. Any employees that are not working properly and working towards the hospitals goals needs to be addressed and potentially removed if needed. Overall, each of these objectives helps Tampa General hospital to achieve all of their overall strategic objectives.

Chron. (2019, April 24th). Tactical and operational planning. Retrieved from;

TGH. (2019). Mission and goals.Retrieved from;

https://www.tgh.org/health-professionals/school-medical-laboratory-science/mission-and-goals

 

SAMPLE ANSWER

Strategic Objectives Response Paper

Dear Cornel Bedward,

Sadeghifar et al. (2014), describe a strategic as being made up of strategic objectives that are important to the organization and have been established to be a significant management practice. This comes out clearly in the strategic plans that have been set out by your institution. I agree with you that the objectives should always be geared towards making the organization better. I also agree with you that strategic plans can be achieved within a specified period of time and as seen in your organization, they are for the year 2018-2020. Olympic medical Centre also has clear operational goals that will be able to help them. However, there is a need to bring out the tactical goals which will aim in the delivery of the strategic plan. Tactical objectives involve objectives at an individual level and are focused on the individuals in the organization.

Reference

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning,

implementation, and evaluation processes in hospital systems: A survey from Iran. Global Journal of Health Science, 7(2), 56–65. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/38626/22539

 

Dear Mackenzie Rodriquez

Tampa General Hospital has established itself to have a strategic plan and set out objectives to achieve them. You have listed some of the objectives that are present in the strategic plan of the organization which is to ensure that all patients get better quality of treatment irrespective of their background. A strategic plan is composed of strategic objectives that are important to the organization and have been established to be a significant management practice (Sadeghifar et al. 2014). I agree with you that for the goals of Tampa General Hospital to be achieved, there is a need to have operational and tactical objectives that have been clearly outlined in your article. However, Strategic objectives are goals that are aimed at being achieved within three to five years, and it has not been brought out when Tampa General Hospital aims at achieving the set out objectives in their strategic plan.

Reference

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning,

implementation, and evaluation processes in hospital systems: A survey from Iran. Global Journal of Health Science, 7(2), 56–65. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/38626/22539

 

 

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Criteria for Impeaching the President

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Criteria for Impeaching the President

Please submit a paper that summarizes (in your own words) the “You are the Policymaker” feature titled “What Should be the Criteria for Impeaching the President?” and then give your opinion; what would you do if you were the policymaker? It must be a minimum of one page in length, typed and double-spaced.

FYI: (professor’s instructions)

Do not use outside sources. Do not quote from the book; I want you to paraphrase the feature (put it into your own words) so I can see that you understand the feature. The papers are to be doublespaced, Times New Roman, size 12 font. The papers must be at least one page in length.

 

SAMPLE ANSWER

What Should be the Criteria for Impeaching the President?

The article “What Should be the Criteria for Impeaching the President?” basically talks about the sex scandal that broke in 1998 between the then President Clinton and Monica Lewinsky. The article notes how President Clinton tried to obstruct justice when he was questioned about the affair with Lewinsky. President Clinton, as noted in the article, president Lewinsky to lie under oath. The President could not be put on trial because of his position and therefore the only way to be help accountable was through the House of Representatives as well as the senate where he faced a possible impeachment. An investigation report by an independent counsel recommended that the president should face 11 counts of possible impeachment offences. The president was accused of braking the law, betraying public trust and dishonoring the presidency.

President Clinton was forced to apologize to the nation. He, through the White House, argued that the mistake affected his personal life and not that of the presidency. The white house also accused the investigator of having personal vendetta against the president.

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The issue on whether the scandal had reached the threshold that could lead to the president’s impeachment then arose. An offense should be grave in order for it to be used to impeach a president. The case of President Clinton is compared to that of President Richard Nixon who was charged with obstructing justice, abusing power and failing to comply with congressional subpoenas. When enough evidence was gathered Nixon resigned in order to avoid being impeached. His impeachment majorly failed because of how the legislatures voted on party lines.

