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Family Genogram -Kate Andrews

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Family Genogram -Kate Andrews

Learning Objectives

Students will:

  • Assess client families presenting for psychotherapy
  • Develop genograms for client families presenting for psychotherapy

To prepare:

  • Select a client family that you have observed or counseled at your practicum site.
  • Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.

The Assignment

NOTE TO WRITER:  You can make up any information in the family client assessment.  Be aware that the family was seen for drug addiction during a family therapy session.

Family Genogram -Kate Andrews

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

  • Demographic information
  • Presenting problem
  • History or present illness
  • Past psychiatric history
  • Medical history
  • Substance use history
  • Developmental history
  • Family psychiatric history
  • Psychosocial history
  • History of abuse and/or trauma
  • Review of systems
  • Physical assessment
  • Mental status exam
  • Differential diagnosis
  • Case formulation
  • Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

 

SAMPLE ANSWER

Part 1: Comprehensive Client Family Assessment

Demographics:  Kate Andrews is a 40-year-old woman and is married to Bob and is also currently living with her son and her father who has Alzheimer’s disease. She is a devout Christian and works as a teacher in a nearby school. Bob is currently jobless.

Presenting problem: Kate is anxious about life and she complains of insomnia and is easily irritable. Bob, on the other hand, is frustrated about unemployment and hence takes alcohol to calm down

History of present illness: Kate exhibited insomnia and irritability for about four years. Two years ago, a clinician offered antidepressants but she declined and hoped that she would get help from God. Bob has been anxious since he lost his job one year ago.

Family Genogram -Kate Andrews

Past psychiatric history: Kate’s symptoms started a few years into her marriage but became severe when Bob became jobless as he also became violent. She was given antidepressants but did not take them. Bob has not sought any help yet.

Medical history: Kate was offered antidepressants but declined to take them. She has been searching for home remedies online including calming concoctions and some exercises such as yoga; she acknowledges that she needs support to cope. Bob and Kate have no other medical issue.

Substance use history: Kate and Bob indulge in alcohol use to calm down

Developmental history: Kate is the firstborn in a strongly religious family of three children, two girls and a boy. Her mother died when she was about ten years old. She was a healthy child and she exhibited exemplary performance in school. Bob is an only child in their family and also has had a healthy childhood although he experienced domestic violence as a child. Both of his parents are alive and there are no mental issues in his history.

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Family psychiatric history: Kate’s grandfather has been diagnosed with depression and her father was at some point diagnosed with an anxiety disorder. Her great-grandmother was schizophrenic. Her grandmother committed suicide and her sister has been diagnosed with an eating disorder. Bob’s father was violent, but there is no other mental history in the family.

Psychosocial history: The family is living with their son and Kate’s father who is suffering from Alzheimer’s disease. They have close friends although Kate also has friends from church who visit and pray with her.

History of abuse/trauma: Bob has been violent and found every reason to beat her up and hurl insults at her since he lost his job. Kate is sad about the state of affairs and is overwhelmed about having to shoulder the responsibilities in the family.

Review of systems

The two look okay generally, there are no major issues. Genrally,l they exhibit malaise and they complain of blurry eyesight. Kate has a sore throat and there is no coughing or wheezing. On musculoskeletal assessment, Bob shows tension in the neck, shoulders, and legs. Psychiatric assessment reveals that there are No thoughts of suicide or hallucinations, although they both exhibit insomnia, and sadness.

Physical assessment: Kate has tension in the neck and shoulders, eyes are red and puffy and Bob looks very tired. Kate has no fever but has lost weight.

Family Genogram -Kate Andrews

Mental status exam: On appearance, Kate has a build posture but exhibits sad emotional expressions. Bob is not well-groomed and has untidy hair and he is unable to maintain eye contact unlike Kate.  Kate speaks while taking long pauses although she is fluent. She is conscious and also has memory although she also goes ahead to provide unnecessary information.

Differential diagnosis: although they have substance abuse as the main issue, the differential diagnosis includes Sadness, Adjustment disorder with depressed mood, and Generalized Anxiety Disorder (GAD. According to Lokko and stern, (2014), sadness occurs when a person exhibits dissatisfaction with life, sorrow, and hopelessness. It presents in different ways and may include insomnia or changes in eating patterns (Bröer, & Besseling, 2017).Casey et al. (2015), define Adjustment disorder with depressed mood as occurring when the patient experiences a change in life which makes them feel overwhelmed. Generalized Anxiety Disorder (GAD) is characterized by a patient showing signs of excessive worry for more than six months (Bui et al .2017).

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Case formulation: Kate and Bob both show worry and anxiety about the inability to take care of their son and Kate’s father. Using the metacognitive model, it becomes evident that Kate is worried that she will be unable to meet their needs while Bob is anxious because he is unemployed. The metacognitive model explains by explaining that ruminative thinking makes an individual to repetitively think about the issues that affect a person’s negative emotional experience (Solem, et al. 2016). It, therefore, influences an individual to get worried and this is stored in their long-term memory. Kate and Bob’s worry triggers ruminative thinking and they remember their troubles and consequently think of the recycled thoughts and emotions, which further bring about rumination and the cycle continues. They then indulge in substance use, as a way to help them out of the problem.

Treatment

  • Medication, such as selective serotonin reuptake inhibitor to ease the symptoms of depressed mood and anxiety (Ionescu et al. 2015).
  • Psychotherapy

 

Part 2: Kate’s Family Genogram

 

Family Genogram -Kate Andrews

 

 

 

References

 Bröer, C., & Besseling, B. (2017). Sadness or depression: Making sense of low mood and the

Medicalization of everyday life. Social Science & Medicine, 183, 28-36.

Bui, E., Anderson, E., Goetter, E. M., Campbell, A. A., Fischer, L. E., Barrett, L. F., & Simon,

  1. M. (2017). Heightened sensitivity to emotional expressions in generalized anxiety disorder, compared to social anxiety disorder, and controls. Cognition and Emotion, 31(1), 119-126. doi.org/10.1080/02699931.2015.1087973

Casey, P., Jabbar, F., O’Leary, E., & Doherty, A. M. (2015). Suicidal behaviors in adjustment

Disorder and depressive episode. Journal of affective disorders, 174, 441-446. doi.org/10.1016/j.jad.2014.12.003Get rights and content

Ionescu, D. F., Rosenbaum, J. F., & Alpert, J. E. (2015). Pharmacological approaches to the

Challenge of treatment-resistant depression. Dialogues in clinical neuroscience, 17(2), 111–126.

Lokko, H. N., & Stern, T. A. (2014). Sadness: diagnosis, evaluation, and treatment. The primary

Care companion for CNS disorders, 16(6), 10.4088/PCC.14f01709. doi:10.4088/PCC.14f01709

Solem, S., Hagen, R., Hoksnes, J. J., & Hjemdal, O. (2016). The metacognitive model of

Depression: an empirical test in a large Norwegian sample. Psychiatry research, 242, 171-173. doi.org/10.1016/j.psychres.2016.05.056

 

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Vargas Family-Discharge Summary

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Vargas Family-Discharge Summary

Read the entire “Vargas Family Case Study” (all eight sections). Consider the progress (or lack thereof) over the past eight sessions. Using the “Discharge Summary Outline” template; include the following in your outline:

1. A brief summary of what was going on with the family

2. A review of the initial treatment goals

3. Theories and interventions used

4. A brief discharge summary for the family treatment

5. Clinical recommendations for sustained improvement or referrals for additional services

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.

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

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

 

SAMPLE ANSWER

PCN-521 Module 8:Vargas Case Study Discharge Summary Outline

  1. A brief summary of what was going on with the family at the onset of counseling:

 

  1. At the onset of counseling, the family was divided. The main reason behind the division was the constant disagreement between Bob and Elizabeth concerning Frank’s bad behavior. Frank was impulsive, consistently lost things, did not listen and was consistently picking on his sister, Heidi. While Elizabeth believed that Frank had ADHD, Bob minimized his behavior claiming that it was normal behavior for a boy. Bob and Elizabeth constantly argued with each other and this created tension in their marriage and the family in general.

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  1. A review of the initial treatment goals:

 

  1. The main goal of the first session was to develop a hypothesis that was maintaining the problem.
  2. The second goal was to develop a therapeutic relationship with each family member to improve the therapy session.
  • Theories and interventions used
    1. Week 1:
      1. Rapport building
      2. Family fun day out
    2. Week 2:
      1. Weekly soccer matches
    3. Week 3:
      1. Developing a family tree
    4. Week 4:
      1. Structural family therapy
      2. Family structure chart
  • Mirroring activity
  1. Constructing genogram
  1. Week 5:
    1. Bateson’s cybernetic model
    2. Strategic family therapy
  • Mental research institute model
  1. The Milan Family system model
  2. Haley and Madanes Strategic Approach

Vargas Family-Discharge Summary

  1. Week 6:
    1. Act and talk it out
    2. Soccer for the mind
  • Paint your feelings
  1. Week 7:
    1. Narrative therapy
  2. Week 8:
    1. Solution-focused brief therapy

Vargas Family-Discharge Summary

  1. A brief discharge summary for the family treatment:

 

  1. Reasons for seeking therapy: the family came to therapy to work on their communication problems. Elizabeth and Bob were fighting in front of their children, Frank was attacking his sister while Heidi’s achievements were ignored leaving her exposed to developing attention deficit disorder.
  2. Significant findings: Frank should get an official ADHD diagnosis and if he has the disorder, proper treatment interventions should be administered. The interventions proposed are designed to facilitate a state of wellness for the entire family. The weekly soccer matches appear to be working as the family report progress and improved interaction. Bob has shown the most transformation towards the end of therapy. He understands the amount of work Elizabeth puts in to take care of Frank. Heidi is also closer to Frank and she no longer feels ignored

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  1. Treatment: solution focused brief therapy was used where solutions were identified. Several sessions were held with the entire family where observations were made. Narrative therapy was also used together with solution-focused brief therapy
  2. Termination of therapy condition: the family has improved its communication strategies, Bob is more passionate about Elizabeth’s struggles and Frank and Heidi are interacting positively. The family is holding weekly bonding sessions over soccer matches and everyone is enjoying each other’s company.
  1. Clinical recommendations for sustained improvement or referrals for additional services:
    1. Frank is referred to a pediatrician for further analysis according to the American Psychiatric Association’s Diagnostic and Statistical Manual
    2. The family should continue to have weekly family time
    3. The family should hold therapy sessions with the extended family
    4. Frank should be enrolled in a soccer camp to improve his soccer skills

 

 

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Personal Practicum Experiences

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Personal Practicum Experiences

As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal.

