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Family Therapies

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Family Therapies

Individuals are born into families, grow and develop in families, and live most of their lives in families. Therefore, it makes sense that clients are best understood within the context of the family system.

——Dr. Candice Knight, Psychotherapy for the Advanced Practice Psychiatric Nurse

 

The family system is a social unit that is based on unique relationships and roles. Structural and strategic therapies are important, because they offer unique insights to the theoretical underpinnings of this system. As a psychiatric mental health nurse practitioner, a strong theoretical foundation will help you better understand the family unit and family therapy; this understanding will, in turn, improve the effectiveness of your work with clients.

This week, as you continue exploring family therapy, you examine structural and strategic family therapies and their appropriateness for client families. You also consider your own practicum experiences involving family therapy sessions.

Learning Resources

 

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

Required Readings

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

  • Chapter 5, “Bowen Family Systems Therapy” (pp. 69–88)
  • Chapter 6, “Strategic Family Therapy” (pp. 89–109)
  • Chapter 7, “Structural Family Therapy” (pp. 110–128)

Gerlach, P. K. (2015). Use structural maps to manage your family well: Basic premises and examples. Retrieved from http://sfhelp.org/fam/map.htm

McNeil, S. N., Herschberger, J. K., & Nedela, M. N. (2013). Low-income families with potential adolescent gang involvement: A structural community family therapy integration model. American Journal of Family Therapy, 41(2), 110–120. doi:10.1080/01926187.2011.649110

Note: Retrieved from Walden Library databases.

Méndez, N. A., Qureshi, M. E., Carnerio, R., & Hort, F. (2014). The intersection of Facebook and structural family therapy volume 1. American Journal of Family Therapy, 42(2), 167–174. doi:10.1080/01926187.2013.794046

Note: Retrieved from Walden Library databases.

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207–215. doi:10.1111/famp.12025

Note: Retrieved from Walden Library databases.

Ryan, W. J., Conti, R. P., & Simon, G. M. (2013). Presupposition compatibility facilitates treatment fidelity in therapists learning structural family therapy. American Journal of Family Therapy, 41(5), 403–414. doi:10.1080/01926187.2012.727673

Note: Retrieved from Walden Library databases.

Sheehan, A. H., & Friedlander, M. L. (2015). Therapeutic alliance and retention in brief strategic family therapy: A mixed-methods study. Journal of Marital and Family Therapy, 41(4), 415–427. doi:10.1111/jmft.12113

Note: Retrieved from Walden Library databases.

Szapocznik, J., Muir, J. A., Duff, J. H., Schwartz, S. J., & Brown, C. H. (2015). Brief strategic family therapy: Implementing evidence-based models in community settings. Psychotherapy Research, 25(1), 121–133. doi:10.1080/10503307.2013.856044

Note: Retrieved from Walden Library databases.

Optional Resources

Coatsworth, J. D., Santisteban, D. A., McBride, C. K., & Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313–332. Retrieved from http://www.familyprocess.org/family-process-journal/

Golden Triad Films (Producer). (1986). The essence of change. [Video file]. Mill Valley, CA: Psychotherapy.net.

National Institute on Drug Abuse. (2003). Brief strategic family therapy for adolescent drug abuse. Retrieved from https://archives.drugabuse.gov/TXManuals/BSFT/BSFTIndex.html

Navarre, S. (1998). Salvador Minuchin’s structural family therapy and its application to multicultural family systems. Issues in Mental Health Nursing, 19(6), 557–570. doi:10.1080/016128498248845

Psychotherapy.net (Producer). (2000b). Satir family therapy [Video file]. Mill Valley, CA: Author.

Psychotherapy.net (Producer). (2011b). Salvador Minuchin on family therapy [Video file]. Mill Valley, CA: Author.

Radohl, T. (2011). Incorporating family into the formula: Family-directed structural therapy for children with serious emotional disturbance. Child & Family Social Work, 16(2), 127–137. doi:10.1111/j.1365-2206.2010.00720.x

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., … Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713–727. doi:10.1037/a0025477

Santisteban, D. A., Suarez-Morales, L., Robbins, M. S., & Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process, 45(2), 259–271. doi:10.1111/j.1545-5300.2006.00094.x

Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple & Family Psychology, 1(2), 134–145. doi:10.1037/a0029002

Szapocznik, J., Zarate, M., Duff, J., & Muir, J. (2013). Brief strategic family therapy: Engaging drug using/problem behavior adolescents and their families in treatment. Social Work in Public Health, 28(3-4), 206–223. doi:10.1080/19371918.2013.774666

