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Legal and Ethical Considerations in Group Therapy

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Legal and Ethical Considerations in Group 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.

 

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.

 

SAMPLE ANSWER

Introduction

Group and family therapy has developed different models. Overtime, therapeutic techniques such s triangulation and use of paradox have become essential in the practice. While individual therapy sessions also require some ethical and legal considerations, it is viewed that group therapy needs more experience (Sori & Hecker, 2015). The paper tries to develop an explanation on the differences between individual and group therapy in terms of legal and ethical considerations. In addition, it elucidates the impact of such differences in group therapy.

Individual vs. Group Therapy

In individual therapy, there is a higher level of confidentiality when compared to group therapy. In addition, clients in individual therapy are given more attention than those in group therapy. Therefore, the therapy is more patient-specific than in group therapy. Moreover, groups may allow unmotivated individuals to hide their concerns, thereby avoiding accountability. From another perspective, group therapy may not be appropriate to individuals who have social issues such s clients who are impulsive or antisocial (Blumer, Hertlein, & VandenBosch, 2015).

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Impact on Group Therapy

The features for group therapy lead to an increased application of informed consent when providing therapeutic prescriptions. They also need high competence to practice during the sessions. In addition, it may need some arrangements for individual consultations to carter for individual needs of the clients. The practitioner also needs to offer high level of neutrality in order to address the issues without offending some members (Mittal et al., 2015).

Conclusion

In psychology, legal and ethical considerations are an essential aspect of the practice. Both individual and group therapies have different advantages. However, in terms of ethical and legal considerations, group therapy is more disadvantageous. Perceived inequities in the therapy need practitioners to arrange for groups with people having similar social characteristics or needs.

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References

Blumer, M. L., Hertlein, K. M., & VandenBosch, M. L. (2015). Towards the development of

educational core competencies for couple and family therapy technology practices. Contemporary Family Therapy, 37(2), 113-121.

Mittal, V. A., Dean, D. J., Mittal, J., & Saks, E. R. (2015). Ethical, legal, and clinical

considerations when disclosing a high‐risk syndrome for psychosis. Bioethics, 29(8), 543-556.

Sori, C. F., & Hecker, L. L. (2015). Ethical and legal considerations when counselling children

and families. Australian and New Zealand Journal of Family Therapy, 36(4), 450-464.

 

 

 

 

 

 

 

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Management Information Systems – Assignment 08

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Management Information Systems – Assignment 08

Be sure to save an electronic copy of your answer before submitting it to Ashworth College for grading. Unless otherwise stated, answer in complete sentences, and be sure to use correct English, spelling, and grammar. Sources must be cited in APA format. Your response should be four (4) double‐spaced pages; refer to the “Format Requirementsʺ page for specific format requirements.

 

  1. Provide a clear description of an enterprise system and describe how it works.

 

  1. Discuss at least three (3) ways an enterprise system can provide value for a company.

 

  1. Discuss the importance of development and integration of information systems in project management.

 

SAMPLE ANSWER

  1. Provide a clear description of an enterprise system and describe how it works.

An enterprise system is the cross-functional information system which assists in providing organizational coordination in the operations process. Similarly, it also enhances the integration of key business processes which facilitate to plan resources of an organization. Therefore, it is essential to understand that with the help of an enterprise system, the operational activities can be managed flawlessly across the company (Teece, 2018). The involved business processes which can be enhanced consist of sales, manufacturing, logistics, production and human resources. Substantially, these processes can also be integrated into organization vast business operations to improve the profitability.

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The enterprise system works from a driven software suited with a set of integrated modules of software with a conventional centralized database. Further, the software modules are useful in supporting the fundamental business processes which are under different functional areas. These modules also ensure the database stores the data and even feeds them into various applications which can support the essential internal business activities (Teece, 2018). The implementation of these enterprise systems requires the organizations to determine the business process which needs to be automated. The following aspect will entail the mapping processes to the provided business processes by the system. Additionally, these activities require a lot of effort because sometimes these systems are not able to support the way organizations work. Therefore, in such cases, the software will be re-customized to meet the requirements of the organizations (Sedera, Lokuge, Grover, Sarker & Sarker, 2016). Otherwise, it would affect the performance of the organization by compromising the information and process for integration in a different department. As a result, obtaining the maximum benefit from a developed enterprise system needs proper planning for software developed (Appelbaum, Kogan, Vasarhelyi, & Yan, 2017). The focus on the organization needs to change the working process to support the operational activities in the company.

Management Information Systems – Assignment 08

  1. Discuss at least three (3) ways an enterprise system can provide value for a company

The enterprise system has become the most critical resources for organizations in the business world. This is because it describes the facet of the modern enterprise, which includes the customer service to operations security and social media practices. In the contemporary world, the development f innovation has improved the efficiency of company operations in different ways. Substantially this has been made possible through the provision of solutions to improve their workflow and customer services (Appelbaum, Kogan, Vasarhelyi, & Yan, 2017). There are various ways in which an enterprise system can provide value to a company. Storing business data in a usable format is one of the ways it brings value to the company. The data stored in a usable form is crucial in improving customer experience through compelling analysis. The aim is to measure, manage as well as executing the essential decision to enhance the efficiency of the operations. For instance, the data which can be stored may entail the customer history on the orders made and how long they may be processed.

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The ability for a company to retrieve these types of information to answer the requirements of the customers reflects on the customer satisfaction. The other value in which an enterprise system may provide is the obtain real-time access to information. The business world is often changing, and therefore, this may take time to retrieve data of these systems are not implemented on time. Therefore, accessing real-time information on business operations is useful to improve the efficiency in the long term (Teece, 2018). Lastly, the enterprise systems are also crucial in reducing the cost of doing business. The companies can have more of their budgets to improve on different departments and become more profitable. For instance, the inventory control can be maintained by keeping a significant amount of stock as well as servicing customers on time.

  1. Discuss the importance of development and integration of information systems in project management.

The development of the information system in project management is necessary for collecting information, classifying them as well as communicating for the success of the objectives. Besides, it is essential to understand that project management may be a complicated task in a company because it requires the involvement of all the departments in an organization. There are various importance of the development and integration of information system in project management, which needs to be put into consideration (Hornstein, 2015). One of the importance is to assist in the management of available resources to complete the project. The focus of this is to understand the predetermined time and organize the activities by utilizing the limited resources to achieve the primary goal.

Management Information Systems – Assignment 08

Similarly, development and integration of information system in project management assistance in improving the level of communication. The establishment of efficient communication is crucial to understand the flow of work in different departments of the company (Hornstein, 2015). As a result, this may assist in solving problems that are not defined accordingly within different channels in the organization. Nonetheless, the development and integration of information can assist in the reduction of costs of operations. Such charges may consist of transaction processing, hardware and software maintenance as well as support staff such as in managing supplies of goods.

 

 

References

Appelbaum, D., Kogan, A., Vasarhelyi, M., & Yan, Z. (2017). Impact of business analytics and enterprise systems on managerial accounting. International Journal of Accounting Information Systems, 25, 29-44.

Hornstein, H. A. (2015). The integration of project management and organizational change management is now a necessity. International Journal of Project Management, 33(2), 291-298.

Sedera, D., Lokuge, S., Grover, V., Sarker, S., & Sarker, S. (2016). Innovating with enterprise systems and digital platforms: A contingent resource-based theory view. Information & Management, 53(3), 366-379.

Teece, D. J. (2018). Business models and dynamic capabilities. Long Range Planning, 51(1), 40-49.