Learning Objectives

Students will:

  • Analyze nursing and counseling theories to guide practice in psychotherapy*
  • Summarize goals and objectives for personal practicum experiences*
  • Produce timelines for practicum activities*

 

In preparation for this course’s practicum experience, address the following in your Practicum Journal:

  • Select one nursing theory and one counseling theory to best guide your practice in psychotherapy.Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources.
  • Explain why you selected these theories. Support your approach with evidence-based literature.
  • Develop at least three goals and at least three objectives for the practicum experience in this course.
  • Create a timeline of practicum activities based on your practicum requirements.

 

SAMPLE ANSWER

Personal Practicum Experiences

The paper journal entry reviews and evaluates the nursing and counseling theory that will help to guide the nursing practice in psychotherapy.

The nursing theory I have chosen is Hildegard Peplau’s Interpersonal Theory. The theory focuses on the nurse-patient relationship as a critical component of healing and care (Belcher & Brittain-Fish, 2012).  Besides, the theory involves interpersonal relations including respect, trust, and communication as critical aspects that increase nurse-patient relationships. Therefore, an excellent nurse-patient relationship enhances patient’s outcomes and improves their quality of life.

The counseling theory I have chosen is the humanistic approach. The theory looks at each patient holistically by focusing on positive characteristics and behaviors (Lego, 2013). Besides, it involves concepts such as self-actualization and self-efficacy by looking at maladaptation and past challenges. The critical aspect of the humanistic theory is that patients are motivated to achieve their great potential (Lego, 2013). Thus, the theory empowers individuals to take control of their health and live a more quality life.

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During the practicum experience, I aim to achieve the following goals: (1). To have a clear understanding and knowledge of both interpersonal theory and humanistic theory in caring for a psychotherapy group to help manage their mental health issues. (2). To practice therapeutic knowledge and skills, particularly communication skills, to help build a rapport and facilitate communication in a group setting during psychotherapy. (3). To use different techniques of psychotherapy during group or family therapy.

The timeline for practicum activities for the course will take about 12 weeks. I will carry out group psychotherapy with minimal supervisions. I will then develop a comprehensive plan of care and an assessment of individuals in group therapy. I will then incorporate the use of DSM-V in diagnosing families and groups. Thus, I will accomplish the goals in 12 weeks of the practicum course.

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References

Belcher, J. R., & Brittain-Fish, L. J. (2012). Interpersonal Relations in Nursing: Hildegard E. Peplau. Nursing Theories: The base for professional nursing practice (5th ed.). Upper Saddle River, NJ: Prentice Hall

Lego, S. (2013). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric & Mental Health Nursing 5(3), 193-196. Doi:10.1046/j.1365-2850.1998.00129.x

 

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Precede-Proceed Model

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Precede-Proceed Model

PRECEDE-PROCEED Model Based on the review of global health epidemiological applications (methods), apply and analyze data to international public health programs to determine stability/instability of health and wellness of these countries. Select any one of your three countries used in an earlier assignment and determine a serious health issue that country struggles with. Using the PRECEDE-PROCEED model, design a model to promote health promotion for this public health issue. Country: S. Africa or Ghana

 

SAMPLE ANSWER

Precede-Proceed Model

Introduction

While HIV/AIDS is the highest disease killer in South Africa, tuberculosis (TB) takes the highest distinction. Over 80 percent of South Africans are thought to have latent TB. Additionally, individuals who have HIV/AIDS are more likely to get infected with TB (Nieburg, 2015). When people with HIV/AIDS get infected with active TB, they experience accelerated progression of their HIV/AIDS disease. While the South African Department of Health is creating policies and programs to control TB infections, it still faces several challenges. The country has slow GDP growth and high rates of unemployment that limit resources to address health challenges (Nieburg, 2015). A structure to assess and analyze the health needs of a population and to guarantee health promotion like the Precede-proceed model will improve health programs proposed by the South African Department of Health to control TB infections.

Precede-Proceed Model to Promote Health Promotion in South Africa

Precede

            Social Assessment: with over 450,000 people developing TB every year, TB has become a public health issue in South Africa. The country has made significant strides towards the eradication of the disease especially in people with HIV/AIDS. However, more needs to be done.

            Epidemiological Assessment: poverty is a key determinant of TB in South Africa. Therefore, alleviating poverty reduces the risk of TB transmission (“Addressing the Social Determinants of TB”, 2019). An effective model should; design effective poverty reduction strategies, reduce food insecurity, improve living standards, control environmental pollutants, and address lifestyles conditions including reduction of drug use and smoking.

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            Ecological Assessment:  minority races in the country are at a higher risk of contracting TB. Additionally, low income and lack of education are strong risk factors for transmission of tuberculosis. Congestion and pollution accelerate the spread of TB in public areas and in slums (Alvaro-Meca et al. 2016).

Administrative and Policy factors: some of the policy factors include; training for TB infection control for all healthcare workers, improved TB infection and spread control policy guidelines, creation of awareness and education of TB infection control measures, improved hygiene practices and destigmatisation (Zinatsa, Engelbrecht, Rensburg & Kigozi, 2018). Administrative strategies to control the spread of TB in South Africa include; the National Strategic Plan on HIV, TB and STIs 2017-2022, Global Plan to End TB 2016-2020 and the Treatment Action Campaign (Kanabus, 2018).

Proceed

            Implementation: At the individual level, isoniazid preventive therapy (IPT) has been seen to reduce TB infections by 60%. Additionally, rapid molecular techniques should be developed to facilitate rapid treatment (Dowdy et al. 2017). Decongestion is also critical since TB is airborne. To implement the proposed strategies, efforts should be intensified in the geographical areas hard hit by TB. Resources should be provided by the national government in collaboration with other relevant health promotion bodies.

            Process Evaluation: healthcare workers and the South African Health Department should carry out regular program checks to determine if the programs implemented are reaching the targeted population and that program goals are met.

            Impact Evaluation: changes in the rate of new TB infections in the country will be used to determine success of the programs.

            Outcome Evaluation: A decrease or increase in the prevalence of TB in the country will be analyzed. Decreasing rate of TB infections will indicate success of interventions while increasing rates of TB infections will indicate failure of interventions.  

 

References

Alvaro-Meca, A., Diaz, A., Diez, J.M., Resino, R. & Resion, S. (2016). Environmental Factors Related to Pulmonary Tuberculosis in HIV-Infected Patients in the Combined Antiretroviral Therapy (cART) Era. Public Library of Science, 11(11). Doi: 10.1371/journal.pone.0165944

“Addressing the Social Determinants of TB”. (2019). World Health Organization. Retrieved from https://www.who.int/tb/areas-of-work/treatment/social-determinants/en/

Dowdy, D.W., Grant. A.D., Dheda, K., Nardell, E., Fielding, K. & Moore, D.A. (2017). Designing and Evaluating Interventions to Halt the Transmission of Tuberculosis. The Journal of Infectious Diseases, 216(6), 654-661. https://doi.org/10.1093/infdis/jix320

Kanabus, A. (2018). Information About Tuberculosis. TBFACTS.ORG. Retrieved from www.tbfacts.org

Nieburg, P. (2015). South Africa’s Health Challenges: An Elephant in the Room. Center for Strategic & International Studies. Retrieved from https://www.csis.org/

Zinatsa, F., Engelbrecht, M., Rensburg, A.J. & Kigozi, G. (2018). Voices from the Frontline: Barriers and Strategies to Improve Tuberculosis Infection Control in Primary Health Care Facilities in South Africa. BMC Health Services Research, 18, 269. Doi: 10.1186/s12913-018-3083-0

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Discussion-ACHE leadership competencies

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Discussion-ACHE leadership competencies

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by providing additional insights or alternative perspectives.

Discussion-ACHE leadership competencies

Peer posts 1

Jacquelyne Atakora 

Wk 4 Discussion

Meeting ACHE leadership competencies means having strategic management skills, which “involves building and allocating resources both to meet the needs of today and to fulfill the vision of the future” (Walston, 2018). Out of the five competencies, I have exceptional professionalism and communication skills that I have gained from overall work experience. Communication and relationship management mainly comes from having suitable customer service skills and knowing how to build appropriate, internal relationships for the betterment of the organization. Areas of weakness include “knowledge of the health care environment” and “business skills and knowledge”, which is based off of not gaining experience in these areas. I have no experience working in a health care, so I would need to get my foot in the door in that field. In order for any leader to effectively improve their weaknesses, they must be able to support change to encompass “encouraging individual growth and learning as well as organizational innovation” (Potthoff, 2004). Individual growth for me would mean building on my communication and relationship building skills to gain knowledge in health care and business. Networking, internships, and entry level positions are all ways in which I can gain proper knowledge to become a better leader. Speaking to the right individuals and getting my foot in the door at a proper business will help me put my strengths to use and continue to gain the knowledge I need to succeed.

Reference:

American College of Healthcare Executives. (2019). ACHE healthcare executive 2019 competencies assessment tool. Retrieved from https://www.ache.org/-/media/ache/career-resource-center/competencies_booklet.pdf

Potthoff, S. (2004). Leadership, measurement, and change in improving quality in healthcare. Frontiers Of Health Services Management, 20(3), 37–40.

Walston, S. L. (2018). Strategic healthcare management: Planning and execution (2nd ed.). Chicago, IL: Health Administration.

 

Peer Posts 2

Cornel Bedward 

Week 4 Discussion

When it comes to the ACHE leadership competencies building on the strengths and improving weaknesses is important to excel as a health care administrator and be successful. When it comes to communication and relationship management it is extremely important to execute this properly. Furthermore, leadership is essential with managing change and communicating the organizations mission and vision. Also, professionalism is a competency domain that meets up with the other domains. Continued education and planning is important to ensure that the role of the individual is being met for the benefit of the organization. Additionally, employees should have a good understanding of the health care environment. Unfortunately, this requires internal and external management constraints that the staff really only understand. If new employees do not understand the flow of the organization, it will be hard for them to grasp the routine and create issues. So ensuring that new employees are educated and understand the vision and mission of the organization is essential for the success of the employees and the organization.