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If I was a policy make, I could not have voted to impeach the president. This is because, while it is true that the president did a mistake by obstructing justice, he accepted the mistake and apologized. In addition, I do not think that his affair with Lewinsky affected his duties as a president in any way. I would consider the affair as a personal life and look at what he has been able to achieve through his presidency. I also do not think the case reaches the threshold for impeachment. The investigations by the legislature might not tell the truth of the matter and that is why the White House rejected the recommendation. Therefore, impeaching President Clinton could not have been the best solution for this case. I would therefore vote to retain President Clinton as the president.

 

 

 

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International Health Disparities

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International Health Disparities

Analyzing epidemiological data.

Based on the review of global health disparities across inter/intra national countries, analyze data by the use of epidemiological analytical methods to infer the factors or causes for these public health disparities. Select any three countries of your choice (one from a developed nation, a ‘second world’ country, and an underdeveloped third world country) and find epidemiological data such as fertility indicators (crude birth and death rates) and other health indicators. Provide an analysis among your three sample countries in a 3-5 page paper. Your writing should follow the conventions of Standard American English (correct grammar, punctuation, etc.) and APA style guidelines. Your work should be well ordered, logical and unified, as well as original and insightful. Your submission should display superior content, organization, style, and mechanics.

 

SAMPLE ANSWER

International Health Disparities

Public health disparities across races, gender, ethnic groups, and other populations is a significant concern in the modern world. Health disparities refer to preventable variances in the disease burden, violence, injury, and available opportunities to access optimum health. Health disparities are caused by a variable number of factors such as environmental factors, poverty, level of education and behavioral and individual factors, among others (National Center for Health Statistics, 2016). This paper analyses health disparity between developed, developing, and underdeveloped countries. The sample countries used in each case include the United States of America for developed countries, China, for strengthening or second world countries and Cuba for the third world or under-developed countries. Different health indicators provided by epidemiological data in the three countries will be used to determine the disparities and their possible causes.

Health indicators in the United States

According to the Nation Master, the total fertility rate in the United States is about 1.99 %. Hospital beds are approximately 3.3 in every 1000 people. Life expectancy in the United States is 76 years (NationMaster (APA), n.d). Life expectancy for women at birth is 81.1, while the total population life expectancy is 78 years. Physicians are rated to be 2.3 in every 100 people. The cost of the healthcare system is 45.82, while the quality of healthcare is about 69.02.

Health Indicators in China

Nation Master report that the total fertility rate in China is about 1.88, and the number of hospital beds per 1000 people is about 2.5.  The life expectancy for men is about 72 years, women 76 years and for the whole population 74 years (NationMaster (APA), n.d).  The number of physicians in every 1000 people is approximately 1.5, while the cost of health care is about 57. The quality of healthcare in China is about 62.

Health indicators in Rwanda

The total fertility rate in Rwanda is reported to be 1.8%, and the number of hospital beds per 1000 people is approximately 1.7. The life expectancy rate for males is 54 years, while that of women is 65 years (NationMaster (APA), n.d). The life expectancy rate for the total population is 58 years. The number of physicians per 1000 people is estimated to be 0.05. The cost of health is reported to be 72 while the quality of healthcare is 49.

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From the health indicators data presented above, it is evident that health quality reduces depending on the level of a country’s development. The United States has the highest presents, the highest quality of health, followed by china and finally Rwanda. Rwanda is an African country which is one of the most under-developed countries across the globe. There are various causes of health disparities around the world which may include:

  1. The quality of education

Education is one of the most significant determinants of health quality in a country. In most of the developed countries such as the United States, high-quality education results in more competent health professionals who provide quality patient care, thus reducing the rates of death and other consequences of poor health (Woolf, 2017). Besides, the number of health professionals, such as physicians tends to be higher compared to those in the second and first world countries.

International Health Disparities

  1. Poverty

Poverty is also one of the leading causes of health disparities across the globe. Most countries in the third world c countries have high poverty levels that they are not able to afford the cost of quality healthcare (Woolf, 2017). Besides, poverty acts as a barrier to quality and enough health facilities and hospital beds. Also, poverty results in lack of enough medicine to treat various diseases (Woolf, 2017). As a result, less developed countries report the highest rate of mortality and morbidity.