 

 

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Management Information Systems – Assignment 04

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Management Information Systems – Assignment 04

Be sure to save an electronic copy of your answer before submitting it to Ashworth College for grading. Unless otherwise stated, answer in complete sentences, and be sure to use correct English, spelling, and grammar. Sources must be cited in APA format. Your response should be four (4) double‐spaced pages; refer to the “Format Requirementsʺ page for specific format requirements.

Management Information Systems – Assignment 04

 

  1. Describe three (3) ways in which information systems are transforming business.

 

  1. Discuss telecommunication operations and three (3) security measures to ensure protection of information.

 

  1. List and describe the organizational, management, and technology dimensions of information systems.

 

SAMPLE ANSWER

Management Information Systems

  1. Describe three (3) ways in which information systems are transforming business.

Business information systems are the amalgamation of various resources such as hardware, software, computers and system connection, which assist in enhancing the business process in a company. Additionally, it also enables the business operations to upgrade the value chain systems of the organizations within the global market. There are multiple ways in which information systems have transformed a business that needs to be put into considerations. Among them are the changes in technology as well as the development of new innovative business models for business operations (Evans, Vladimirova, Holgado, Van Fossen, Yang, Silva, & Barlow, 2017). Substantially, this aspect has transformed the social life and the practices in the business field through the use of smartphones, social networking, emailing, and webinars tools.

Management Information Systems – Assignment 04

Moreover, all of these tools have become essential to improve services to the customers and suppliers. The information system has also transformed business through sensing and responding to changing business operations by managing changing customer demand, reduction of inventories to the lowest possible level as well as achieving higher operational efficiency. This transformation aims to focus on the establishment of better decision-making practices for organizations (Hull & Nezhad, 2016). The informed decision, on the other hand, assists in making improved choices in supply chain management. This is achieved through the establishment of a more fast-pace since companies of all sizes depend on the provision of just in time inventory practices. Lastly, information system has also transformed the global market operations for the customers. The development of e-commerce and internet marketing have continued to expand in different regions (Hull & Nezhad, 2016). As a result, there is an increase in the targeted customers to acquire their goods and services conveniently.

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  1. Discuss telecommunication operations and three (3) security measures to ensure the protection of information.

Telecommunication operations are the process of managing the services of telecom systems to ensure maximum availability as well as minimal disruption of these services to organizations. The telecom operations process also involves the management of functions such as network inventory systems, management of provision issues, network availability and any cases of fault management (Peltier, 2016). Besides the management of telecom operations, there are various vital processes which should also be put into consideration by organizations. These entail request fulfilment, incident management, access and event management and can be useful in establishing a standard telecom process framework. Most of the telecom companies often provide different unique expert services and diagnostics in the network to help their customers improve value proposition in their activities (Peltier, 2016). Notably, the business organization also uses these services to rationalize their operational investments to improve margins as well as operational efficiency.

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The security measures to ensure the protection of information is essential for most of the companies in the business world. Data security provides safety of data from the company to reach in the hands of cyber attackers. Therefore, it is essential to understand various measures which can be put in place to minimize attacks. Protecting the wireless networks which a company is using is one of the ways to safeguard information. These wirelesses are at a higher risk of cyber-attacks compared to the wired networks since it is an open nature and comparatively weaker control (Rittinghouse & Ransome, 2017). As a result, pay more attention to secure these wireless networks by switching to the latest wireless security technologies is necessary. Taking regular backups on the data is also another way to secure information by an organization. Substantially, this will protect against the frequent cyber attacks that target the system. The importance of taking the backup of the data is to enable the organizations to reclaim the information which has already backup. Additionally, it is also vital to make regularly scheduled backup to keep the data safe from attackers. Installing a firewall and using complex passwords is also another to protect the information (Rittinghouse & Ransome, 2017). The use of passwords is hard to guess if they contain a combination of numbers, upper- and lower-case letters and symbols.

  1. List and describe the organizational, management, and technology dimensions of information systems. 

The organizational dimension of the information system describes the characteristics of significant practices and leadership orientation in the organization. These dimensions entail the hierarchy of the organization, and business processes practised, the existing culture and political interest of the groups involved in the organization. The management dimension of the information system, on the other hand, illustrates the distinct function priorities and their effort to a joint mission (Evans et al., 2017). They consist of setting organizational strategies, creating new products and services in the market, allocating resources in the company as well as re-organizing the practices of the organization.

The technology dimensions of information system describe the cultures of the tools and skills that are put in place to address the technological changes in the market. The concern of this aspect establishes the level of interaction as well as communication in diverse systems. Similarly, it also addresses the issues on the management of functions such as network inventory systems, management of provision issues, network availability and any cases of fault management (Peltier, 2016). The technology dimension information system consists of computer software, hardware, management of data technology and also networking services in an organization.

 

References

Evans, S., Vladimirova, D., Holgado, M., Van Fossen, K., Yang, M., Silva, E. A., & Barlow, C. Y. (2017). Business model innovation for sustainability: Towards a unified perspective for creation of sustainable business models. Business Strategy and the Environment, 26(5), 597-608.

Hull, R., & Nezhad, H. R. M. (2016, September). Rethinking BPM in a cognitive world: Transforming how we learn and perform business processes. In International Conference on Business Process Management (pp. 3-19). Springer, Cham.

Peltier, T. R. (2016). Information Security Policies, Procedures, and Standards: guidelines for effective information security management. Auerbach Publications.

Rittinghouse, J. W., & Ransome, J. F. (2017). Cloud computing: implementation, management, and security. CRC press.

 

 

 

 

 

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The use of SBIRT in Adolescent Population

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The use of SBIRT in Adolescent Population

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

  1. Provide an overview of the problem and the setting in which the problem or issue occurs.
  2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
  3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
  4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
  5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
  6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

SAMPLE ANSWER

The use of SBIRT in Adolescent Population

Problem Overview

Abusing drugs among adolescents is primarily prevalent in the United States. This makes adolescent years a critical window for the development of substance use disorders. Abusing drugs among the youth influence both their social and psychological development primarily cognitive development (Aldridge, Linford, & Bray, 2017). Nurses and physicians need to intervene early before substance abuse leads to cognitive health issues.  According to Johnston, O’Malley, Bachman & Schulenberg, 2013), physicians need to provide both holistic and quality care to their patients. Through the Road to Evidence-based practice, health care practitioners can find the evidence, appraise the evidence, implement the evidence and evaluate the evidence. Through the use of SBIRT as an evidence-based practice, healthcare practitioners can recognize, decrease and prevent harmful and unhealthy ways of substance use and abuse (Aldridge, Linford, & Bray, 2017). This paper develops a proposal for quality improvement through the introduction of screening, Referral to Treatment (SBIRT) screening tools, intervention, and intervention procedures to adolescent population affected by substance abuse in a health care institution.

The use of SBIRT in Adolescent Population

Why a Quality Improvement Initiative is Required

The quality improvement initiatives are required because the use and abuse of drugs have become common among adolescents, which make it a critical public concern. The Healthy People 2020 developed critical objectives aimed to reduce substance use and abuse among teenagers (Healthy People 2020, 2018). In addition, most government agencies, medical institutions and medical professional associations have developed free counseling programs and screenings for youth such as initiatives that involve SBIRT integration within the medical health care system in collaboration with the White House Office of National Drug Control Policy, Agency for Health care Research and Quality, Health Resources and Services Administration, National Institutes of Health (NIH), and SAMHSA (Johnston, O’Malley, Bachman & Schulenberg, 2013). Besides, the medical professional associations and international and national public health agencies developed recommendations aimed to guide health care professionals to carry out screening and interventions for individuals especially teenagers believed to abuse and use drugs. Therefore, SBIRT is a critical part that can be placed as part of the Affordable Care Act legislation and Patient Protection Act to help deal with the issue of substance abuse among teenagers in the US (Johnston, O’Malley, Bachman & Schulenberg, 2013). Besides, based on the Periodic Screening, Diagnosis, and Treatment statue, each federal government in the US is expected to provide Medicaid screening assessments for both physical and mental development among teenagers.