Reference

American College of Healthcare Executives. (2016). ACHE healthcare executive 2016 competencies assessment tool. Retrieved from, https://www.ache.org/pdf/nonsecure/careers/competencies_booklet.pdf

 

SAMPLE ANSWER

PEER RESPONSES

Jacquelyne Atakora 

Hi Jacquelyne,

I enjoyed reading your post. It is good that you seem to have realized your strength and weaknesses. A good leader should try to know his or her weaknesses as much as knowing the strengths. Weaknesses can hold someone back and prevent them from achieving their dreams. However, when one realized and acknowledges the weaknesses, they will work on improving them. As Geil Browning notes, “to truly be a great leader, you can’t just take advantage of your strengths. You also have to recognize your weaknesses, and learn how to make them benefit your particular leadership style” (Browning, 2017). A leader should understand well their area of work and therefore, understanding the healthcare system is very important for you in order to become a leader in the sector. In addition, having skills and knowledge related to the healthcare field is important for one to lead others in a healthcare system. The willingness you have to improve in the areas is the first step that is required to achieve your goals.

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Reference

Browning, G. (2017). Excel at What Does Not Come Naturally: 7 Ways to Lead Better. Retrieved from https://www.inc.com/geil-browning/leadership-managing-identify-your-weaknesses-and-lead-effectively-because-of-them.html

 

Cornel Bedward 

Hi Cornel,

You brought our good insights in your discussion. One thing that I can agree with you is that continued education and planning is important especially in the healthcare setting. Continuing professional development is important because it ensures you continue to be competent in your profession. It is an ongoing process and continues throughout a professional’s career. Continuous professional development ensures that one stays relevant and up to date (Prince & Reichert, 2017). Thus, one is more aware of the changing trends and directions in the profession. There are many changes happening in the healthcare sector especially in terms of technology. Thus, if one stands still, they risk being left behind, as the knowledge and skills they have become outdated.

Discussion-ACHE leadership competencies

Reference

Prince, S. & Reichert, C. (2017). The Importance of Continuing ProfessionalDevelopment to Career Satisfaction and Patient Care:Meeting the Needs of Novice to Mid- to Late-CareerNurses throughout Their Career Span. Retrieved from https://res.mdpi.com/d_attachment/admsci/admsci-07-00017/article_deploy/admsci-07-00017.pdf

 

 

 

 

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Statistical Analysis Assignment 08

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Statistical Analysis Assignment 08

1. In the following situations, indicate whether you’d use the normal distribution, the t distribution, or neither.

a. The population is normally distributed, and you know the population standard deviation.b. You don’t know the population standard deviation, and the sample size is 35.c. The sample size is 22, and the population is normally distributed.d. The sample size is 12, and the population is not normally distributed.e. The sample size is 45, and you know the population standard deviation.

Statistical Analysis Assignment 08

2. The prices of used books at a large college bookstore are normally distributed. If a sample of 23 used books from this store has a mean price of $27.50 with a standard deviation of $6.75, use Table 10.1 in your textbook to calculate the following for a 95% confidence level about the population mean. Be sure to show your work.

a. Degrees of freedomb. The critical value of tc. The margin of errord. The confidence interval for a 95% confidence level

3. Statistics students at a state college compiled the following two-way table from a sample of randomly selected students at their college:

 Play chess

Don’t play chess

Male students

25

162

Female students

19

148

Answer the following questions about the table. Be sure to show any calculations.

a. How many students in total were surveyed?b. How many of the students surveyed play chess? c. What question about the population of students at the state college would this table attempt to answer?d. State Hº  and Hª for the test related to this table.

4. Answer the following questions about an ANOVA analysis involving three samples.

a. In this ANOVA analysis, what are we trying to determine about the three populations they’re taken from?b. State the null and alternate hypotheses for a three-sample ANOVA analysis. c. What sample statistics must be known to conduct an ANOVA analysis?d. In an ANOVA test, what does an F test statistic lower than its critical value tell us about the three populations we’re examining?

 

SAMPLE ANSWER

  1. In the following situations, indicate whether you’d use the normal distribution, the distribution, or neither.

 

  1. The population is normally distributed, and you know the population standard deviation.

 

Since the population is normally distributed and we know the population standard deviation it is a normal distribution (z-distribution).

  1. You don’t know the population standard deviation, and the sample size is 35.

 

We don’t know the population standard deviation, but we know the sample size is 35 we will do a normal, t-distribution.

  1. The sample size is 22, and the population is normally distributed.

 

With a normal distribution and a sample size of 22 we will do a normal, t-distribution.

Statistical Analysis Assignment 08

  1. The sample size is 12, and the population is not normally distributed.

 

Since the population isn’t normal and the sample size is 12 we will do neither distributions.

  1. The sample size is 45, and you know the population standard deviation.

Knowing the population standard deviation and the sample size we will do a normal distribution, (z-distribution).

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  1. The prices of used books at a large college bookstore are normally distributed. If a sample of 23 used books from this store has a mean price of $27.50 with a standard deviation of $6.75, use Table 10.1 in your textbook to calculate the following for a 95% confidence level about the population mean. Be sure to show your work.

Given:

 

Sample size: n :23

Sample mean: ̅x : $27.50

Sample Standard deviation: ơ: $6.75

95% Confidence Level

Level of Significance = α = 1-95 = 0.05

 Nursing Paper Help

  1. Degrees of freedom,

 

df: n-1 = 23-1 = 22 Degrees of freedom

  1. The critical value of t: 1-α/2,

df = 1-0.05/2, 22 = 0.975, 23 = 2.074

  1. The margin of error:

 

z x ơ/ √n = 1.96 x 6.75/√23 = (1.96 x 6.75√23) / 23 = (13.23 √23)/ 23 = $2.758 = $2.76

  1. The confidence interval for a 95% confidence level:

 

 ̅x ± z x ơ / √n =

 

  1. Statistics students at a state college compiled the following two-way table from a sample of randomly selected students at their college:

 

 Play chess Don’t play chess
Male students 25 162
Female students 19 148

 

Answer the following questions about the table. Be sure to show any calculations.

  1. How many students in total were surveyed?

 

25+19+162+148 = 354

  1. How many of the students surveyed play chess? 

 

25+19 = 44

  1. What question about the population of students at the state college would this table attempt to answer?

 

The population of male students who play chess (p₁) is equal to the population of female students who play chess (p₂).

  1. State Hºand Hª for the test related to this table.

 

Hº: p₁=p₂       Hª: p₁≠p₂

 

  1. Answer the following questions about an ANOVA analysis involving three samples.
  2. In this ANOVA analysis, what are we trying to determine about the three populations they’re taken from?

 

What we are trying to determine about the three populations that ANOVA is taken from is the difference in means. It’s a way to figure out if the survey or experiment results are significant.

  1. State the null and alternate hypotheses for a three-sample ANOVA analysis.

 

H0:μ1=μ2=μ3=…

Ha: At least one of the means is different from the others.

  1. What sample statistics must be known to conduct an ANOVA analysis?

 

Sample statistics of the sample size, mean and standard deviations of all comparison groups must be known in order to conduct an ANOVA analysis.

  1. In an ANOVA test, what does an F test statistic lower than its critical value tell us about the three populations we’re examining?

 

When the F test statistic is lower than its critical value this tells us that at least one of the three populations means we are comparing is different. This indicates that the null hypothesis is rejected.

 

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Qualitative Research Critique and Ethical Considerations

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Qualitative Research Critique and Ethical Considerations

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

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

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

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

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

SAMPLE ANSWER

Qualitative Research Critique and Ethical Considerations

Article 1

Johnson, J., Suwantarat, N., Colantuoni, E., Ross, T. L., Aucott, S. W., Carroll, K. C., & Milstone, A. M. (2019). The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. Journal of Perinatology, 39(1), 63. https://www.nature.com/articles/s41372-018-0231-7

Study Problem

Skin bacterial burden on the patients in the Neonatal Intensive Care Unit is a significant issue in the present world. The condition leads to high morbidity and mortality rates of patients in the ICU. Besides, the bacterial skin burden leads to extended stays in the hospital, which leads to increased healthcare costs for the patients. In the United States, more than 300 000 patients in the ICU are reported to have a bacterial skin burden (Johnson et al. 2019). Therefore, research needs to be done to solve the issues of Central-Line-Associated Stream Infection in the Neonatal Intensive Care Unit.

Qualitative Research Critique and Ethical Considerations

Significance of the study to the nursing practice

Antiseptic chlorhexidine gluconate is one of the primary measures that can be used to reduce bacterial infections in the central nervous and central line catheters. Chlorhexidine helps to prevent secondary and primary infections in patients because it has antibacterial activities which reduce pathogens in patient’s skin (Johnson et al. 2019). Therefore, nurses should consider the use of antiseptic chlorhexidine gluconate in the ICU since it is effective in preventing bacterial infections in patients as compared to regular soap and water bathing.

The objective of the study

The primary purpose of the study is to examine the effect of bathing with chlorhexidine gluconate on bacterial skin burden on patients admitted in the Neonatal Intensive Care Unit.

Research Question

Does bathing with chlorhexidine gluconate reduce bacterial skin burden in neonates admitted in the Neonatal Intensive Care Unit?

How does the article answer the PICOT question?

The PICOT question researches the comparison of the effects of bathing with Chlorhexidine and bathing with soap and water daily in decreasing the rate of central line-associated bloodstream infections in patients admitted in the Intensive Care Unit for one year. Therefore, the article helps answer the question by assessing the effectiveness of daily Chlorhexidine baths in reducing central line-associated bloodstream infections. The utilization of antiseptic chlorhexidine gluconate can be used as the primary intervention to fight bacterial load both in the central lines and central venous catheters. Therefore, chlorhexidine gluconate daily baths are imperative compared to regular baths using soap and water in the ICU unit.

How the intervention and comparison groups in the article compare with that one identified in the PICOT question

The PICOT question compares the effects of daily chlorhexidine baths and soap and water baths on the reduction of central line-associated bloodstream infections in patients admitted in the Intensive Care Unit. On the other hand, the article examines the effect of Chlorhexidine daily baths on central-line associated bloodstream infections by comparing the reduction level of central line-associated bloodstream infections between patients in the neonatal Intensive Care Unit who are exposed to Chlorhexidine and those who are not exposed.