  • Behavioral and individual behaviors

Individual behaviors in various countries are also some of the main causes of health disparities as they determine their life style and the probability of living a healthy life. Reports show that most people in the third world countries die due to conditions such as heart attack, respiratory diseases and obesity (Woolf, 2017. Most of these conditions are related to lack of adequate physical exercise. This can be linked to insufficient healthcare professionals to create awareness on the benefits of living a healthy lifestyle.

  1. Level of economic growth and development

Economic growth of a country determines the per capita income of people in that nation. In addition, the level of economic development determines the living standards of citizens in a country. Per capita income is one of the main determinants on whether an individual can afford quality medical services even if it means seeking them outside the country (Woolf, 2017. The level of living standards determines factors such as healthy diet and ample physical exercise. Therefore, countries in the first world have high quality of health compared to second and third world countries.

In conclusion, international health disparities mostly exist due to the level of development of nations. Developed countries have the highest living standards, where citizens can access quality healthcare and also live healthy lives in terms of diet. Also, first world countries have the highest quality of education that they can produce high-quality health practitioners who provide excellent services, thus reducing the mortality rate in the nation.

 

References

Nation Master. (n.d).”Health: China and United States compared”. Retrieved from http://www.nationmaster.com/country-info/compare/China/United-States/Health

NationMaster. (n.d).”Health: Rwanda and United States compared”. Retrieved from http://www.nationmaster.com/country-info/compare/Rwanda/United-States/Health

National Center for Health Statistics (US. (2016). Health, United States, 2015: with special feature on racial and ethnic health disparities.

Woolf, S. H. (2017). Progress in achieving health equity requires attention to root causes. Health Affairs, 36(6), 984-991.

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Qualitative Study

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Qualitative Study

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses.

Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

SAMPLE ANSWER

Qualitative Study

Study Protocol of ” Worth the Walk”: a randomized controlled trial of a stroke risk reduction walking intervention among racial /ethnic minority older adults with hypertension in community senior centers by Kwon, et al., (2015).

Background of the study

Stroke has become one of the leading causes of high mortality rates in the United States. Stroke is also responsible for disabling most of the minority seniors. Approximately 30% of the strokes are related to lack of physical activity, but most of the older generations in most of the ethnic groups in the United States tend to participate most in physical exercise.

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Significance of the study

Most of the African American, Chinese, Korean, and Latino seniors with hypertension are the most affected groups by stroke. As a result, the cost of health among the mentioned groups tends to be high, and yet the mortality rate continues to be high every year. Walking among the seniors can increase their physical activity, which can, in turn, reduce the risks of stroke, especially among those seniors suffering from hypertension.

The purpose of the study

To conduct a randomized controlled trial to assess the effects of a culturally designed walking intervention that is community-based to decrease the risk of stroke by increasing the rate of physical exercise among Latino, African American, Korean and Chinese seniors suffering from hypertension.

Research question

Does walking intervention reduce the risk of stroke among the racial/ethnic older adults with hypertension in senior community centers?

Research method

The researchers enrolled the minority seniors of the targeted groups at senior centers and used data collection with complete baseline. The selected groups were then assigned to receive the walking intervention randomly. The sample size was 120, which was obtained after a full 90 days follow up intervention. The researchers’ assigned trained case managers to conduct qualitative methods to answer the research questions. They implemented the intervention sessions two times a week for four consecutive weeks to the targeted intervention group. The measures for primary outcome included the stroke knowledge, mean steps per day for more than seven days, and self-efficacy for reducing the risk of stroke. The measures for exploratory and secondary measures include health-seeking, health-related quality of life, and biological markers for health. The researchers collected the outcome data from participants in the wait-list control and intervention participants three months after complete baseline data collection (Chiu, Bergeron,Williams, Bray, Sutherland & Krauss, 2015). The outcomes were then compared between the two groups using randomized trials data analytic methods. The facilitators and the barrios to the successful implementation of worth the walk were also assessed. The researchers did not indicate the weakness of the available studies and also did not include a conceptual framework in their research.