Vetere, A. (2001). Therapy matters: Structural family therapy. Child Psychology & Psychiatry Review, 6(3), 133–139. Retrieved from http://www.iupui.edu/~mswd/D642/multimedia/word_doc/StructuralFamilyTherapy_Vetare.pdf

Weaver, A., Greeno, C. G., Marcus, S. C., Fusco, R. A., Zimmerman, T., & Anderson, C. (2013). Effects of structural family therapy on child and maternal mental health symptomatology. Research on Social Work Practice, 23(3), 294–303. doi:10.1177/1049731512470492

Although structural therapy and strategic therapy are both used in family therapy, these therapeutic approaches have many differences in theory and application. As you assess families and develop treatment plans, you must consider these differences and their potential impact on clients. For this Assignment, as you compare structural and strategic family therapy, consider which therapeutic approach you might use with your own client families.

Learning Objectives

Students will:

  • Compare structural family therapy to strategic family therapy
  • Create structural family maps
  • Justify recommendations for family therapy

To prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide on structural and strategic family therapies.
  • Refer to Gerlach (2015) in this week’s Learning Resources for guidance on creating a structural family map.

The Assignment

In a 2- to 3-page paper, address the following:

  • Summarize the key points of both structural family therapy and strategic family therapy.
  • Compare structural family therapy to strategic family therapy, noting the strengths and weaknesses of each.
  • Provide an example of a family in your practicum using a structural family map. Note: Be sure to maintain HIPAA regulations.
  • Recommend a specific therapy for the family, and justify your choice using the Learning Resources.

SAMPLE ANSWER

Structural versus Strategic Family Therapies

Family therapy is a critical aspect of psychotherapy that helps to investigate changes for the welfare of a family. Psychologists use either strategic or structural therapy when dealing with patients with different issues. Having a better understanding of the models helps psychologists to the best therapy to apply to their customers (Szapocznik et al., 2015). This paper analyzes both structural and strategic therapy as forms of family therapy by discussing their strengths and advantages. The paper also uses a structural family map to give and recommend the best recommendation that will be applicable to the family involved.

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The structural family therapy (SFT) is an intervention aimed to address interaction patterns that lead to challenges and issues among family members. The model diagnoses and treats the dysfunction by changing the structure of the family instead of looking to change individual members of the family (Nichols & Tafuri, 2013). It is assumed that problems in the family occur when there is a problem with the hierarchical family structure or when family boundaries are ignored and not met. SFT is critical in maintaining interactions and communications among family members to ensure a healthy healthier family structure (José et al. 2015). Engaging family members can help facilitate change. Changing the family structure can help family members to overcome challenges and interact positively.

The strategic family therapy is more of a problem-solving approach that helps to address dysfunctions within the family. The model aims to influence family members using directives for resolving problems and using carefully planned interventions (Szapocznik et al., 2015). Therefore, the strategic family therapy looks into the strategic way of developing a form of change for each individual in the family. In this way, the underlying problems are recognized and diagnosed to help eliminate negative vibes and unfavorable contacts (Szapocznik et al., 2015). Thus, strategic family therapy uncovers negative feelings within the family and provides ways of engaging destructive behaviors, which encourage positive interactions.

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Both the structural family therapy and strategic family therapy helps to ensure behavioral change, reduce dysfunctional communication, and improve communication among family members. Therefore, both models aim to reduce maladaptive practices that reduce family cohesion to guarantee appropriate family balance (Robbins et al., 2011).  However, both structural family therapy and strategic family therapy have disadvantages. The structural family therapy does not primarily look into the issues causing the issues of a dysfunctional family, and it only focuses on interaction and cohesion as the primary form of ensuring the excellent family balance (Nichols & Tafuri, 2013). The strategic family therapy also applies unbalanced techniques during the therapy process such as using a planned and practical form of solving individual family member problems (Robbins et al., 2011). Thus, the models do not use problem-focused form of intervention to address dysfunctional behaviors within the family.

A structural family map can be used as a form of intervention in a family I encountered during my practicum. The family involves Mr. John and Mrs. Mary, where parental communication was minimal, and the woman was dominated. The major conflict within the family was ways of raising their children leading to a mixed-up family hierarchy.

Figure 1: The structural family map.