Results from Previous Research

According to National Institute on Drug Abuse (2014), drugs such as alcohol, tobacco and other illegally prescribed drugs during adolescent are often abused during the adolescent stage. It is estimated that about 70% of students in high school have abused either alcohol or other drugs while 30% might have abused prescribed medications for non-medical reasons (NIDA, 2014). The desire to fit in and faces new experiences, and deal with peer pressure or problems in school are the primary reasons for abusing drugs.

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According to Singh et al., (2017) the factors that influence the use of drugs among adolescent youths include peer pressure and the availability of narcotics in the school, community or neighborhood. The family environment is also a critical factor that may influence teenagers to use and abuse drugs. For example, a violent environment, mental illness, physical and emotional abuse, and the use of drugs in the household may influence the child to use and abuse drugs (Singh et al., (2017). Other factors for abuse of drugs includes the beliefs that drugs are cold, mental health conditions such as ADHD, anxiety, and depression, personality traits such as the need for excitement or poor impulse control, and adolescent’s inherited genetic vulnerability.

The use of SBIRT in Adolescent Population

The U.S. Preventive Services Task Force (USPSTF) recommends providing routine screening for substance abuse among teenagers between 16 years and 17 years. The USPSTF also found that the use of SBIRT among teenagers is a critical area within the nursing practice that needs to be looked into. According to Aldridge, Linford, & Bray, (2017), SBIRT is a public health approach that is integrated and comprehensive to the delivery of treatment and intervention for individuals at risk of developing substance abuse disorder or for individuals who have a substance abuse disorder. The practice of SBIRT as an evidence-based practice involves screening individual’s suspected of substance abuse and encouraging them to change their behavior through motivational interviews and putting them under a treatment plan. Thus, SBIRT is a simple medical practice that is both effective and brief. Evidence from researches shows that cost-effectiveness and efficacy of SBIRT among adults and its help in managing drug use although is useful, it has mixed reaction. A study by Aldridge, Linford, & Bray, (2017), further states that SBIRT is the evidence-based practice that can help the use of drugs among the youths and prevent cannabis use among teenagers.

The use of SBIRT in Adolescent Population

SBIRT, as an intervention, also leads to changes in substance use behaviors among patients who were addicted to drugs and went through the SBIRT tool intervention plan. The large-cohort SAMHSA study in 2017, showed the effectiveness of the SBIRT intervention. The study was quasi-experimental and sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2017). The study sample was about one million individuals, and the study participants were screened for substance abuse disorders, and the SBIRT was used as an intervention plan for five years. The use of SBIRT intervention process was linked with a decrease in substance use among the individuals who were under the SBIRT intervention process (SAMHSA, 2017). SBIRT is a critical intervention tool that is validated to help assess the risk of substance abuse and developing intervention to encourage the reduction of substance use and ensure treatment who have improve both physical and psychological issues resulting from substance use and misuse (Schmidt, 2010). Therefore, SBIRT is a standardized and evaluated screening tool that is effective, patient-centered, evidence-based and an ongoing transition to treatment and care of patients addicted to substance use.

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Steps to Implement the Quality Improvement Initiative

            The first step of implementation of SBIRT intervention plan for patients engaged in substance abuse is to train the health care providers and physicians who will participate in the program. The health care providers who will be involved in the study will be reimbursed for every screening (SAMHSA, 2017). The SBIRT will include four steps during the screening process.

  1. The first step: The first step will involve the screening process where the health care practitioners will develop an evidence questionnaire to identify patient admitted for substance abuse ranging from addiction, problematic and riskiness of substance abuse. The screening process is critical in raising awareness to help people reduce substance use and misuse. The risk of substance use can be divided into four patterns: low risk or abstinence involves those who no consumption of alcohol, tobacco or any other drug. Driving risk includes those adolescents who use drug and alcohol and drive or ride with adolescents high on drugs or alcohol. Moderate risk includes individuals who have started using drugs and alcohol. Finally, high risk involves individuals who use drugs and alcohol often.
  2. The second step: This step involves a brief intervention process where teenagers showing mild symptoms get about 15 to 45-minute intervention including motivational interviewing. This helps to develop a behavioral change among teenagers to help reduce substance use and abuse.
  • The third step: The step involves a brief treatment process where adolescents with a score of moderate to severe in substance use and abuse are provided with a treatment plan that requires counseling sessions.
  1. The fourth step: The step involves the referral to treatment where the patients are connected to a physician for behavioral health treatment, comparative health assessment, or a specialty treatment program for substance abuse disorder.

These steps are critical during the implementation of the SBIRT as an intervention plan based on the following essential components: identifying adolescent at risk of substance abuse and disorders, educate adolescents and create awareness on substance abuse by showing the dangers of drinking and using drugs to help adopt a more healthy behavior (Schmidt, 2010). The potential for preventing substance abuse in the United States should not be underestimated. SBIRT is a critical intervention tool that helps in the reduction of substance abuse and its implementation as evidenced-based practices is an economic strategy that can help reduce abuse among teenagers in the US.

References

Aldridge, A., Linford, R., & Bray, J. (2017). Substance use outcomes of patients served by a broad US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT). Addiction, 112, 43–53. https://doi-org.lopes.idm.oclc.org/10.1111/add.13651

Healthy People 2020. (2018). Increase the proportion of adolescents aged 12 to 17 years perceiving great risk associated with substance abuse. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse/objectives

Johnston, L., O’Malley, P., Bachman, J., & Schulenberg, J. (2013). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings. Bethesda, MD: National Institute on Drug Abuse, 2013. Retrieved from www.monitoringthefuture.org

National Institute on Drug Abuse [NIDA]. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. Retrieved from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide

Schmidt, C. S., Schulte, B., Seo, H.-N., Kuhn, S., O’Donnell, A., Kriston, L., … Reimer, J. (2010.). A meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings. ADDICTION, 111(5), 783–794. https://doi-org.lopes.idm.oclc.org/10.1111/add.13263

Singh, M., Gmyrek, A., Hernandez, A., Damon, D., & Hayashi, S. (2017). Sustaining Screening, Brief Intervention, and Referral to Treatment (SBIRT) services in health-care settings. Addiction, 112, 92–100. https://doi-org.lopes.idm.oclc.org/10.1111/add.13654

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2017). About screening, brief intervention, and referral to treatment (SBIRT). Retrieved from https://www.samhsa.gov/sbirt/about

 

 

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PICOT Question and Literature Research

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PICOT Question and Literature Research

**This assignment needs 3 QUANTITATIVE and 3 QUALITATIVE sources

The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

PICOT Question and Literature Research

Use the “Literature Evaluation Table” to complete this assignment.

  1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
  2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
  3. The PICOT question will provide a framework for your capstone project.
  4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

PICOT Question and Literature Research

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

PICOT Question and Literature Research

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 not required to submit this assignment to LopesWrite.