 

Article 2

Savage, T., Hodge, D. E., Pickard, K., Myers, P., Powell, K., & Cayce, J. M. (2018). Sustained reduction and prevention of neonatal and pediatric central line-associated bloodstream infection following a nurse-driven quality improvement initiative in a pediatric facility. Journal of the Association for Vascular Access, 23(1), 30-41. Doi: 10.1016/j.java.2017.11.002

Study Problem

Central Line-Associated Blood Stream Infection (CLABSI) is a bloodstream infection that primarily leads to increased mortality and morbidity rates of patients in hospital. About 260,000 central line-associated bloodstream infections are reported in hospitals in the United States. Also, approximately 29,000 death cases related to the central line-associated bloodstream infections are reported every year. Nearly 29,000 US dollars are spent on treating each patient, which creates a burden of about 2.4 billion dollars on the US healthcare system every year.

Significance of the study to nursing

The suffering experienced by families and patients due to the central line-associated bloodstream infections acquired in the hospitals is immeasurable. Therefore, there is a need for nurses to focus on the prevention strategies for bloodstream infections in hospitals, especially in the Intensive Care Unit.

The objective of the study

Hospitals commit developing strategies to minimize the cases of central line-associated bloodstream infections which are the primary source of high costs of care by both patients and health institutions. Also, bloodstream infections are the leading causes of high mortality rates of patients admitted to hospitals. Therefore, the main objective of the study is to characterize the effectiveness and development of centralized Central Line-associated bloodstream infections prevention bundle in pediatric hospitals.

Qualitative Research Critique and Ethical Considerations

Research question

What is the effectiveness of centralized Central Line-Associated Bloodstream Infections prevention bundle in preventing CLABSI for patients in pediatric intensive care unit?

How does the article answer the PICOT question?

The PICOT question researches the comparison between the effects of daily baths with Chlorhexidine and with soap and water in reducing the rate of central line-associated bloodstream infections in patients in the Intensive Care Unit. The article answers the PICOT question by examining the effects of central line-associated bloodstream infections prevention bundle in reducing CLABSI in patients in the neonatal and Pediatric Intensive Care Unit. Therefore, the utilization of antiseptic chlorhexidine gluconate can be used as the primary intervention to fight bacterial load both in the central lines and central venous catheters. Chlorhexidine gluconate daily baths are imperative compared to regular baths using soap and water in the ICU unit.

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

The PICOT question compares the effectiveness of two interventions, that is, daily baths with Chlorhexidine and regular baths with soap and water in reducing the rate of Central Line-Associated Bloodstream Infections for patients in the Intensive Care Unit. On the other hand, the article compares different interventions, that is, central CLABSI prevention bundles in reducing the rate of Central Line-Associated Bloodstream Infections in patients in the neonatal and pediatric intensive care unit.

Study methods used in each of the two articles and how different they are

The article by Johnson et al. (2019) used an observational study to determine the relationship between Chlorhexidine baths and Central Line-Associated Bloodstream infection prevention. The groin and arm skin bacterial growth were observed in non exposed patients, and 40 Chlorhexidine exposed patients in the Neonatal Intensive Care Unit. The exposed patients were given 2 % Chlorhexidine baths for Central Line-Associated Bloodstream infection prevention.

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On the other hand, the study By Savage, et al. (2018) used a research method where the researchers applied a retrospective time series to examine the effectiveness of various prevention bundles that were developed by nurses in infection control in neonatal and pediatric intensive care unit in 2006-2014. The research was subdivided in to post, peri, pre, and second peri-intervention periods depending on each bundles implementation status.

Results of the studies and their implications to nursing

The study by Johnson et al. (2019) indicated that the bacterial burden reduced after the patients took the first bath. However, the bacterial load returned to baseline after 72 hours. The concentration of residual CHG on the skin reduced with time as the bacterial burden increased.

Bathing with Chlorhexidine decreases the bacterial burden on the skin. However, the burden’s baseline returns after 72 hours. Nurses should be aware that CHG bathing twice a week may not be adequate in reducing the growth of bacterial skin burden in patients admitted in the neonatal Intensive care unit. Targeted interventions in the ICU such chlorhexidine gluconate daily baths can reduce the risk of CLABSI associated with using central lines and central nervous catheters. Thus, the study has shown the efficacy of chlorhexidine gluconate in intensive care patients and support is increasing in caring for non-ICU patients.

On the other hand, the study by Savage et al. (2018) showed that there was a significant reduction in unit Central Line-Associated Bloodstream Infection rates where all units were less than the corresponding National Healthcare Safety Network Central Line-Associated Bloodstream Infection rates after the study.

Prevention bundle for centralized Central Line-Associated Bloodstream Infection can be useful in universalizing central line care, improve and control the quality of care to help maintain low CLABSI rates in the hospital. Thus, the study has shown the efficacy of chlorhexidine gluconate daily baths in reducing the risk of CLABSI associated with the use of central lines and central nervous catheters in intensive care patients.

Ethical Considerations

When conducting research, it is vital to maintain the confidentiality of patient information. Secondly, the study should be supported and approved by the Institutional Review Board.  The Institutional Review Board approved the two articles. Besides, participants of the studies were chosen voluntarily, and their health information was confidentially maintained.

References

Johnson, J., Suwantarat, N., Colantuoni, E., Ross, T. L., Aucott, S. W., Carroll, K. C., & Milstone, A. M. (2019). The impact of chlorhexidine gluconate bathing on skin bacterial burden of neonates admitted to the Neonatal Intensive Care Unit. Journal of Perinatology, 39(1), 63. https://www.nature.com/articles/s41372-018-0231-7

Savage, T., Hodge, D. E., Pickard, K., Myers, P., Powell, K., & Cayce, J. M. (2018). Sustained reduction and prevention of neonatal and pediatric central line-associated bloodstream infection following a nurse-driven quality improvement initiative in a pediatric facility. Journal of the Association for Vascular Access, 23(1), 30-41. Doi: 10.1016/j.java.2017.11.002

 

 

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Action Plan in Counselling

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Action Plan in Counselling

If counseling is all talk and no action, it is not effective counseling. The problem is that clients encounter many barriers in carrying out actions they identify in the counseling process.

Write a 750-1,000-word paper discussing action planning and overcoming barriers for client treatment. Please use headings and include the following in your paper:

1.      Discuss the principles for effectively implementing an action plan.

2.      Describe at least five barriers that might interfere with client implementation of the action plans that are created. Include a case example of each barrier.

3.      Outline a counselor intervention that would help to overcome each barrier.

4.      A list of your local community resources for different types of needs.

5.      Outline an aftercare plan that utilized local community resources.

Include at least three scholarly references in your paper.

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

Action Plan in Counselling

Introduction

Mental health is an important health field that is helping a lot of people who in the past struggled in silence. For it to be effective, it is important to understand the specific steps that needs to be taken as well as possible barriers to effective treatment and how to overcome them (Treatment, 2014). The following is an analysis explaining principles of effective action plan implementation, its barriers and ways to address the barriers. It also explores possible resources available to assist the clients and how they can be used for the benefit of the patient.

Action Plan in Counselling

Principles of Effective Action Plan

The first principle for an effective treatment plan is that of clarity in that all the activities that are to be done need to be clearly defined as well the period they will run. The second principle is that of sufficiency. It explains that for an action plan to be effective then all of the objectives that were defined before its implementation are done (Treatment, 2014). The third on is that of resources. For an action plan to be effective there needs to be very specific resources that are available to the person. Principle of resources require that the resources need are well explained as well as how they will be availed. Finally, the action plan needs to meet the principle of flexibility. It explains that for an action plan to be effective, then it needs to be one that can respond effectively to new changes as well as emerging barriers and opportunities.

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Barriers

One of the barriers to be addressed is stigma. A lot of people suffering from mental problems are stigmatized which can make them not want to take advantage of the resources available to address the problems for fear of being stigmatized. For example, people tend to categorize any person receiving any mental health related care as being crazy which can inhibit the willingness from seeking help so as not to be categorized as such. Another barrier is financial (Treatment, 2014). Treatment can be expensive and implementation of action plan will need specific resources that might need to be paid to acquire. Many who do not have the financial capacity to pay for these resources can struggle to effectively address their problem. For example, some action plans might need insurance to be effective and if a person cannot afford a cover, then it will be hard to effectively implement it.

Another barrier is reluctance to face problems. A lot of people that need counselling tend to be unwilling to take the necessary steps for them to get better due to various reasons such as being in denial (Drake & Latimer, 2014). For example, an action plan might need an individual to apologize for something that they did and if unwilling, then it is hard to implement that part of the plan. For those people, it will be hard to get the right assistance because they do not feel like the need it in the first place. Many of them also do not feel like counselling and the steps that need to be taken will be effective and the end up not either seeking help or following up on everything that needs to be done. Other health problems can also be a source of barrier to effective implementation of an action plan. For example, those suffering from health problems such as HIV/AIDS or with chronic diseases that are painful may be unable to be actively involved in all required activities. Finally, there are also many system problems that can also result in barriers. For example, if a person was getting help from Medicaid to implement the action plan and end up taking a better paying job, then they will not be eligible to getting the financial help anymore.

Resources available for Various Needs

There are various resources available to those who need them. For information, some of the online resources include American psychological association, American Psychiatric Association, and Psychology Today websites. For military and Veterans, they can get the help they need from the veteran affairs offices, military pathways offices and the national association on mental illness. For the young people, some resources that are available to them include the US office of adolescent health, Jed foundation, youth.gov and law lifeline (Sanetti & DiGennaro Reed, 2014). The Mental Health America (MHA) is also a viable option for many and is community based. Among the resources it provides include screening tools and approach to getting help among others.

Action Plan in Counselling

Aftercare Plan

A good after plan provides assistance after the action plan implementation to ensure that a person continue of the upwards trajectory of recovery. A good option to consider is joining a support group. The aftercare plan needs to start with finding a good after care group near and individual and cites such as Mental Health America can help (Drake & Latimer, 2014). One will then need to approach the group which is in most cases made up of people recovering from similar problems. It gives them a chance to share and talk about their experiences as well as offer support to each other. This can help a person feel strengthened and have people to talk to during challenging times.