Family Therapies

It is recommended that the family should undergo structural family therapy to help improve their communication skills. The therapist should use case-specific creativity by using structural treatment to develop a structural family map for the intervention. Thus, a structural therapy will help build interdependence and communication mechanism between Mr. John and Mrs. Mary because the treatment helps to analyze dysfunctional families and find solution to the underlying issues

References

Nichols, M., & Tafuri, S. (2013). Techniques of structural family assessment: A qualitative analysis of how experts promote a systemic perspective. Family Process, 52(2), 207–215. DOI:10.1111/famp.12025

Ryan, W. J., Conti, R. P., & Simon, G. M. (2013). Presupposition compatibility facilitates treatment fidelity in therapists learning structural family therapy. American Journal of Family Therapy, 41(5), 403–414. DOI:10.1080/01926187.2012.727673

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K., … Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance-using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713–727. DOI:10.1037/a0025477

Szapocznik, J., Muir, J. A., Duff, J. H., Schwartz, S. J., & Brown, C. H. (2015). Brief strategic family therapy: Implementing evidence-based models in community settings. Psychotherapy Research, 25(1), 121–133. DOI:10.1080/10503307.2013.856044

 

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Strategic Controls and Monitoring Tools

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Strategic Controls and Monitoring Tools

Organizational leaders must be aware of external forces that may impact their organization. Strategic controls and monitoring tools allow leaders to evaluate these forces and develop tactical objectives to limit negative consequences. For this Team Discussion, you explore how strategic controls, monitoring tools, and tactical objectives might be used to address issues impacting health care organizations.

To prepare:

In Week 1, the Instructor assigned to your team a scenario that involves a health care organization with an issue requiring an evaluation of the organization’s strategic plan. Reflect on the issue and, as a team, begin identifying and discussing evaluation or monitoring tools that would be useful to address this issue. Be sure to consider the following:

  • What strategic controls (e.g., promise control, implementation control, strategic surveillance, and special alert control) might you use and why?
  • What monitoring tools (e.g., Gantt Chart, Balanced Scorecard, Dashboard, etc.) might you use and why?
  • What are two tactical objectives that the organization might leverage to effectively address operations requirements and limit negative consequences?

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  • Group C’s Scenario: Lake County Medical Practice is a large physician practice in Tallahassee, Florida providing one-stop medical and ancillary services to their patients. Of the approximately 80,000 patients Lake County serves annually, 38% are Medicare beneficiaries. Recently, the Centers for Medicare & Medicaid Services reduced reimbursement rates by approximately 11% for office visits, surgical procedures, and a range of diagnostic and therapeutic services. Based on a projection from the chief financial officer, the new reimbursement rates equate to a $5.8 million reduction in revenue for the medical practice. This comes at a time when Lake County Medical Practice has experienced an increase in new Medicare beneficiaries, as one of the area’s medical practices closed its door after the founder and chief executive officer retired four months ago. Other Medicare beneficiaries have been unsuccessful at finding new primary care physicians, as area physicians are not accepting new Medicare patients. Therefore, Medicare beneficiaries are traveling at least 40 miles to the nearest provider to get medical service.

 

SAMPLE ANSWER

Strategic Controls and Monitoring Tools

Strategic and implementation controls are designed to assess the overall organizational strategies and the impacts of internal and external factors. In this scenario, some of the external factors affecting Lake County Medical Practice include a reduction in Medicare and Medicaid reimbursement. The organization can employ various strategic controls such as strategic surveillance, implementations control, and premise control. With strategic surveillance, it would be possible to observe and continuously analyze the necessary factors that might impact the selected strategy (Ginter, Duncan & Swayne, 2018). Further, premise control will enable the management to track each strategy as it gets implemented to make necessary adjustments to achieve maximum results.

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Besides selecting and measuring the strategies, it is also essential for the organization to monitor the performance. Using monitoring tools such as balanced scorecard, the management would be able to address business performance comprehensively by combining both financial and non-financial indicators (Bisbe & Barrubés, 2012). With the organization currently projecting a $5.8 million reduction in revenue due to the new reimbursement, employing a balanced scorecard will facilitate proper monitoring and assessment of the implementation process. Besides, the Gantt charts can also be used for planning organizational strategies by determining the required resources and the order in which projects should be accomplished (Bisbe & Barrubés, 2012).

The organization can reduce the negative impacts by implementing tactical objectives that work synergistically with the selected strategies to complement one another in achieving positive results. As such, tactical objectives that should be considered, based on the strategies chosen may involve, increasing the number of primary care providers and reconsidering the hospital’s financial budget to accommodate the Medicare beneficiaries they are going to serve.

 

References

Bisbe, J., & Barrubés, J. (2012). The balanced scorecard as a management tool for assessing and

monitoring strategy implementation in health care organizations. Revista Española de Cardiología (English Edition), 65(10), 919-927.

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care

organizations. John Wiley & Sons.