Qualitative Study

Results of the study

The randomized controlled trial demonstrated considerable improvements in knowledge about stroke and body exercise in the intervention group as compared to the control group (Chiu, et al. 2015). Nurses should consider the intervention as the primary prevention strategy for stroke among seniors in various minority ethnic or racial groups in the United States.

The findings of the study suggest that nursing education should highly consider training the nurses about physical exercise and implement the worth a walk intervention to improve patient outcome.

Ethical considerations

Patient confidentiality was considered in the study. Information regarding individual participants in the study was well handled to avoid its leakage to unauthorized persons. Also, the study was approved by the Institutional Review Board.

Conclusion

The risk of stroke is highly increased with the reduction of physical exercise, especially among the seniors in the minority ethnic or racial groups in the United States. Nursing practice should emphasize increased physical activity among the minority groups, especially the seniors with hypertension, to reduce the risks of stroke. It is the responsibility of the nurses to create awareness on the benefits of body exercise in minimizing the stroke cases, which can, in turn, reduce the treatment costs and reduce the mortality rates.

Quantitative Study

Comparison of the Dash (Dietary Approaches to Stop Hypertension) diet and a higher-fat Dash diet on blood pressure and lipids and lipoproteins: a randomized controlled trial, by Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015).

Background of the study

The Dietary Approaches to prevent and stop hypertension include incorporation of a dietary pattern that is high in vegetables, fruits, and low in fats, especially dairy foods. The Dash enhances low-density lipoprotein, lowering of high blood pressure and cholesterol, that is high-density lipoprotein.

Significance of the study

Hypertension is a condition that is a highly experienced condition, especially among the aging generations. The leading causes of hypertension are reduced physical exercise and poor dieting. Hypertension increases health costs and also leads to high mortality rates, especially among the senior groups in society.

Purpose of the study

The main objective of the study was to examine the effects of substitution of full-fat with low-fat dairy food products in the DASH diet with a corresponding increase in fat and a decrease in the intake of sugar on plasma lipids, lipoproteins and blood pressure.

Qualitative Study

Research question

Do the DASH and HF-DASH diet lower high-density lipoprotein cholesterol, low-density lipoprotein, and high blood pressure?

Research methods

The researchers used a sample size of three health persons to conduct a randomized crossover trial based on three periods. The individuals consumed a standard Dash diet, a control diet, a lower carbohydrate modification of Dah diet, and a high-fat diet for three weeks each which was separated by two weeks’ periods for washouts (Kwon, et al. 2015). The researchers then conducted laboratory measurements that included the concentration of lipoprotein particles determined by the mobility of ions, which was established at the end of each experimental diet (Kwon, et al. 2015). The researchers used both dependent and independent variables. The dependent variable was high blood pressure, and the DASH and HF-DASH diet were the independent variables that were presented after the tests (Kwon, et al. 2015). The variables were shown on a graph with the high blood pressure being on the y-axes and the DASH and HF -DASH diets being on the x-axes. Each of the researchers analyzed the data using the Statistical Packages for Social Sciences and compared their results to eliminate the chances of personal bias and ensure the accuracy of results.

Results of the study

The participants of the study finished the three dietary periods. The HF-DASH and DASH diets profoundly reduced blood pressure compared to the control diet. There was a reduction in the concentration of medium and large very-low-density lipoprotein particles and triglycerides (Kwon, et al. 2015). The HF-DASH diet also increased the peak particle diameter of LDL and decreased the HDL cholesterol, LDL cholesterol, apolipoprotein A-I, large LDL particles Intermediate density lipoprotein and the width of LDL peak compared with the control diet. The researchers did not mention any limitations of the study.

Qualitative Study

Ethical considerations

The Institution Review Board approved the study. Also, the confidentiality of the participants in the study was highly maintained.

Conclusion

The DAS diet significantly lowered blood pressure to the same extent as the HF- DASH diet and also reduced the concentration of VLDL and plasma triglyceride without increasing the cholesterol. The findings of the study can help improve nursing practice in managing hypertension. Nurses should create awareness among patients and the community at large about the DASH and HF-DASH diet to help reduce the mortality rates and the costs of treatments.