Conclusion

Mental health is an important issue in America and action plans are central to an effective recovery. They need to have some specific principle to be effective. It is also important to identify barriers that can inhibit successful implementation and devise ways to eliminate them. Finally, one needs to have an effective aftercare plan to assist the person recovering to keep moving forward.

References

Drake, R. E., & Latimer, E. (2014). Lessons learned in developing community mental health care in North America. World Psychiatry, 11(1), 47-51. doi:10.1016/j.wpsyc.2012.01.007

Sanetti, L. M., & DiGennaro Reed, F. D. (2014). Barriers to Implementing Treatment Integrity Procedures in School Psychology Research. Assessment for Effective Intervention, 37(4), 195-202. doi:10.1177/1534508411432466

Treatment, C. F. (2014). Enhancing Motivation for Change in Substance Abuse Treatment.

 

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Hillsboro County Home Health Agency Strategic Plan

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Hillsboro County Home Health Agency Strategic Plan

The strategic planning process is essential for all organizations. Strategic plans help organizations’ Hillsboro County Home Health Agency Strategic Planleaders and stakeholders keep sight of their missions and visions, achieve their goals and objectives, and address their challenges and issues. As a health care leader, you must be able to develop a strategic plan and use it to drive your organizational decision making. For the Final Project, you develop a comprehensive strategic plan to address challenges that have adversely impacted a health care organization.

To prepare:

Review the Hillsboro County Home Health Agency, Inc. (HCHHA) case study in this week’s Learning Resources.

Note: Your Final Project should show effective application of triangulation of content and resources in your conclusion and recommendations.

The Assignment

HCHHA’s board of directors and executive leadership team have asked for your assistance with addressing some of the major issues that have adversely impacted the organization’s financial and operational performances. They have requested that you advise them on the following:

  • Strategies to help the organization address the absence of a Medicare-certified hospice, which has inconvenienced patients and their family members and has led to negative publicity for the organization
  • Strategies that might improve HCHHA’s overall financial performance
  • Strategies that might improve HCHHA’s operational performance
  • Strategies that might assist HCHHA with effectively addressing the various external factors that may potentially threaten its market share

In a 20-page strategic plan, include the following components:

  • Mission statement (provided in the case study)
  • Vision statement
  • Core values
  • SWOT analysis
  • Grand strategies or long-term strategic priorities
  • Operational and tactical plan
  • Key performance and evaluation indicators
  • Change management plan, including the following:
    • The size of the change and its impact on the community and the organization
    • The organization’s readiness for change
    • Change management strategy
    • Team structure and responsibilities
    • Sponsor roles and responsibilities
    • Planning and implementation
    • Communications plan
    • Change management resistance plan
    • Training plan
    • Incentives and celebration of successes
    • Timeline/schedule of activities
    • Budget for change management

The 20-page narrative plan should be written as if it were to be presented to the board of directors. The plan should also include the following pages that will not count toward the 20-page limit:

  • One-page Executive Summary
  • Tables, graphs, and/or charts

The plan should include at least 15 current (no older than 4 years) quality resources, with 10 of those resources being from peer-reviewed sources.

In addition to the paper, you must produce a PowerPoint presentation highlighting the key elements of the paper. The presentation should not be more than 15 slides, excluding the cover slide and the appendices. Be sure to include 100- to 150-word speaker notes to explain the content on each slide.

This Assignment is due by Day 7 of Week 10.  

 

Resources

Walston, S. L. (2018). Strategic healthcare management: Planning and execution (2nd ed.). Chicago, IL: Health Administration.

  • Chapter 13, “Strategic Change Management” (pp. 305-322)

Al-Adwani, A. B. (2014). The extent to which human resources managers in KNPC believe in human resource investment. International Business Research, 7(4), 132–141. Retrieved from http://www.ccsenet.org/journal/index.php/ibr/article/view/31563/20091

Cocks, G. (2014). Optimising pathways for an organisational change management programme. TQM Journal, 26(1), 88–97.

Note: Retrieved from Walden Library databases.

Gopal, S., & Kumar, D. M. (2015). Strategic interventions in tackling poor performance of service departments: Study on Muhibbah engineering. Journal of Economics and Behavioral Studies, 7(4), 6–13. Retrieved from https://www.researchgate.net/publication/281544969_Strategic_Interventions_in_Tackling_Poor_Performance_of_Service_Departments_Study_on_Muhibbah_Engineering_M_Bhd_Malaysia

Henderson, S., Kendall, E., Forday, P., & Cowan, D. (2013). Partnership functioning: A case in point between government, nongovernment, and a university in Australia. Progress in Community Health Partnerships, 7(4), 385–393.

Note: Retrieved from Walden Library databases.

Kash, B. A., Spaulding, A., Johnson, C. E., Gamm, L., & Hulefeld, M. F. (2014). Success factors for strategic change initiatives: A qualitative study of healthcare administrators’ perspectives. Journal of Healthcare Management, 59(1), 65–81.

Note: Retrieved from Walden Library databases.

Martínez-Jerez, F. A. (2014). Rewriting the playbook for corporate partnerships. MIT Sloan Management Review, 55(2), 63–70.

Note: Retrieved from Walden Library databases.

Mutale, W., Stringer, J., Chintu, N., Chilengi, R., Mwanamwenge, M. T., Kasese, N., … Ayles, H. (2014). Application of balanced scorecard in the evaluation of a complex health system intervention: 12 months post intervention findings from the BHOMA intervention: A cluster randomised trial in Zambia. PLoS One, 9(4).

Note: Retrieved from Walden Library databases.

Ovseiko, P. V., Melham, K., Fowler, J., & Buchan, A. M. (2015). Organisational culture and post-merger integration in an academic health centre: A mixed-methods study. BMC Health Services Research, 15, 417–443.

Note: Retrieved from Walden Library databases.

Rajaram, S. S., Grimm, B., Giroux, J., Peck, M., & Ramos, A. (2014). Partnering with American Indian communities in health using methods of strategic collaboration. Progress in Community Health Partnerships, 8(3), 387–395.

Note: Retrieved from Walden Library databases.

Reid, M. F., Brown, L., McNerney, D., & Perri, D. J. (2014). Time to raise the bar on nonprofit strategic planning and implementation. Strategy & Leadership, 42(3), 31–39.

Note: Retrieved from Walden Library databases.

Shea, C. M., Jacobs, S. R., Esserman, D. A., Bruce, K., & Weiner, B. J. (2014). Organizational readiness for implementing change: A psychometric assessment of a new measure. Implementation Science, 9(7), 1–15.

Note: Retrieved from Walden Library databases.

Steinbauer, R., Renn, R. W., Taylor, R. R., & Njoroge, P. K. (2014). Ethical leadership and followers’ moral judgment: The role of followers’ perceived accountability and self-leadership. Journal of Business Ethics, 120(3), 381–392.

Note: Retrieved from Walden Library databases.

Traberg, A., Jacobsen, P., & Duthiers, N. M. (2014). Advancing the use of performance evaluation in health care. Journal of Health Organization and Management, 28(3), 422–436.

Note: Retrieved from Walden Library databases.

Resources for the Final Project

Iedunote (n.d.). Strategic planning process: 9 steps of setting proper strategic plan. Retrieved from https://iedunote.com/strategic-planning-process

Invest-Tech Limited. (2016). Business planning papers: Developing a strategic plan. Retrieved from http://www.planware.org/strategicplan.htm

Queensland Government Chief Information Office. (n.d.). Change management plan workbook and template. Retrieved from http://www.nrm.wa.gov.au/media/10528/change_management_plan_workbook_and_template.pdf

SAMPLE ANSWER

Executive Summary

Hillsboro County Home Health Agency is among the best healthcare providers in the region. In addition to offering quality services to its patients, the agency has massive successes in its main divisions; Home Care Division, Private Duty Division and Community Health Division. However, the facility has been facing challenges that have adversely affected its operations. As such, the board of directors has requested that a strategic plan be designed to address major issues and to improve HCHHA’s financial and operational performance. Additionally, the board of directors has requested that strategies be designed to address the absence of a Medicare –Certified Hospice in the region and what can be done to close the gap. In line with these requests, a strategic plan has been designed. A SWOT analysis has been conducted and grand strategies listed down. Under product development strategies, the plan recommends that HCHHA collaborates with doctors and hospice nurses and other key shareholders to develop a Medicare –certified hospice. To improve market penetration HCHHA should invest in advertisement, expanding its operations to neighboring regions and diversification of products and services. To address the financial problems in the agency, the retrenchment strategy recommends the adoption of the diagnosis related group program system (DRG) to track payments from Medicaid. A tactical plan has been provided that highlights specific goals with fixed deadlines to help the agency develop a Medicare-Certified Hospice facility. Budgets, resources and a marketing plan have also been highlighted. An operational plan is presented where single use plans have been designed to address the high employee turnover rate in the facility. Key performance indicators have been provided that focus on financial metrics, customer metrics, process metrics and people metrics. Lastly, a change management plan has been discussed with key areas highlighted.

Hillsboro County Home Health Agency Strategic Plan

Introduction

The strategic planning process is made up of several steps that effectively use human resources and materials to achieve organizational objectives. The strategy collectively states the purpose of the organization, its mission statement and long-term objectives. Additionally, the strategy develops an appropriate course of action and allocates resources towards the achievement of set strategies (Iedunote). The strategic planning process has nine key steps including; planning awareness, goal formulation, analysis of both the internal the external environments,  identification of threats and strategic opportunities, carrying out a gap analysis, designing alternative strategies, implementing set strategies and measuring progress (Iedunote).  Following these steps, this strategic plan will carry out an initial examination of HCHHA’s state of affairs and develop a plan that will affect daily performance of the organization.

The Hillsboro County Home Health Agency (HCHHA) is among the best health care providers in the country. Founded in 1946 as a nonprofit home health agency, HCHHA has successfully provided quality healthcare services to the people of Hillsboro. However, in recent times, the healthcare facility has struggled with several issues that have negatively affected its financial status and operational performance. As such, the board of directors and the executive leadership team has requested assistance in the development of strategies that;

  • Address the absence of a Medicare-certified hospice resulting in negative publicity for the facility
  • Improve overall financial performance
  • Improve operational performance
  • Address external factors that might negatively affect the facility’s competitive advantage

In line with the aforementioned key areas, this report will provide strategies to help the facility manage the challenges while also maintaining profitability.