 

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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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Ethical and Legal Implications of Prescriptions

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Ethical and Legal Implications of Prescriptions

You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs.  As advanced practice nurses, almost every clinical decision you make will have ethical or legal implications.  Your ethical and legal knowledge is fundamental to your ability to resolve the multitude of challenging issues encountered in practice.  For the Week 1 Assignment, you will explore the ethical and legal implications of the following scenario, and consider how to appropriately respond:

Scenario

A friend calls and asks you to prescribe a medication for her. You have this autonomy, but you don’t have your friend’s medical history. You write the prescription anyway.

 

Write a 2- to 3-page paper that addresses the following: all papers submitted include a title page, introduction, summary, and references.

1.      Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

2.      Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.

3.      Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

4.      Explain the process of writing prescriptions, including strategies to minimize medication errors.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

 

SAMPLE ANSWER

Ethical and Legal Implications of Prescriptions

Introduction

In healthcare, practitioners often find out that their friends, co-workers, or relatives may request informal medical advice. In addition, people close to the practitioners may ask for medical prescriptions without following medical procedures.  Practitioners realize that engagement in informal prescriptions increase their chances of having malpractice liability. In serious cases, they face legal investigations and risk going to jail or losing their job (Arcangelo et al., 2017). This paper tries to determine the ethical and legal implications that are associated with casual prescriptions. It involves a scenario where a female friend calls for medical prescription while the practitioner does not have her medical history. With that autonomy, the prescription is still written.

Ethical and Legal Implications

The scenario creates an ethical challenge to the practitioner. Due to their close association, the practitioner’s professional objectivity may be affected. The fact that the practitioner prescribes medicine for the client without her medical history shows that the doctor’s judgment is based on their relationship. Legally, if the state law requires the patient to be present during prescription, the process would be against the authority. In addition, the process would be inefficient due to lack of physical examinations (Kling, 2015).

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From another perspective, if the state requires an association between the physician and nurse, an investigation may be enforced on the practitioner for engaging in the process alone. Moreover, if the prescription is done away from the facility setting, it will be illegal. It can also be viewed that if the patient’s condition deteriorates after prescription, there will be no documentation to reveal the drugs she had taken. This act would jeopardize further assistance. Also, there will be no evidence of the patient’s informed consent (Arcangelo et al., 2017).

Strategies for Disclosure and Nondisclosure

Disclosure of patient safety is an important aspect in any healthcare situation. From the scenario, the practitioner may choose to orally disclose the error to a colleague and the patient. This act would increase trust between the practitioner and co-workers. In addition, it would create a suitable patient-nurse relationship. Also, the practitioner may create a formal report to the facility, revealing the details of the error in a way to reduce such errors in future (Kling, 2015).

Strategies for Decision Making

When it comes to decision making, the practitioner may choose to reject the patient’s request. This act would be done in a polite way, with the practitioner giving an explanation of associated ethical concerns. This may be followed by the practitioner assigning the patient to a different qualified nurse to engage in the prescription. Contrarily, the practitioner may choose to engage in the prescription process. However, the process needs the nurse to have a professional relationship with the patient. The procedure should be done in a facility setting, with the practitioner making suitable medical assessments of the patient. It would need official documentation which would enhance a suitable follow-up (Bao et al., 2016).

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Prescription Writing Process

Having a systematic approach in prescribing drugs is required to enhance prescription quality. The process should start with proper evaluation and definition of the patient’s problem. This step is followed by development of a therapeutic objective. A proper drug therapy is initiated. Thereafter, details, warnings, and instructions should be provided. To avoid errors, the practitioner may apply the five rights of drug prescription. They involve the needs for the right drug, right patient, right dosage, right process, and right time. Another strategy is to employ computer technology in designing the prescription (Ladd & Hoyt, 2016).

Conclusion

The paper shows that prescription of drugs to people close to a practitioner is associated with ethical and legal implications. These issues may make a nurse lose his or her job, especially if it is associated with errors. Nurses need to be careful when administering drugs to patients who are associated with them. The paper tries to reveal that with proper strategies, the process can be done properly, thereby limiting ethical and legal consequences. In addition, it is observed that drug prescription needs to follow a systematic approach to avoid errors.

 

References

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

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

Bao, Y., Pan, Y., Taylor,A., Radakrishnan, S., Luo, F., Pincus, H. A., &Schackman, B. (2016).

Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Affairs, 35(6), 1045 -1051.

Kling, S. (2015). Is it ethical to treat one’s family and friends?: ethics article. Current Allergy &

            Clinical Immunology, 28(2), 118-120.

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

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

 

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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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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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