 

References

Chiu, S., Bergeron, N., Williams, P. T., Bray, G. A., Sutherland, B., & Krauss, R. M. (2015). Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: A randomized controlled trial–3. The American journal of clinical nutrition, 103(2), 341-347. https://www.ncbi.nlm.nih.gov/pubmed/26718414

Kwon, I., Choi, S., Mittman, B., Bharmal, N., Liu, H., Vickrey, B., Song, S., Araiza, D., McCreath, H., Seeman, T., Oh, S. M., Trejo, L., … Sarkisian, C. (2015). Study protocol of “Worth the Walk”: A randomized controlled trial of a stroke risk reduction walking intervention among racial/ethnic minority older adults with hypertension in senior community centers. BMC Neurology, 15, 91. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0346-9

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Vargas Family Case Study: Fifth Session

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Vargas Family Case Study: Fifth Session

Read “Topic 5: Vargas Family Case Study.” Write a 750-1,000-word paper in which you demonstrate how therapists apply Strategic Family Therapy theories to analyze the presenting problems and choose appropriate interventions.

Be sure to answer the following questions in your paper:

1. How would Jay Haley or Chloe Madanes approach the current presenting problem? Identify and describe two interventions that he/she may use and why.

2. How would an MRI-style therapist approach the current presenting problem? Identify and describe two interventions that would be used and why.

3. How would a Milan-style therapist approach the current presenting problem? Identify and describe two interventions that would be used and why.

Cite at least three academic sources (peer-reviewed journal articles, books, etc.).

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center

 

SAMPLE ANSWER

Vargas Family Case Study: Fifth Session

Introduction

Strategic family therapy has been significantly influenced by concepts found in the Bateson’s cybernetics model. Based on both family and brief psychotherapy, the model focuses on transforming behavior rather than changing insight as seen in other creative interventions (Tramonti, 2018). Under the Bateson’s cybernetics model are three models including; the mental research institute (MRI) model, Haley and Madanes strategic approach and the Milan model. According to Jay Haley, strategic therapy is a form of therapy where the therapist initiates the entire therapy session, designs approaches for every family member with a presenting problem, and takes responsibility about the care offered (Szapocznik et al. 2015). The MRI approach is based on the view that the client’s complaint is the main problem and it is not a symptom of other issues (Ray, 2018). The Milan Family System model views the family as a single functioning unit throughout the entire therapeutic process (Brown, 2015). By using the aforementioned strategic family therapy theories, appropriate interventions will be provided to facilitate a state of wellness for the Vargas family members.

Haley and Madanes Strategic Approach

The Haley and Madanes strategic approach is more concerned with symptoms and the function they serve in the therapy process. After analyzing triadic interactions over long periods of time, Haley was more concerned with power struggles and formulated rules following a hierarchical order (Szapocznik et al. 2015). Madanes on the other hand, was more concerned with incongruous hierarchies where children use symptoms to change the behaviors of their parents. Additionally, this strategic approach believes that families go through dysfunctional stages to be able to get to functional stages. The approach also posits four categories of problems arising from; a desire to dominate, control, be loved, love and to protect others and a desire to repent and forgive (Szapocznik et al. 2015). Therefore, the model focuses on both short and long-term sequences to reflect on chronic structural problems.

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The Haley and Madanes approach to family therapy focuses more on increasing the family members’ ability to love and soothe than to dominate or gain control over other family members. With this objective in mind, the love-first approach to intervention is the most effective strategy to use when addressing the Vargas Family. This approach encourages the family to provide love to each other throughout the treatment process (“Types of Intervention Methods”, 2019). The Haley and Madanes model also recognizes the role that children play in affecting their parent’s behavior. As such, the systematic family model of intervention which highlights the influence that one family member has on other members of the family is an effective intervention. By doing this, the highlighted family member responds better to treatment.