Hillsboro County Home Health Agency Strategic Plan

Mission Statement

“The mission of HCHHA is to serve individuals in their usual environments and is concerned with well people as well as people with illness or disabilities. We strive to prevent disease or to retard its progress and to reduce the ill effects of unavoidable disease. We provide quality nursing and therapeutic care to the noninstitutionalized sick and disabled. We also provide information and encouragement to individuals and families, special groups and the community as a whole for the promotion of health”.

Vision Statement

To provide quality healthcare services to every individual in need.

Core Values

  1. To provide patient-centered care
  2. To be a resource center for patients, their families and the community in general
  3. To build good leadership skills
  4. To build and enhance collaboration
  5. To nature professionalism
  6. To offer quality care
  7. To ensure prudent administration of funds

SWOT Analysis

Strengths

  • Good governance
  • Effective community health division at the facility
  • Only Medicare-certified home care service in the county
  • Contracts with managed care organizations
  • Home care division
  • Can-do attitude

Weaknesses

  • Increased dependence on Medicare and other government programs
  • Staff turnover
  • Physician recertification for Medicare patients
  • Lack of employee credentialing and background checks
  • Outdated work rules
  • Lack of Medicare-certified hospice

Opportunities

  • Modernized building
  • Technological advancements
  • Year-round fundraising activities
  • Collaboration with other home health agencies to offer hospice services to the residents of Hillsboro County
  • Increasing market share

Threats

  • Increased competition from other agencies in the home care field
  • Reimbursement changes
  • Increased interest from managed care organizations and insurance companies in the use of home care services
  • Referral of patients living in Jasper to the Capital City Visiting Nurse Association instead of HCHHA
  • Lack of funds
  • Lack of support from United Appeal

Long-term Strategic Priorities

Long-term strategies are corporate level strategies used to identify the organization’s choice with regards to the direction it will follow to achieve set objectives. Setting grand strategies requires the organization to choose a long-term plan from a set of available resources (Silove, 2017). The grand strategies guide the organization’s decision on the allocation of resources from one area of the business to the other and in managing their portfolio efficiently (Silove, 2017). In doing so, the organization chooses the best alternative available. A strategic plan with long term objectives acts as a framework to guide the decision-making process and provide a basis for planning. By analyzing information in a long-term strategic plan, managers are able to make required changes and create a platform for further planning to be done. Thus, a long-term plan is a road map through which a strategic plan will be accomplished.

HCHHA long term plan has the following; product development plan, market growth plan, retrenchment strategies, stability strategies, combination strategies and retrenchment strategies.

Product Development

            A product development strategy is based on the creation of new products or the transformation of already existing products to become new and introducing these products to the market (Kim, Park & Sawng, 2016). Product development strategies are introduced when there is little growth in the company’s current market. In such a state, a company could upgrade an already existing product, evolve a new product or completely abandon the product all together. For many companies, abandoning a product is not economically viable. Therefore, strategies are designed to either upgrade or evolve a product and introduce it into an existing market or into a new market altogether.

After the Middleboro Sentinel news article and the news feature on TV Channel 32, HCHHA has realized the need for a Medicare-certified hospice. The lack of a hospice in Middleboro has prompted HCHHA to develop strategies to address this need. In line with this objective, HCHHA has engaged the services of a consultant to estimate the need for a Medicare-certified hospice in Hillsboro County. This hospice facility is a new product that HCHHA is intending to introduce into the market. According to Kim, Park and Sawng (2016), a new product can be defined as a product in which a company introduces to a new market and in which changes are conveyed. New product development process involves the formalization of planning and thoughts from the initial stage of generating ideas to the last stage of market launching. This product development strategy for a new Medicare-certified Hospice will highlight seven key phases of; idea discovery, idea screening, concept development, business analysis, developing a mix between marketing and the product, market testing and product launch.

New product development projects often fail during the early stages of development or in the last stage of product launch phase. The underlying causes of failure often occur in the initial stage of product development (Floren, Frishammar, Parida & Wincent, 2018). Managing the front end of the new product development process has significant implications on product success. Based on the consultant’s report, over 55% of individuals who have cancer seek the services of a hospice. Additionally, most hospice care is offered to individuals at their home. With 85% of individuals who seek Medicare-certified hospice care being fully covered by Medicare, the need for a HCHHA hospice care is long overdue. Due to lack of physical space, HCHHA can opt to offer these services at the patient’s home. Hospice care is designed to offer care for 24 hours a day, 7 days a week (Meier, 2015). By coordinating with doctors, hospital social workers, case managers and discharge planners, a HCHHA Medicare-funded hospice is a possible new product.

Hillsboro County Home Health Agency Strategic Plan

Market Growth

Most organizations have plans to grow their business and increase sales. As such, market growth strategies are necessary to facilitate this growth. There are several growth strategies that organizations can employ. They include; market development, market penetration, product expansion and diversification (Boag & Dastmalchian, 2015). Growth under market penetration attempts to increase an organization’s market share using current products and services. HCHHA has several programs that it offers to residents of Hillsboro County and beyond. The private duty division and the community health division have several programs that offer a wide range of services including high blood pressure screening programs, senior health clinics, personal care services, head lice program and senior health clinics. Recently, there have been increased referrals to Capital City Visiting Nurse Association instead of HCHHA. To improve market penetration, HCHHA can increase its marketing efforts by placing adverts in the local dailies and TV stations.

Achieving growth requires several strategies that increase profitability and success. Market development involves introducing products and services to new markets. HCHHA is a reputable facility known to offer quality care to residents of Hillsboro County. With this in mind, the facility should invest in expanding its business to neighboring counties. Diversification on the other hand, involves creating a completely new product for a new market (Liabotis, 2017). This strategy is the most uncertain making it the riskiest strategy yet. By venturing into the hospice business, HCHHA risks failing and the same time, the possibility of reaping high benefits is also present. Overall, for HCHHA to increase its value, it must invest in the aforementioned growth strategies.

To achieve growth, HCHHA should strengthen their infrastructure to ensure that it is up to standards to support successful execution (Liabotis, 2017). HCHHA has already invested resources to renovate Middleboro office in the Hartsdale House by installing new sprinkler systems and fire warning systems. It is recommended that the facility utilizes performance drivers that align with the growth strategy. Additionally, the facility could grow more leaders at both managerial and non-managerial levels of the organization.

Hillsboro County Home Health Agency Strategic Plan

Retrenchment Strategy

            Retrenchment strategies seek to divest, restructure or sell a business unit with the purpose of reducing costs, streamlining operations and stabilizing cash flow. There are three primary retrenchment strategies; turnaround strategy, divestment and liquidation strategies 9Casillas, Moreno-Menendez, Barbero & Clinton, 2018). The turnaround strategy requires the realignment of operations to be more profitable. Often, turnaround strategies are designed as a response to ineffective strategies causing harm to the organization. HCHHA has financial issues both in the private duty division and the community health division. The home care division is fully funded by Medicare and Medicaid. However, the facility is receiving less money per patient that what Medicare allocates to other facilities. It is recommended that HCHHA adopts the diagnosis-related group (DRG) payment system to track payments from Medicare and other private health insurance companies. When the facility treats a patient, they should assign a DRG when the patient is discharged. The facility is paid a fixed amount for the DRG regardless of the amount of money it spent in the patient. If the facility effectively treats a patient for less money than what Medicare pays for the DRG, the facility is able to make money on that hospitalization (Davis, 2019).

Divestment strategies involve reducing operations or getting rid of a business unit. These strategies are often implemented when a business unit is losing money or when it does not fit with the company’s core objectives. Divestment strategies require the facility to allocate resources to other profitable business units (Casillas et al. 2018). Recently, HCHHA staff nurses have expressed their concern on the extra time it takes to do paperwork from home after work. This in turn reduces productivity and increases costs. It is recommended that HCHHA employs data clerks to help staff members file paperwork.

Hillsboro County Home Health Agency Strategic Plan

Liquidation strategies are similar to divestment strategies. Liquidation focuses on shutting down units and selling specific assets (Casillas et al. 2018). With the unstable Medicare reimbursement system, HCHHA should consider selling some of its divisions to other local hospitals to mitigate losses.

Stability Strategy

Stability strategies seek to maintain operations in a business. These strategies are characteristic of organizations that are comfortable with their current positions. Some of the strategies include; no change strategies, profit strategies and caution strategies (Alshawabkeh et al. 2019). No change strategies are used when an organization makes no changes to its operations. The organization examines factors affecting its market environment and decides to maintain its strategic objectives. HCHHA at the moment has a positive rapport with its customers. Therefore, it should continue to stay unaffiliated with other hospitals in the region. Profit strategies are used to improve profitability. Profit strategies may include; increasing output, raising prices or offsetting losses. It is recommended that HCHHA should boost its home visits to boost productivity. According to board member David Ruseski, staff productivity should be increased. Thus, the Home Health Visit Staff Productivity Profiles for RN, LPN, HC aide, Physical therapists, occupational therapists and social workers should be implemented at the facility. Caution strategies on the hand, require organizations to wait and assess the market before employing new strategies. These strategies are considered to be reconnaissance and are conducted before any strategic action is taken (Alshawabkeh et al. 2019). In line with this objective, HCHHA should first assess the market for Medicaid-funded hospice services before embarking into this venture. Stability strategies are used to maintain an organization’s position in the market.

Combination Strategy

            Combination strategies are used to combine several master strategies. Combination strategies may include the use of different strategies in each business unit. Additionally, the strategies may include the use of multiple strategies in individual business units at the same time or during different occasions (Parnell, 2014). Thus, combination strategies are designed to mix growth strategies, retrenchment strategies and stability strategies. It is recommended that HCHHA continues to consolidate its position in the existing business of home care while also entering new areas like the hospice home care services.