 

SAMPLE ANSWER

Summary of Clinical Issue (200-250 words):

Hypertension is one of the highest health problems globally because it contributes to increased rates of mortality and morbidity. It is estimated that approximately 56% of coronary artery diseases and 48% of stroke incidences result from hypertension (Chiu et al. 2014). In the US, hypertension affects 29% of the population leading to risks of cardiovascular diseases and stroke.  Factors such as poor dietary practices, sedentary lifestyles, and physical inactivity are the primary contributors to hypertension. According to Osté (2010), physical inactivity augments the risk of hypertension 8-9 times. Lifestyle modifications, including exercise and diet changes are the central management and preventive measures against cardiovascular diseases and hypertension (Apovian et al. 2014).  Besides, lifestyle modifications increase the efficacy of antihypertensive drug and control of blood pressure. Therefore it is critical to maintaining levels of blood pressure through exercises and dietary changes to prevent damage of vital body organs.

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The PICOT question aims to determine whether the DASH and WTW improve blood pressure control among urban African Americans within five months of initiation of the intervention. According to Apovian et al. (2018), enhancing adherence to exercises and the DASH diet is essential to reducing an individual’s blood pressure. However, WTW is an intervention looking to reduce physical inactivity among individuals to help manage cardiovascular diseases and stroke. EBP intervention can be implemented and applied to determine whether they enhance or impede high-quality nursing care. This help to evaluate the outcome of the WTW and DASH on improving the level of patient’s high blood pressure.

PICOT Question and Literature Research

 

PICOT Question:

Does the DASH (Dietary Approaches to Stop Hypertension) and “Worth the Walk” (WTW) improve blood pressure control among urban African Americans within five months of initiation of the intervention?

PICOT Question and Literature Research

 

 

Criteria Article 1 Article 2 Article 3
APA-Formatted Article Citation with Permalink 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

 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
How does the Article Relate to the PICOT Question?  

The article proves whether the

(DASH) the diet has a significant blood pressure (BP)-lowering action

  

The article analyzes whether the DASH Dietary Approaches to Stop Hypertension is a critical dietary modification for reducing cardiovascular disease and blood pressure (BP) risk.

 The article reflects how physical activity through the Worth the Walk” (WTW) can help prevent stroke by reducing blood pressure.
Quantitative, Qualitative(How do you know?) The article is quantitative because it is based on the collection and analysis of numerical data. The article is quantitative because it is based on the collection and analysis of numerical data. The article is quantitative because it is based on the collection and analysis of numerical data.
Purpose Statement The effect of the DASH diet on the pressure-natriuresis relationship to find out the mechanisms of its BP-lowering action. The effects of substituting full-fat for low-fat dairy foods in the DASH diet, with a corresponding increase in fat and a reduction in sugar intake, on blood pressure and plasma lipids and lipoproteins The relationship between the Worth the Walk” (WTW) intervention and biological markers of health including blood pressure, non-HDL cholesterol, and body-mass index,
Research Question Does Dietary Approaches to Stop Hypertension (DASH) diet, rich in fruits, vegetables, and low-fat dairy foods, have substantial blood pressure (BP)-lowering action? Does substituting full-fat for low-fat dairy foods in the DASH diet, with a corresponding increase in fat and a reduction in sugar intake affects blood pressure and plasma lipids and lipoproteins Does the WTW increase physical activity and improve self-efficacy for being physically active and reducing the risk of stroke.
Outcome The study outcome is to find out whether the DASH diet can lower high blood pressure among patients with hypertension. The DASH significantly reduces blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol in the body. The WTW intervention will increase physical activity and reduce the risk of stroke
Setting

(Where did the study take place?)

 The study was carried out in a hospital setting that is not mentioned n the study.

 

 The study was carried out at a clinical research center in Berkeley, California. The study was carried out at four ethnic-specific clusters at senior centers in Los Angeles.
Sample The study sample 412 participants were expected, but a sample size of n=375 was used in the study. The study sample involves thirty-six participants who finished all the experimental diets and took part in the study. The study sample involves a total of 240 participants (60 participants from each of the four targeted ethnic groups).
Method The study employed a parallel-group design. The study employed a 3-period randomized crossover trial design. The study employed a single-blind randomized wait-list controlled trial design.
Key Findings of the Study The study showed that the DASH diet reduced BP effectively in groups with high sodium sensitivity. Besides, the DASH diet did not imply blood pressure at low intakes of sodium. The HF-DASH diet significantly reduced lipoprotein (VLDL) and triglycerides concentrations and significantly increased LDL compared with the DASH diet.

The DASH diet significantly reduced BP, LDL cholesterol, and HDL cholesterol.

 The results showed that the physical activity was improved through the WTW intervention and this, in turn, reduces the risks of stroke. Therefore, WTW intervention reduces hypertension and stroke.
Recommendations of the Researcher It is recommended that the DASH diet is a critical non-pharmacological measure for controlling BP. It is recommended that the modified HF-DASH diet can be used as an effective alternative to the DASH diet. It is recommended that the Worth the Walk should function as the primary stroke prevention model stroke patients.

 

Criteria Article 4 Article 5 Article 6
APA-Formatted Article Citation with Permalink  

Apovian, C. M., Murphy, M. C., Cullum-Dugan, D., Lin, P. H., Gilbert, K. M., Coffman, G., … & Moore, T. J. (2010). Validation of a web-based dietary questionnaire designed for the DASH (dietary approaches to stop hypertension) diet: the DASH online questionnaire. Public health nutrition, 13(5), 615-622.

https://www.ncbi.nlm.nih.gov/pubmed/19912673

  

Osté, M. C., Gomes‐Neto, A. W., Corpeleijn, E., Gans, R. O., de Borst, M. H., van den Berg, E., … & Bakker, S. J. (2018). Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. American journal of transplantation, 18(10), 2523-2533.

https://www.ncbi.nlm.nih.gov/pubmed/29464830

 Staffiliano, A. B., Tangney, C, C., Fogg, L. (2018). Favorable Outcomes Using an eHealth Approach to Promote Physical Activity and Nutrition Among Young African American Women. The Journal of Cardiovascular Nursing. 33, 62–71.

https://www.ncbi.nlm.nih.gov/pubmed/28481823

 
How Does the Article Relate to the PICOT Question?  

The article looks at the DASH diet its correlation to lowering blood pressure and reduces the risk of heart disease, stroke, and osteoporosis.

The article addresses the Dietary Approach to Stop Hypertension (DASH) diet.

 

 The article analyzes improving healthy nutrition behaviors by including a DASH diet can reduce the risk of hypertension.
Quantitative, Qualitative(How do you know?) The study is qualitative research because it marked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. The study is qualitative research because it marked by use of online questionnaires, to collect verbal information, perceptions, and understandings of the topic. The study is qualitative research because it marked by use of Web-based questions that are accessible via the Internet and mobile devices, to collect verbal information, perceptions, and understandings of the topic.
Purpose Statement Assess the validity of a new, short, online dietary questionnaire created to capture DASH food intake. Dietary Approach to Stop Hypertension (DASH) diet and the risk of renal function decline and all‐cause mortality in renal transplant recipients. Favorable Outcomes Using an eHealth Approach to encourage Physical Activity and Nutrition Among Young African American Women
Research Question Does the validity of a new, short, online dietary questionnaire capture DASH food intake. Does the DASH diet lead to a lower risk of renal function? Does eHealth approach promote physical activity and nutrition among young African American women?
Outcome The DASH OLQ is a critical assessment tool for measuring DASH diet adherence.

The Dietary Approach to Stop Hypertension (DASH) diet reduces the risk of renal transplant among patients.