MRI Style Therapist Approach

This approach is based on the view that problems arise from the way difficulties in life are handled by an individual or by other members of the family (Rohrbaugh & Shoham, 2013). The therapist’s main aim is to gather adequate information about the presented problems and establish minimal goals towards change. The focus of all interventions is on solving the presenting problem rather than seeking changes in the entire family system. With this in mind, the most effective intervention for Frank Vargas will require the interruption of ionic processes that take place during repeated attempts to address his behavior. Ionic problem solution loops should be used to assess the intervention (Rohrbaugh & Shoham, 2013). In addition to interrupting ionic processes, the therapist can carry out activities that encourage family members to ritualize specific scenarios that result in conflict using objects like hats. The therapist then uses the information to interrupt the problem sequence and allow the family members to reconfigure themselves (Mloispro, 2017).

Milan-Style Therapist Approach

The Milan-style therapist approach shifts the focus away from interactive sequences in the family and directs it towards questioning the family’s belief systems. Therefore, the model strives to help families examine their thoughts and belief systems instead of helping the family transform their behavior (Loras, Bertrando & Ness, 2017). In line with this, two key interventions are identified that could benefit the Vargas family. They include; positive connotations and family rituals. Positive connotation involves reframing the problematic behavior in the family where the symptoms are viewed as positive since they help facilitate the family’s well-being. Family rituals like weddings and funerals play a central role in the family’s life. Therapeutically, these rituals may be used to establish family patterns and alter beliefs (Loras, Bertrando & Ness, 2017).

Conclusion

The Haley and Madanes strategic model, the MRI style approach and the Milan-style therapist approach all draw fundamental concepts from the Bateson’s Cybernetics model. By focusing on the effects that children have on their parent’s behavior, Haley and Madanes model provides interventions that focus on the effect that one family member has on other members. The MRI interventions on the other hand interrupt ionic processes to control behaviors. Lastly, the Milan intervention concentrates on family rituals and uses them to transform behavior.

 

References

Brown, J. M. (2015). The Milan Principles of Hypothesizing, Circularity and Neutrality in Dialogical Family Therapy. Australian and New Zealand Journal of Family Therapy, 31(3). https://doi.org/10.1375/anft.31.3.248

Loras, L., Bertrando, P. & Ness, O. (2017). Researching Systematic Therapy History: In Search of a Definition. Journal of Family Psychotherapy, 28(2), 134-149. Doi: 10.1080/08975353.2017.1285656

Mloispro. (2017). Mental Research Institute (MRI) Systemic Therapy. Mindfully, Retrieved from https://mindfullyhealing.com/mental-research-institute-mri-systemic-therapy/

Ray, W.A. (2018). Bateson’s Cybernetics: The Basis of MRI Brief Therapy: Prologue. Researchgate, 36(8), 859-870. Doi: 10.1108/03684920710777388

Rohrbaugh, M.J. & Shoham, V. (2013). Brief Therapy Based on Interrupting Ironic Processes: The Palo Alto Model. Clinical Psychology (New York), 8(1), 66-81.

Szapocznik, J., Muir, J.A., Duff, J.H., Schwartz, S.J. & Brown, H. (2015). Brief Strategic Family Therapy: Implementing Evidence-based Models in Community Settings. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 25(1), 121-133. Doi: 10.1080/10503307.2013.856044

Tramonti, F. (2018). Steps to an Ecology of Psychotherapy: The Legacy of Gregory Bateson. Systems Research and Behavioral Science, 36(1). Doi: 10.1002/sres.2549

“Types of Intervention Methods”. (2019). Ridgefieldrecovery. Retrieved from www.ridgefieldrecovery.com/intervention-guide/intervention-methods/

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Crisis Counseling

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Crisis Counseling

Sometimes clients come into the counseling session with an immediate crisis. They need an immediate solution to a problem. Counseling in these situations needs to be focused and goal oriented.

Jamila has been working with her counselor on learning to better manage her 9-year-old son. Last night, her son was hit by a car and is in the hospital. This has created a number of problems:

1. She has to arrange childcare for her daughter so she can stay with her son in the hospital.

2. He will need some special care when he gets home because he will be in a wheelchair.

3. She is fearful that she will lose her job as a teacher’s aide in the local public school.

Write a 500-750-word paper addressing the following:

1. How would you prioritize Jamila’s concerns in the counseling session? What would you address first?

2. What steps would you take in this session to make sure that Jamila has the resources she needs right now?

3. How would you help Jamila develop a plan to manage the current crisis?

Include at least three scholarly references in your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

SAMPLE ANSWER

Crisis Counseling

Introduction

A person is viewed to be in a crisis when they experience a situation which is considered too difficult for them to handle. This issue occurs due to personal inadequacies or insufficient resources. The above factors may make the situation to exceed the individual’s tolerance capabilities. Crisis counseling is therefore a technique that may offer immediate help to an individual in a crisis. To achieve this goal, there are various priorities and models that counselors may use during the intervention (Taylor, & Gibson, 2016).  The essay intends to develop suitable priorities, design ways of creating efficient resources, and develop a suitable management plan for a presented case.