Hillsboro County Home Health Agency Strategic Plan

            When businesses experience deteriorating performance due to market erosion, they respond by selecting strategies that redirect attempts to turnaround its operations and improve its competitive position (Casillas et al. 2018). One form of retrenchment strategies is a turnaround strategy that focuses on operational improvement. When organizations adopt retrenchment strategies, they reduce one or more business operations with the aim of cutting expenses to reach a stable financial position. In addition to turnaround strategies, businesses can either adopt divestment strategies or liquidation strategies (Casillas et al. 2018). HCHHA may consider charging customers who seek their Telehealth program instead of offering the service for free. If this venture proves difficult, HCHHA should shut it down.

Operational and Tactical Plan

Tactical Plan

A tactical plan describes tactics that an organization plans to implement to achieve what is outlined in the strategic plan. Tactical plans are short range, with a scope of one year or less. Tactical plans are flexible and are designed to achieve the organization’s goals and objectives (“Strategic Planning”, 2014). The following are important components of a tactical plan

Specific Goals with Fixed Deadlines

  • Open a Medicare-funded hospice division within ten months
  • Adopt a Diagnosis-related group payment system (DRG) within three months
  • Hire data clerks to help home care nurses with paper work in a month
  • Increase staff profitability by reducing travel time to and fro patient’s houses within two months
  • Conduct benchmarking activities on other hospice facilities to determine viability and opportunity for growth within the next six months
  • Adopt performance drivers to grow more leaders in the facility and to reduce employee turnover rates within the next year
  • Modernize the Middleboro office by adding fire alarm systems and sprinkler system within four months

Hillsboro County Home Health Agency Strategic Plan

Budgets

A majority of the funding or revenue inflow for the strategic plan will come from fundraising activities and grants. Additionally, funds will be obtained from the 960,000 USD bequest given to the facility by a former patient. A budget will be allocated for hiring new data clerks. Additionally, a budget will be allocated for marketing campaigns in the local newspapers and TV stations.

Resources

The resources that are required to achieve the organization’s aims include; human resources and cash resources. HCHHA will continue contracting the services of a private duty nurse, Amy Edwards, RN and her associates who conduct in-home IV therapy. This is in line with the facility’s mission of providing quality care to patients. With word going around that Rock Creek, a private long-term care facility in Mifflenville is developing plans to start a private home care agency, HCHHA risks losing some of its clients to Rock Creek. As such, a majority of the cash resources should be directed towards advertisements to reassure customers of HCHHA quality services.

Marketing

HCHHA will create an affiliate program to improve its marketing strategy. Additionally, due to the financial constraints, HCHHA will use growth hacking to combine creativity, social metrics and analytical thinking to sell the facility’s services. Referrals programs will form a large portion of the marketing for the facility. Clients will be incentivized to tell others about the services offered at HCHHA. In addition to using traditional methods of advertising, HCHHA will use earned media or free media to facilitate inbound marketing and to increase awareness of the services offered at the facility. Lastly, HCHHA will use content marketing which emphasizes on education rather than selling to influence the buying behavior.

Operational Plan

            An operational plan describes daily activities in the running of a business. It provides a roadmap for achieving tactical goals within realistic frameworks. An operational plan is highly specific with emphasis placed on the achievement of short-term objectives (“Strategic Planning”, 2014). Operational plans are divided into single use plans and ongoing.

            Single Use Plans

Single use plans are created for single occurrences and are highly specific (“Strategic Planning”, 2014). According to Catherine Newfields, the home care division manager, there has been high employee turnover and a reluctance of staff to provide all round IV therapy to cancer patients. A recruitment drive to hire new employees is an effective single use plan that the facility can adopt.

            Ongoing Plans

Ongoing plans focus on policies, rules and procedures and are created on an ongoing basis. Policies are used to dictate how managers approach situations. Policies also decision-making processes in the organization. Rules on the other hand are regulations designed to help organizations function. Rules are hard coded and are enforced stringently while procedures are step-by-step processes that accomplish specific objectives (“Strategic Planning”, 2014). HCHHA should therefore develop ongoing plans that include termination of contracts, hiring new employees and sourcing for medical equipment among other tasks.

Hillsboro County Home Health Agency Strategic Plan

Key Performance and Evaluation Indicators

Key performance indicators (KPI) are performance measurements that institutions use to gauge how they are performing. KPIs act as compasses helping organizations understand whether they are taking the right path towards their strategic goals (Jahangirian, Taylor, Young & Robinson, 2017). To be effective, KPIs must be quantifiable, well-defined, must be communicated throughout the organization and its departments, must be crucial to achieving strategic goals and must be applicable to the organization’s line of business (Jahangirian et al. 2017). For HCHHA, the key performance indicators that will be used include; financial metrics, customer metrics, process metrics and people metrics.

Financial Metrics

  1. Profit: gross and net profit margins will be analyzed to understand how successful the organization is at generating high returns.
  2. Cost: cost effectiveness of the proposed interventions will be analyzed to determine ideal ways of reducing and managing costs
  3. Line of business revenue Vs. Target: HCHHA’s actual revenue will be compared with its projected revenue. Discrepancies will be charted and analyzed to help management identify departments that are performing better than others.
  4. Cost of services offered: the production costs of the services offered by the home care division, private duty division and community health division at HCHHA will be tallied. This will help the facility get a better idea of its profit margin. This information will be used to determine how to outsell its competition.
  5. Line of Business (LOB) Expenses Vs Budget: The actual overhead with the forecasted budget will be compared. This will help the facility understand where it deviated from the plan to help the facility created effective departmental budgets in the future.

Customer Metrics

  1. Customer Lifetime Value (CLV): CVL will help the facility understand the long-term value of maintaining customer relationships. This indicator will be used to identify the best channel to use to gain customers for the best price.
  2. Customer Acquisition Cost (CAC): this indicator will help HCHHA evaluate the cost effectiveness of its marketing campaigns
  3. Customer satisfaction and retention: the facility can use customer satisfaction scores and percentage of return customers to gauge customer satisfaction levels.
  4. Net Promoter Score (NPS): the facility can determine its NPS by sending quarterly to customers to gauge the likelihood of them referring the facility to other patients. By establishing a baseline, strategies can be put in place to help the numbers grow.
  5. Number of customers: the organization can determine the number of customers it has gained or lost to determine whether the consumer’s needs are met.

Process Metrics

  1. LOB Efficiency Measure: efficiency can be measured by analyzing the number of patients that HCHHA meets in a day and the percentage of time the facility was operational.

People Metrics

  1. Employee Turnover Rate (ETR): HCHHA will calculate its ETR and if it is high, the facility should examine its workplace culture, work environment and employment packages to determine areas of change.
  2. Employee Satisfaction: the facility will use surveys to measure employee satisfaction. The information obtained will be used to gauge organizational health.

Change Management Plan

The change management process follows a sequence of steps that a change management team will apply to a change to drive individual transition and ensure that the organization meets its intended outcomes (Malek & Yazdanifard, 2014). There are several key elements that guarantee a successful change management process. Change management plans on the other hand, are designed to support a project until it delivers change. HCHHA like other organizations is consistently going through change. The development of a new Medicare-funded hospice division is one example of change. In line with this, a change management plan is essential as it minimizes the impact of change on the organization and staff.

Size of the Change

            In the recent past, there has been concern over the lack of a Medicare-Certified hospice facility in Middleboro. HCHHA as a home health agency is tasked with the responsibility of providing hospice care to the terminally ill in the town. This need has prompted HCHHA to engage consultants to estimate the need for a Medicare-Certified hospice in Hillsboro. A hospice will provide much needed home care to the terminally ill in the community. HCHHA will need to hire new staff members who are well trained in hospice care. Financial resources must be directed towards providing infrastructure to facilitate the creation of a hospice facility. The change management team will be assessed before the plan is designed. Additionally, every team member will be allocated specific tasks and areas of the project. Rules will also be created to control the change management process. The rules will provide a guideline on how teams are chosen, how team members are assigned tasks and how everyone will be held accountable for their actions. Project completion objectives will also be set.

Hillsboro County Home Health Agency Strategic Plan

Readiness for Change Assessment

Readiness assessments are used by the change management team to assess the organization’s readiness to change. The assessment provides the project team with insights into opportunities and challenges that the project might face during the change process (Weiner, 2014). The readiness for change assessment will provide; the scope of the change in terms of the department that will be affected, number of employees impacted by the change, type of change and amount of change that has currently been done.

The first step in the readiness assessment is the data collection step. Data will be collected using both qualitative and quantitative methods. Qualitative data will be collected by conducting interviews with key stakeholders (Weiner, 2014). This will involve individuals in the leadership position and other staff members directly involved in the hospice project. Additionally, internal organizational influencers will be included. During the interviews, several outcomes will be analyzed; the level of understanding of the project, the level of understanding of the benefits and barriers that the project will face, understanding of the project’s vision and mission, an appreciation of the organization’s need for change. Quantitative data will be collected via the distribution of a readiness survey (Weiner, 2014). The survey will be distributed to the leadership team, the project team and the end users. The survey will ask questions around project sponsorship, resources, support and understanding the change. The data collected is analyzed to gauge readiness for change and to tailor communications that target specific departments. Lastly, recommendations are made to improve project understanding and competency.

Change Management Strategy

Change management strategies are used to highlight specific ways in which organizations address change. The first step in the change management strategy involves urgency creation. Change will only be successful if the entire staff at HCHHA wants it. By creating awareness around the program, staff members at the facility will receive the idea well (Jalagat, 2016). Awareness will be created through the use of statistics and visual presentations to convey the benefits of offering hospice services. In addition to creating awareness for the project, a team will be selected to carry out the change. The team will be organized and responsibilities assigned to each member. Creating a vision for the change process is essential as it makes everything clear to all parties involved. Additionally, a clear vision will help the project implementation team better perform their duties. The vision derived must then be communicated to the rest of the staff members (Jalagat, 2016). The project’s vision should be communicated frequently. Obstacles to change are expected. Therefore, strategies to remove obstacles should be created to increase the team’s morale. To avoid failure, the project team should refrain from declaring victory early. Instead, the team should let the change mature. Lastly, mechanisms should be created to integrate the change into the organization’s culture.