 To improve healthy nutrition behaviors to decrease health risk behaviors, and decrease the risk of hypertension based on the DASH diet.
Setting

(Where did the study take place?)

The study was carried out at Boston University Medical Center, Boston, Massachusetts. The study was carried out in a large single‐center prospective cohort of RTR at the University Medical Center Groningen. The study was carried out at the University Medical Center
Sample The study sample includes faculty and staff aged 20–70 years at Boston University Medical Center The study sample includes the 817 invited patients; however, 632 participants were eligible for analyses. The study sample of 142 participants was expected, but a sample size of 124 was used in the study.
Method The study employed a cross-sectional validation of the DASH OLQ method. The study employed the observational prospective cohort study, and data were collected through a validated 177‐item food frequency questionnaire. A randomized, pre-post design Web-based design was used in the study.
Key Findings of the Study The DASH OLQ is a critical assessment tool for measuring DASH diet adherence. The DASH diet lowers blood pressure, cholesterol and the risk of stroke, osteoporosis, and heart disease.

 

 The study showed that adherence to a DASH‐style diet is linked with a lower risk of renal function. The DASH participants showed that eHealth approach could be used for changing health behaviors patients with hypertension.
Recommendations of the Researcher It is recommended that the DASH OLQ is important in assessing the DASH diet adherence in clinical practice. It is recommended that a randomized clinical trial should be carried out to show whether adherence to the DASH diet risk of renal function. It is recommended that the eHealth approach is a critical program that can be used for changing health behaviors for other populations at risk.

 

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Telling the Story

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Telling the Story

Hector is a 35-year-old Hispanic male. Hector was seriously injured in an auto accident 5 months ago. He spent 4 months in the hospital. One leg and hip suffered permanent damage. He will probably always need a cane and walk with a limp. He also has limited mobility in his right arm and shoulder and cannot lift anything heavy.

Hector grew up in a family with a construction business. He has been working in construction since high school. Social work at the rehab hospital referred Hector to counseling because he is not adjusting well to his injuries. He is very depressed and angry because he cannot continue to work in his chosen occupation. Hector says, “What use am I now? I am the man in the family. I should be strong. I need to support the family. I don’t want my wife to work. I don’t know what I am going to do to make a living.”

Telling the Story

Hector still experiences severe pain in his shoulder and his leg. He spends a lot of time watching TV and drinking. At this point, he is not looking for work. His family has reached out to him but he avoids interaction with his siblings and his parents because they remind him of what he no longer can do. He feels shame when he is around family members because of his disability. His relationship with his wife is tense because he is often angry and withdrawn.

You are meeting with Hector for the first time and want to get the story.

As we meet with a new client we develop some hypotheses to explore, as well as listening to what the client says about himself.

Write a 750-1,000-word paper addressing the following:

1. What are some of primary issues that Hector is addressing?

2. What are some of Hector’s feelings?

3. What are Hector’s behaviors and how are these impacting his adjustment?

4. How might Hector’s cultural heritage be impacting his adjustment to his injury?

5. What are some beliefs that may be impacting Hector’s adjustment?

6. How might Hector’s family background be impacting his adjustment?

7. What might be some issues that will need to be addressed in counseling?

8. What are the stages of change the counselor will help Hector through? Provide a brief definition of each stage.

9. What steps can a counselor take to help Hector explore his problems?

10. Consider the following counselor skills: eye contact, closed and open-ended questions, paraphrasing and summarizing, reflection, body language, tone, listening, empathy, genuineness, unconditional positive regard, interpretation, tracking, reflecting emotion, active presence, structuring sessions, encouragement, questioning and clarifying, counselor self-awareness, tolerating intensity, validating, challenging, multicultural awareness/acceptance, probing and questioning, posture. Pick one skill and discuss how a counselor should use this in their sessions with Hector.

Include at three scholarly references in your paper. At least two resources should identify issues that need to be addressed when you are working with someone who is being rehabilitated from a serious injury.

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

Telling the Story

 

SAMPLE ANSWER

  1. What are some of primary issues that Hector is addressing?

Hector is addressing various issues in his life as a result of the change that he has experienced as a result of the accident. The accident led to permanent damage as a result of the impact on the left and hip. Consequently, he is unable to walk properly unless he uses a cane. Also, his right arm’s motility was affected and this impairs his ability to lift heavy things. Furthermore, he still experiences pain on the shoulders as well as the leg. Therefore, the primary issues that he is experiencing are the body function impairment and this makes him angry and depressed. Depression, anxiety as well as other mental disorders are a common thing among people that have experienced any form of disability and therefore Hector is not an exception. (Noh et al, 2016).

  1. What are some of Hector’s feelings?

Hector also experiences feelings that are associated with the state of his life after the accident. He feels angry about life because he is unable to push through with what he would want to do as a career. Also, he feels helpless and consequently avoids interactions with family members as they make him realize that he can no longer do what he used to do. He also feels shame when he feels like he will be unable to cater for the needs of his family. He feels hopeless based on the fact that he asks “what use am I now?” which implies that he has lost hope and does not believe that something positive could be made out of the prevailing circumstances.

Telling the Story

  1. What are Hector’s behaviors and how are these impacting his adjustment?

Hector’s behaviors influence the adjustment that he has to make regarding his life. As a person with hips, legs, and arms that have been affected, he needs to do some exercises that may be helpful in one way or another. This will be useful alongside physiotherapy that will help Hector regain his mobility (Harvey, 2016). Also, interacting with people frequently will be an avenue to help him overcome the concerns and find new ways to cope with the challenges that life has presented to him. However, he does not want to interact with people and even his relatives and instead chooses to sit and watch TV all day and also indulge in drinking.

Nursing Paper Help

  1. How might Hector’s cultural heritage be impacting his adjustment to his injury?

Adjustment to the new life is also greatly influenced by the culture of Hector. His belief that he needs to be strong and fend for his family seems to be something that is embedded in his culture. It comes out that he does not want his wife to work showing that it is a norm for the husband to work and fend for the family. This ideally should make him get the desire to work towards finding help and helping himself but is instead making him feel hopeless.

  1. What are some beliefs that may be impacting Hector’s adjustment?

The main belief that Hector has is that as the man of the family he needs to be strong and support his family. This makes him feel so hopeless because he is unable to do what he believes he should do.

Telling the Story

  1. How might Hector’s family background be impacting his adjustment?

Hector’s family background also has an impact on his adjustment. His family owns a construction family and he believe that it is what he should be doing but is unable to because of his predicament. Also, his family reminds him so much of the things that he is no longer able to do hence making his adjustment more difficult.

  1. What might be some issues that will need to be addressed in counseling?

During counseling, various issues will need to be addressed. The first issue is the acceptance of the disability and the need to have him understand that it is not an inability. Depression and anxiety will also be addressed as well as substance use since he spends time drinking.

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  1. What are the stages of change the counselor will help Hector through? Provide a brief definition of each stage.

Hector like other people will move through a series of stages namely pre-contemplation (PC), contemplation (C), preparation (PR), action (A), and maintenance (M). At the pre-contemplation stage, Hector will be unaware of the fact that his behavior has negative consequences. As he moves to contemplation, he will be gaining an understanding of what needs to be done and will show intentions to be done to improve the quality of life. The preparation stage is characterized by individuals being ready to take action and they make small steps towards behavior change. Action comes in when people start modifying their behaviors to adopt new and healthier ones and this is followed by maintenance.