Case Overview

The crisis counseling session focus on a client whose name is Jamila. The client is a teacher’s aide and has two children; a boy and a girl. The son is involved in an accident and needs special care from the mother. In addition, the daughter needs to be placed in a childcare facility to provide time for her son’s care. By caring for her son, Jamila risks her losing her job.

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Prioritizing Client’s Concerns

In the scenario, every element is crucial to the client, thereby creating a dilemma to her. From the client’s time and finances are essential concerns for her. Therefore, it would be important to prioritize Jamila’s concerns basing on time and finances. Moreover, it would also focus on the impact of the issue to other issues. The counselor may need to address her job concern first. This is because it would affect her ability to pay for her son’s hospital bill and her daughter’s daycare fees. In addition development of a suitable job schedule may help the client to care for her son without problems. The second issue to be addressed will be son’s care. This concern has been ongoing for the client; hence it is more urgent than her daughter’s daycare concern (Taylor, & Gibson, 2016).

Steps for Attainment of Resources

A systematic approach is suitable in enabling the client to attain resources for controlling the problem. The six-step crisis intervention model will be useful in helping Jamila. In the model, the first step involves defining the problem and understanding it from the client’s perspective. The second step is focused at ensuring the client’s safety. In the scenario, this step focuses on the psychological danger that Jamila may face. Thirdly, the counselor will provide support to the client through suitable communication skills (Silva, Siegmund, & Bredemeier, 2015).

The fourth phase involves examination of different resource alternatives. It may involve assessment of the client’s situational support or involving people close to her. Fifthly, the counselor will engage in making detailed plans and outline the persons and other referral resources that can enhance support to the client. Lastly, the counselor needs to obtain commitment from the client to ensure that the crisis counseling session is effective (Silva, Siegmund, & Bredemeier, 2015).

Developing a Management Plan

Developing a management plan needs suitable strategies. However, there are two broad frameworks that the assistance will follow; nondirective and collaborative counseling. If the client is able to initiate and develop their own management plans, nondirective counseling will be used. Contrarily, collaborative counseling will be suitable if the counselor has established a reliable partnership with the client. A suitable strategy for enhancing proper management planning is creation of awareness. This strategy attempts to bring to the clients thoughts and behaviors that may solve her crisis. In addition, provision of support is essential throughout the six-step process as it validates and expands on suggestions for controlling the situation. Lastly, the practitioner may provide guidance and direction on how to use the resources to manage the crisis (Crosby, Cwik, & Riddle, 2015).

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Conclusion

Crises are a common occurrence in people’s lives. However, it is often difficult to manage these challenges without the help of other people. The paper tries to show the role of counselors in helping clients solve their crisis issues. From the paper, it can be shown that using a systematic approach is suitable in helping clients manage their crises. In addition, one can depict that the counseling strategies such as support of clients and offering clients are beneficial tin crisis counseling management.

 

References

Crosby B. M., Cwik, M. F., & Riddle, M. A. (2015). Awareness, attitudes, and use of

crisis hotlines among youth at‐risk for suicide. Suicide and Life‐Threatening Behavior, 45(2), 192-198.

Silva, J. A. M. D., Siegmund, G., & Bredemeier, J. (2015). Crisis interventions in online

psychological counseling. Trends in Psychiatry and Psychotherapy, 37(4), 171-182.

Taylor, J. V., & Gibson, D. M. (2016). Crisis on campus: eating disorder intervention from a

developmental-ecological perspective. Journal of American College Health, 64(3), 251-255.

 

 

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