Team Structure and Responsibilities

The main purpose of change teams is to effect change. Thus, a change management team is vital to the health of this change program (By, Kuipers & Procter, 2018). Before selecting a change team, their roles and responsibilities must be determined. Responsibilities revolve around the problem being solved by the change project, the task being executed and the change model already in place. The change model implemented will be used to determine; the change model, the organization structure and budgetary constraints. The HCHHA change will comprise of; change leaders, change managers and change agents. The role of the change leader is to create the vision for change and to drive the change itself (By, Kuipers & Procter, 2018). Therefore, the change leader acts as the impetus that propels the change forward. The change manager will oversee and administer change initiatives. Change agents are tasked with the responsibility of enacting the change. Prosci’s change team structure will be used to provide a step-by-step guide for mapping out and enhancing change. The framework has five key roles for the change management team, executives and senior managers, supervisors and managers, the project team and project support functions. Overall, the team makeup is crucial in ensuring the success of the change management initiative.

Hillsboro County Home Health Agency Strategic Plan

Sponsor Roles and Responsibilities

            Involving leaders to effect change is not enough, change initiatives need sponsorships. Sponsors help the project allocate resources, acquire critical stakeholders, resolve conflicts, provide leadership and needed support to effect change. In line with this, sponsorship is essential to guaranteeing success in organizations’ change management strategies (Helm & Remington, 2015). Sponsors introduce leadership and new information to projects so that project teams can work efficiently. Additionally, sponsors provide resources and eliminate potential roadblocks to change. Leaders have the responsibility for providing budgets and resources to help the project move forward. Good sponsors provide the team with what they need currently and what they might need in the future. Sponsors create alignment, improve communication channels and use their influence to shape and reinforce behavior. Good sponsors unite people and helps them work through roadblocks and move towards productive agreements (Helm & Remington, 2015). Sponsors also demonstrate a sense of commitment to their roles and to their project success. Lastly, sponsors work towards achieving sustainable change during the course of the project and beyond it.

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The HCHHA hospice project will be sponsored by grant holders. The finance committee will oversee budget implementation and will examine budget variances. Additionally, resources will be obtained from the 960,000 USD restricted bequest that HCHHA received from a former patient.

Planning and Implementation

Management support is essential in improving employee comfort levels during change implementation. A case for change should be created from different sources. Data should be collected from customer satisfaction surveys, employee satisfaction surveys, business goals and strategic planning (Cocks, 2014). The data should then be used o identify the best ways to identify and justify areas that need improvement. Change efforts should incorporate employees at all levels. Any change should be effectively communicated and explained to all employees. Communication should be structured and systematic to minimize resistance and improve inclusion. Once a change has been planned, effective communication is necessary to facilitate the implementation stage (Cocks, 2014). A timeline should be made to allow for appropriate resources and training to take place before the change is fully implemented. Without a logical order, the implementation process can create frustration for the shareholders. Whenever a change is introduced, a follow-up must be done after the implementation process to assess if the change delivered the results intended. If the desired results are not achieved, adjustments should be made until the desired results are achieved. Change implementation often encounters barriers. Barriers may come from other employees, organizational departments, lack of training or lack of equipment. Management should ensure that these barriers are dealt with (Cocks, 2014). Lastly, management should celebrate the success of small changes as they happen to build momentum for bigger changes.

Communications Plan

A communication plan is a crucial part of every organization’s management toolkit. With a communication plan in place, the management will be better placed to announce changes in the organization. An effective communication plan should have an audience analysis. An audience analysis requires management to separate the management group and the employee group to ensure that a more tailored communication is delivered (Newman, 2016). Once the audience has been identified, tailored questions will be created to better understand the audience. In addition to conducting an audience analysis, communication objectives should be set to address each audience. The objectives might be broad, for HCHHA, the broad objective will be to develop a Medicare-certified hospice in Hillsboro. The objectives should then be narrowed down to become more specific. Afterwards, communication channels should be selected based on the best ways to reach the audiences (Newman, 2016). Using a variety of communication channels including written and oral communication increases the odds of success. Responsibilities should also be assigned to every member of the communication team to determine who writes and who delivers the messages. Message timing is also important to a well-constructed communication plan. Lastly, during a change process, messages should be appropriately sequenced and closely tied to guarantee maximum output (Newman, 2016). Therefore, timing and frequency of messages should be determined.

Hillsboro County Home Health Agency Strategic Plan

Change Management Resistance Plan

One of the most recalcitrant problems that many changes management team face is employee resistance to change. Resistance takes a number of forms including chronic quarrels, strikes, requests for transfers or other pseudological reasons why the change might not work (Marrewijk, 2018). To avoid forcing change on employees, strategies should be put in place. Getting employees involved in the change will help management avoid resistance. Additionally, by understanding the true nature of resistance will reduce friction. Resistance is usually as a result of blind spots and attitudes that many employees have as a result of their preoccupation with technical factors associated with new ideas (Marrewijk, 2018). Knowing this, the change management team can take concrete steps to address staff attitudes. This includes emphasizing appropriate standards of performance and encouraging staff to think differently and accept change. Top executives should also make their efforts effective during meetings with other employees and in change management groups where change is being discussed. This will increase receptiveness to change. Additionally, creating win-win situations will make it easy for resistant employees to participate in the change (Marrewijk, 2018). A majority of resistance to change can be avoided if efficient change management is applied at the beginning of each change project. This can be achieved by utilizing a structured change management approach at the beginning of the project. Senior leaders should also be engaged as sponsors. Likewise, every employee at all levels of management should be engaged as advocates of change (Marrewijk, 2018). Lastly, resistance can be avoided by communicating the need for change, the impact the change will have on the employees and the benefits the change will bring to the organization as a whole.

References

Alshawabkeh, Z.A. et al. (2019). Stability Strategies and its Direct Role in Achieving Competitive Advantage at Jordanian Communication Companies. Academy of Strategic Management Journal, 18(3), 1-12. Retrieved from https://www.researchgate.net/publication/334548918_stability_strategy_and_its_direct_role_in_achieving_competitive_advantage_at_jordanian_communication_companies

Boag, DA. & Dastmalchian, A. (2015). The Relationship Between Growth Strategy and Market Performance in Technology-Based Manufacturing Companies. Proceedings of the 1987 Academy of Marketing Science (AMS) Annual Conference, 382-386. Doi: 10.1007/978-3-319-1

By, R.T., Kuipers, B. & Procter, S. (2018). Understanding Teams in Order to Understand Organizational Change: The OTIC Model of Organizational Change. Journal of Change Management, 18(1), 1-9. Doi: 10.1080/14697017.2018.1433742

Casillas, J.C., Moreno-Menendez, A.M., Barbero, J.L. & Clinton, B.E. (2018). Retrenchment Strategies and Family Involvement: The Role of Survival Risk. Family Business Review. Doi: 10.1177/0894486518794605

Cocks, G. (2014). Optimizing Pathways for an Organizational Change Management Programme. The TQM Journal, 26(1), 88-97. Doi: 10.1108/TQM-02-2013-0015

Davis, E. (2019). How a DRG Determines How Much a Hospital Gets Paid. Verywell Health. Retrieved from https://www.verywellhealth.com/how-does-a-drg-determine-how-much-a-hospital-gets-paid-1738874

Floren, H., Frishammar, J. & Parida, V. (2018). Critical Success factors in Early New Product development: A Review and a Conceptual Model. International Entrepreneurship and Management Journal, 14(2), 411-427. https://doi.org/10.1007/s11365-017-0458-3

Helm, J. & Remington, K. (2015). Effective Project Sponsorship an Evaluation of the Role of the Executive Sponsor in Complex Infrastructure Projects by Senior Project Managers. Project Management Journal, 36(3), 51–61. Doi:10.1177/875697280503600306

Iedunote (nd). Strategic Planning Process: 9 Steps of Setting Proper Strategic Plan. Retrieved from https://iedunote.com/strategic-planning-process

Jahangirian, M., Taylor, S.J., Young, T. & Robinson, S. (2017). Key Performance Indicators for Successful Simulation Projects. Journal of the Operational Research Society, 68(7), 747-765. Doi: 10.1057/jors.2016.1

Jalagat, R. (2016). The Impact of Change and Change Management in Achieving Corporate Goals and Objectives: Organizational Perspective. International Journal of Science and Research, 5(11), 1233-1239. Retrieved from https://www.researchgate.net/publication/310828676_The_Impact_of_Change_and_Change_Management_in_Achieving_Corporate_Goals_and_Objectives_Organizational_Perspective

Kim, Y., Park, S. & Sawng, Y. (2016). Improving New Product Development (NPD) Process by Analyzing Failure Cases. Asia Pacific Journal of Innovation and Entrepreneurship. 10(1), 134-150. Doi: 10.1108/APJIE-12-2016-002

Liabotis, B. (2017). Three Strategies for Achieving and Sustaining Growth. Ivey Business Journal. Retrieved from https://iveybusinessjournal.com/publication/three-strategies-for-achieving-and-sustaining-growth/

Meier, D.E. (2015). Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care. `The Milbank Quarterly, 89(3), 343-380. Doi: 10.1111/j.1468-0009.2011.00632.x

Malek, R. & Yazdanifard, R. (2014). Overview of Change Management and its Implementation. Business, Economics, Financial Sciences and Management, 143, 149-153. Doi: 10.1007/978-3-642-27966-9_21

Marrewijk, A. (2018). Digging for Change: Change and Resistance in Interorganizational Projects in the Utilities Sector. Project Management Journal. 49(3) 34–45. Doi: 10.1177/8756972818770590

Newman, A. (2016). Communication Planning: A Template for Organizational Change. Cornell University School of Hotel Administration, 16(3), 3-6. Retrieved from https://scholarship.sha.cornell.edu/cgi/viewcontent.cgi?article=1004&context=chrreports

Parnell, J. (2014). Strategic Clarity, Business Strategy and Performance. Journal of Strategy and Management, 3(4), 304-324. Doi: 10.1108/17554251011092683

Silove, N. (2017). Beyond the Buzzword: The Three Meanings of “Grand Strategy”. Journal of Security Studies, 27(1), 27-57. Doi: 10.1080/09636412.2017.1360073

“Strategic Planning”. (2014). Scandinavian Journal of Public Health, 42(14), 106-112. Doi: 10.1177/1403494813515117

Weiner, B.J. (2014). A Theory of Organizational Readiness for Change. BMC Implementation Science, 4(67). Doi: 10.1186/1748-5908-4-67

 

 

 

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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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