Telling the Story

  1. What steps can a counselor take to help Hector explore his problems?

Hector will be helped through the pre-contemplation so that he can realize that not accepting the situation brings more harm to him. At contemplation, he will be helped to recognize that there are negative consequences that he needs to address. This will be achieved through various strategies such as motivational interviewing so that he can be helped to come up with solutions to his problem. He will also be helped through the preparation and action and he will ebb motivated to keep up with the strategies that are aimed at meeting the intended goals.

Telling the Story

  1. How a counselor should use empathy in their sessions with Hector.

Empathy is one of the skills that will be adopted in helping Hector find a solution to his problem. In order to help Hector through the process of recovery and acceptance as well as behavior change, the therapist will need to express empathy and be able to understand Hector’s issues, struggles as well as the barriers that he experiences in becoming better as this is a key element in helping him be freer (Dwyer et al, 2015). In conclusion, Hector is experiencing challenges coping with life after an accident that left him with a disability. Therapy will be beneficial in helping him make changes in his life and learn to cope with the challenges that the disabilities present.

 

References

Dwyer, L., Parkin-Smith, G. F., Brantingham, J. W., Korporaal, C., Cassa, T. K., Globe, G., … &

Tong, V. (2015). Manual and manipulative therapy in addition to rehabilitation for osteoarthritis of the knee: assessor-blind randomized pilot trial. Journal of Manipulative and Physiological Therapeutics, 38(1), 1-21. doi.org/10.1016/j.jmpt.2014.10.002

Harvey, L. A. (2016). Physiotherapy rehabilitation for people with spinal cord injuries. Journal

of Physiotherapy, 62(1), 4-11. doi.org/10.1016/j.jphys.2015.11.004

Noh, J. W., Kwon, Y. D., Park, J., Oh, I. H., & Kim, J. (2016). Relationship between Physical

Disability and Depression by Gender: A Panel Regression Model. PloS one, 11(11), e0166238. doi:10.1371/journal.pone.0166238

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Vargas Family Case Study Fourth Session

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Vargas Family Case Study Fourth Session

Read “Topic 4: Vargas Family Case Study.” Write a 750-1,000-word paper in which you demonstrate how therapists apply structural family therapy theory to analyze the presenting problems and choose appropriate interventions.

Be sure to answer the following questions in your paper:

1. What are two current presenting problems for the Vargas family?

2. How are the problems maintained according to the structural family therapy perspective?

3. What structural interventions would you plan to use in your next session? (identify and describe your plan for two interventions)

4. What is the role of the counselor in the change process according to the structural family therapy perspective?

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.

 

SAMPLE ANSWER

Vargas Family Case Study Fourth Session

Structural family therapy is a form of treatment that focuses on patterns of interaction that cause problems within a family (Fisher, 2017). Structural family therapy (SFT) focuses on improving communication and interactions in the family and highlighting boundaries that would result in a healthier family structure. After having sessions with the family and observing how they communicate and interact with each other, the therapist should then draw a chart of the family’s structure. The chart is used to identify hierarchy, sub relationships and boundaries within the family unit. Additionally, the chart helps the therapist identify interventions that will help improve the situation (Fisher, 2017). According to SFT, the root cause of many childhood problems originates within the family unit. Therefore, to successfully transform a child’s behavior, a therapist must first help change the family and its dynamics.

Current Presenting Problems for the Vargas Family

A fourth session with the Vargas family has highlighted several problems. Bob and Elizabeth are still not communicating effectively when it comes to Frank and how to handle his behavior. After arriving separately to the session, Elizabeth is clearly upset when she learns that instead of Bob taking Frank to work, he takes him out for ice cream and a movie. Additionally, Bob does not believe that Frank’s suspension from school was valid. Furthermore, he thinks that Elizabeth is overacting and Frank’s behavior is normal. There is also a clear division within the family’s dynamics. Elizabeth and Heidi are on one side with Bob and Frank on the opposite side. Frank is more comfortable with his farther and believes that his mother gets angry easily. Heidi on the other hand, gravitates towards her mother and prefers sitting next to her. Despite Heidi’s stellar performance in school, more attention is still given to Frank and his behavior. As a result, Heidi feels left out. Lastly, Bob and Elizabeth are still divided on Frank’s behavior and whether there is something wrong with it.

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How the Problems are Maintained according to the Structural Family Therapy Perspective

According to structural family therapy, problems in the family are maintained by dysfunctional family organizations. Every family is organized into subsystems that have boundaries used to control interactions between family members (Jimenez et al. 2019). The family subsystems are further divided into several categories including spousal, parental, sibling and extended categories. Every family member has a specific role to play in each subsystem. Likewise, every subsystem has unique tasks and when one subsystem intrudes on another, it results in structural difficulties. In the case of the Vargas family, Frank belonging to the sibling category, through his bad behavior is intruding into his parents’ relationship altering the family structure. Additionally, problems are caused when the family’s communication patterns are altered (Jimenez et al. 2019). The Vargas family has clear breakdowns in their communication patterns. Bob takes Frank out on a fun day despite Elizabeth’s instructions not to do so. Likewise, Bob instructs Frank to keep the trip a secret from his mother. When Heidi tries to tell his parents about her achievements in school, she is practically ignored and all attention is directed towards Frank. Overall, a breakdown in the family structure and communication channels between the Vargas family members are the two main contributing factors to the family’s problems.

Vargas Family Case Study Fourth Session

Structural Interventions to be used

The mirroring activity is a fun exercise to help family members relate better with each other. The therapist begins by directing each individual to stand in front of them and copy everything they do or say. Essentially behaving like a mirror. This a fun activity especially for children as it helps them better communicate their emotions to the therapist (Ackerman, 2017). The activity requires family members to be attentive to each other, cooperate with each other and communicate with both their body language and their words. Additionally, the mirroring activity allows family members to be in tune with their feelings and with each other. It is effective with siblings and with parents.

Constructing a genogram helps the therapist and client identify patterns in the family’s genealogy and history and how they might have influenced their emotions and behaviors. A genogram is a graphic representation of the client’s family tree. It contains basic information including name and date of birth (Ackerman, 2017). It also contains additional information concerning chronic illnesses and social behaviors. By constructing a genogram, clients are able to analyze their relationships and determine whether there is abuse or whether the relationships are built on love and understanding.

Role of the Counselor in the Change Process

According to the structural family therapy perspective, the counselor’s main role is to modify the family’s dynamics and way of interacting to develop appropriate boundaries and effective family structures (Williams, Foye & Lewis, 2016). To effect change, counselors should be actively involved in the therapy session, map out the family’s underlying structure and identify potential avenues for change. Additionally, therapists should implement interventions that will change ineffective family structures to ensure healthy functioning.

 

References

Ackerman, C. (2017). What is Family Therapy? +6 Techniques & Interventions. PositivePsychology.com. Retrieved from https://positivepsychology.com/family-therapy/

Fisher, U. (2017). Use of Structural Family Therapy with an Individual Client Diagnosed with Intermittent Explosive Disorder: A Case Study. Journal of Family Psychotherapy, 28(2), 150-169. https://doi.org/10.1080/08975353.2017.1288989

Jimenez, L., Hidalgo, V., Baena, S., Leon, A. & Lorence, B. (2019). Effectiveness of Structural-Strategic Family Therapy in the Treatment of Adolescents with Mental Health Problems and their Families. International Journal of Environmental Research and Public Health, 16(7), 1255. Doi: 10.3390/ijerph16071255

Williams, N.D., Foye, A. & Lewis, F. (2016). Applying Structural Family Therapy in the Changing Context of the Modern African American Single Mother. Journal of Feminist Family Therapy, 28(1), 30-47. Doi: 10.1080/08952833.2015.1130547

 

 

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Evidence Based Practice Guidelines for Otitis Media

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Evidence Based Practice Guidelines for Otitis Media

Assignment: Analysis of Current Evidence Based Practice Guidelines for the Treatment of OM

 

First, carefully review the case. Then, using the Internet, find a current (no older than 4 years old) relevant evidence based practice guideline for the treatment of otitis media for this particular pediatric patient.

Make sure to address the following in your paper:

  • Briefly explain your search strategy. For example, how did you find the correct guideline?
  • Who developed the guideline?
  • Is this a revision of a previous guideline or an original? What is the date of publication?
  • Explain the concept of “systematic review of current best evidence.”
  • How was conflict of interest managed in the development of these guidelines?
  • How is quality of evidence defined?
  • Explain differences among strong recommendation, recommendation, and option
  • What are “key Action statements?”
  • For this particular child, what are the specific treatment recommendations including any diagnostics, medications (include exact dosage, frequency, length of treatment), follow-up, referral, prevention, and pain control.

Case:

A 5-year-old male is brought to the primary care clinic by his mother with a chief complaint of bilateral ear pain for the last three days. The mother states that the child has been crying frequently due to the pain. Ibuprofen has provided minimal relief. This morning, the child refused breakfast and appeared to be “getting worse.”

Vital signs at the clinic reveal HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.

After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media.

 

SAMPLE ANSWER

Evidence Based Practice Guidelines for Otitis Media

            The research strategy involved searching for content relevant to the subject in the various online journal databases. In the research, I used key words related to the condition, which yielded some results. Furthermore, I also added various filters when conducting the research to ensure that the guideline met a certain criterion. These filters included year of publication and needed to be peer reviewed.

Evidence Based Practice Guidelines for Otitis Media

The guideline is developed by the American Academy of Otolaryngology, The American Foundation of Pediatrics, Head, and Neck Surgery Foundation, and the American Academy of Family Physicians. Various researchers and medical practitioners are involved in the development of the guide. This involved include medical practitioners who may be involved in the treatment of Otitis media. Furthermore, the guideline is a revision of a guideline that was developed by the same organizations in 2004. The article was published on February 1, 2016, and it provides evidence-based recommendations for the management and treatment of otitis media (Rosenfeld et al., 2016).

The concept of systematic review of the current best practice applies in the context of the guideline. A systematic review includes a summarization of the results of carefully designed controlled trials or healthcare studies. Furthermore, they provide a high level of evidence regarding the effectiveness of the healthcare interventions that are used (Harmes et al., 2013). The researchers make judgments regarding the interventions and the outcomes, thus informing their recommendations. The changes that the researchers incorporated in the guideline included 20 new systematic reviews, evidence clinical practice guidelines, and 49 randomized control trials (Rosenfeld et al., 2016). Therefore, one can see the applicability of the concept of systematic review of current best practice, whereby the researchers combined the findings of various evidence based studies to recommend updated practices for addressing the problem.

Evidence Based Practice Guidelines for Otitis Media

To manage conflicts of interest, various strategies were employed. One of these was ensuring that the AAO-HNSF fully funded the entire research project. This ensured that no individual company or organization that may benefit from the research influenced it (Rosenfeld et al., 2016). Furthermore, the potential conflicts of interest for the various members who were involved in the research were compiled. After a review of the potential conflicts of interest, the panel set some conditions for the individuals who had conflicts of interest to remain in team. These included recusing themselves from discussions related to the areas that have conflict of interest, agreeing not discuss aspects related to the guideline to industry players before its publication, and ensuring that personal experiences of the panelists does not cause conflict of interest (Rosenfeld et al., 2016).

Quality of evidence may be described as the confidence that the estimates that are reported are sufficient to support specific recommendations. The quality of evidence can be described as high, moderate, low, or very low based on grading quality of evidence and strength of recommendations (GRADE) (Chonmaitree et al., 2016). High tends to have the best quality, while very low tends to have the least quality. Some of the key considerations when determining the quality of evidence include publication bias, imprecision, indirectness of evidence, risk of bias, inconsistency of results between different studies. In the guideline, these elements were considered to ensure that the quality of evidence was high.

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A strong recommendation implies that a review panel or committee believes that the benefits associated with the recommended approach exceed the harms of the same approach. Recommendation, on the other hand, means that the magnitude of the benefits is relatively small, or when benefits are there, by offset by other adverse consequences. Moreover, an option means that the evidence quality is suspicious, or the properly conducted studies have shown that there is little advantage of one approach over the other (Schilder et al., 2016).

For the particular child, one of the elements in the diagnosis is the symptoms. The child has been experiencing bilateral year pain during the last three days, which tends to be one of the symptoms for the condition. However, additional tests would be required to ascertain whether the child in indeed having the condition. One of these tests is otoscope, which involves looking into the child’s year and checking elements such as pus, redness, and swelling. A tympanometry test may also be conducted to determine the air pressure in the child’s eardrum. Furthermore, reflectometry may also be conducted to determine if the child has fluid in his years (Harmes et al., 2013). Treating the condition may include observation or antibiotic therapy. Studies have shown that two in every three children may heal without using antibiotics. Furthermore, the American Academy of Physicians suggests not prescribing antibiotics for treating the condition for children aged between 2 and 12 years particularly if their symptoms are not severe (Rosenfeld et al., 2016).

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If observation does not work within 48 to 72 hours, it is imperative for the patient to take antibiotics. The first antibiotic that needs to be used is Amoxicillin, but if it does not work, Cefdinir can be used as an alternative. Furthermore, analgesics are also recommended for addressing symptoms such as irritability, fever, and year pain. The analgesics are particularly important for addressing the symptoms that can make parents alarmed. The recommended analgesics include acetaminophen and ibuprofen. Benzocaine can also be used. However, ibuprofen needs to be the fast option considering it is less toxic in the event of overdose and it has a longer duration (Rosenfeld et al., 2016).

Therefore, the selected article is an update of a 2004 guideline related to the diagnosis, management, and treatment of otitis media. The guideline is developed by the American Academy of Otolaryngology, The American Foundation of Pediatrics, Head, and Neck Surgery Foundation, and the American Academy of Family Physicians. It was published in 2016. To find the guideline, I searched online journal databases using the appropriate keywords and using filters to ensure that the article is timely and relevant. In the development of the guideline, the issue of conflicts of interest is thoroughly addressed. Furthermore, the researchers ensure that the quality of evidence is high. For the 5-year-old male, the first in his treatment is analyzing his symptoms. Thereafter, various tests need to be conducted to ascertain whether he is suffering from acute otitis media. These tests may include otoscope, tympanometry, and reflectometry. If the results are positive, the observation may be one of the interventions. However, if there are no improvements, antibiotics therapy can be used. Some of the antibiotics that can be used include amoxicillin and Cefdinir. Furthermore, analgesics also need to be used to alleviate some of the symptoms associated with acute otitis media such as fever and pain.

 

References

Chonmaitree, T., Trujillo, R., Jennings, K., Alvarez-Fernandez, P., Patel, J. A., Loeffelholz, M. J., … & McCormick, D. P. (2016). Acute otitis media and other complications of viral respiratory infection. Pediatrics, 137(4), e20153555.

Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Van Harrison, R., & Passamani, P. P. (2013). Otitis media: diagnosis and treatment. Children, 100(8), 10.

Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., … Corrigan, M. D. (2016). Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery, 154(1_suppl), S1–S41. https://doi.org/10.1177/0194599815623467

Schilder, A. G., Chonmaitree, T., Cripps, A. W., Rosenfeld, R. M., Casselbrant, M. L., Haggard, M. P., & Venekamp, R. P. (2016). Otitis media. Nature Reviews Disease Primers, 2, 16063.

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The Future of Nursing

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The Future of Nursing

1. A two-page (500-word) paper that summarizes recommended changes for the future of nursing

 

a. Research the future of nursing.

 

What is meant by the future of nursing? Think about a topic of your choice that includes cultural implications. Describe the topic and include any references and citations you may have used.

 

b. Identify the major recommendations.

 

Identify two or three of the major strategies/recommendations for the future of nursing.

 

c. Explain key terms.

 

Describe how cultural sensitivity, cultural competency, and interprofessional collaboration could be addressed in the proposed changes.

 

SAMPLE ANSWER

The Future of Nursing

The future of nursing refers to how the nursing profession will be like in the years to come. For instance, the United States is currently focusing on improving nursing education to provide affordable, quality, and seamless care that can be easily accessed by all people(Institute of Medicine (US), 2011). The future of nursing is expected to provide improved and evidence-based care that will result in quality patient outcome. In the world today, challenges in healthcare have increased dramatically. Nursing still cares for patients relating to the education they attained in the 20th century. However, the training offered in the 20th century is not adequate in the 21st century when dealing with current health realities (Institute of Medicine (US), 2011). Patient care and needs environment have drastically become complex, and therefore, nurses need to acquire more education to improve their competencies to deliver high-quality care.

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Major Recommendations

Nurses should give care by utilizing their full training and education. Some nurses do not practice their full professional knowledge when providing care to the patients, which in turn reduces the quality of the patient outcome. Nurses should attain high education through an education system that is up to date to enhance seamless academic development. Also, nurses should incorporate inter-professional collaboration with other health professionals such as physicians to redesign healthcare sector.

Cultural sensitivity and competency must be considered for the proposed changes and recommendations to be effective. In cultural sensitivity, nurses should care for all the patients without discrimination. Nurses should understand and accept that cultural similarities and differences exist (Giger, 2016). Nurses should, therefore, enhance cultural competency by delivering healthcare services that are in line with the cultural and social values of the patients. Besides, inter-professional collaboration is one of the critical factors that can be utilized to meet the recommendations. Nurses should work as a team with other professions to enhance the sharing of knowledge and experience that can help improve the quality of care in the healthcare sector.

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References

Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier Health Sciences.

Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

 

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Economic principles in Decision Making

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Economic principles in Decision Making

Unit outcomes addressed in this Assignment: •Utilize economic principles in decision making. •Use planning and prioritization to achieve organizational goals. Course outcomes addressed in this Assignment: • Apply economic principles to health care decision making. • Achieve goals through planning and prioritization. Instructions: In this scenario you have been hired by the World Health Organization. As a leader in the organization you have been assigned to assess a small developing nation and determine the most cost effective public health solutions to improve overall health in the country. You need to select public health options that will allow you to help the most people. You have a budget of $700 million, you cannot divide services in half as a means of cutting cost and you cannot go over budget. Review an overview of the country as well as the available public health services using this document: •Economic Health Decision Making Data Requirements: •Use the Unit 5 Assignment Submission Template to indicate your selections and write your narrative. •A 500-800 word narrative explaining how you used planning and prioritization to make your decisions and reach your goal as well as which of the Unit 4 trainings you found most prepared you for this Assignment and why.

SAMPLE ANSWER

 

Service Cost Reason for Selection:
Basic health education and empowerment $120 million Focusing on interactive group education on health factors such as nutrition and family planning, is critical in promoting health, especially in a developing nation.
vaccination $50 million Administering vaccines will mostly focus on children and pregnant women. This is necessary for the prevention infectious diseases.
basic sanitation and supply of clean water $130 million In such a developing nation, poor hygiene and inadequacy of clean water has a significant impact on the general health of the people, hence the need for supply of clean, purified water.
Access to antibiotics $50 million As a developing nation, the need for antibiotics is high and with this amount, it would be possible to provide adequate antibiotics to treat infections.
Disease detection $75 million Health promotion will be more natural if the country develops the necessary measures to monitor the outbreak and spread of infections.
Maternal and childcare $50 million As mothers and children are most affected in this country, setting aside such an amount is essential to provide necessary care to reduce morbidity and mortality rates
Control of communicable diseases $50  million This service will be beneficial in preventing the spread of infectious diseases such as measles and hepatitis, considering that such diseases significantly contribute to increased death rates.
Vector control $25 million Vector control will assist in the elimination of diseases causing insects.
Properly equipping the health centers $ 100 million Community health centers will be equipped with necessary tools and adequately staffed to provide quality care and improve general wellbeing of the citizens.
Training programs $50 million Training programs should be developed to efficiently train future health providers and equip them with necessary skills to provide quality care.

 

 

Service Cost Reason Not Selected:
Developing more health center $350 million As the country is still developing, there is still a need for advanced health facilities. However, this would be challenging to implement due to the costs involved.
Screening services $300 million For diseases that require advanced screening and tests, it might be challenging to achieve this due to the funds required as well as the equipment.
Development of infrastructure $100 million Timely access to health facilities is significantly affected by poorly developed roads. However, to develop better transport systems, the organization might be forced to work with the authorities. Road building is expensive and is not under the control of health sector policymakers.

 

Narrative

Planning and priority setting in healthcare are necessary since resources will always be limited, hence the need for prioritization. In the given case, a budget of $700million was provided to improve health provision in a small developing nation and the choices to invest in a particular service reflects the society’s values and visions for the health systems. Considering the setting of a developing nation, the principle decisions to focus on areas such as health education and maternal health care over other services were made after a situational analysis.

Economic principles in Decision Making

By incorporating planning and prioritization in the decision-making process, the aim was to select and address the most critical health issues among different options. However, essential issues of health in this case may not be viewed with the same weight as those of people in developed countries. In such countries health targets are achieved by emphasizing on healthy lifestyles and disease minimization through supportive environment. In this case, though, factors such as water purification and sanitation were prioritized as well as individual involvement in health provision. Further, other areas of focus like nutritional education and vaccination are prioritized over other health issues like cancer screening. Planning and priority-setting was used based on the most affected population and the most common health issues affecting the population in question. However, this was not just focused on prioritizing the health problems, but also the possible intervention

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Among the different options available for health investment, the priorities selected were influenced by various factors besides the limited financial resources. Such choices were influenced by the general distribution of resources as a response to population needs and demands. For instance, in such developing country, health promotion must  begin from the basics of general health education such as hygiene, before implementing more advanced care. As such, while other areas of health providers such as setting up of new health facilities might be regarded important, effectiveness can only be attained if the citizens are also trained on personal health. This would assist in preventing overcrowding in those health centers and unnecessary hospital visits. The priorities were also influenced by the need to reduce the high mortality rates that were attributed to lack of vaccination, antibiotics, and antenatal care. Further, the priority setting in selecting health interventions was based on the options that would achieve high health standards and maximization as required by WHO, reduce health inequalities, as well as financial protection.

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In the previous unit, financial management was identified as  a critical factor when it comes to health provision and proper budgeting. In this case, health provision must take into consideration all-round factors ranging from development of health facilities, provision of cost-effective medication, and holistic care. As cost is an essential factor of health provision, focusing on health improvement in such  developing nation would require effective planning and prioritizing essential services to the most affected groups. As such, issues such as immunization and vaccination to prevent communicable diseases as well as provision of health education to the general public must be addressed first.

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