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Chronic and Acute Asthma

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Chronic and Acute Asthma

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

 

1. Describe the pathophysiological mechanisms of chronic asthma and acute asthma exacerbation. Be sure to explain the changes in the arterial blood gas patterns during an exacerbation.

2. Explain how the factor you selected might impact the pathophysiology of both disorders. Describe how you would diagnose and prescribe treatment for a patient based on the factor you selected.

3. Construct two mind maps—one for chronic asthma and one for acute asthma exacerbation. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

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

 

SAMPLE ANSWER

Asthma

Asthma is referred to as a chronic inflammatory disorder that causes constriction and obstruction of the bronchial mucosal. Asthma attack can also lead to inflammation of the smooth muscles due to the hyper- responsiveness of the airway resistance or narrowed (Wenzel et al. 2016). Both acute and chronic asthma are often similar in their pathophysiology. This paper analyzes the pathophysiological mechanisms of chronic asthma and acute asthma and explains the changes in the arterial blood gas patterns during an exacerbation (Wenzel et al. 2016). The paper also explains how age factor impact the pathophysiology of both disorders.

Chronic Asthma Exacerbation

The pathophysiology of chronic asthma is characterized by bronchoconstriction stimuli and mucus secretion. The bronchoconstriction is caused by peptide neurotransmitters, the bronchial neural function, and induced by smooth muscle contractions (Evans et al. 2012). In the early stages, the toxic neuropeptides, and eosinophils are released leading to the inflammatory response and bronchial hyper-responsiveness (Evans et al. 2012). Oxygenation is also involved in chronic asthma because of the bronchial airway restriction. Hyperventilation often affects the arterial blood gas leading to hypoxemia and respiratory alkalosis in patents.

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Acute Asthma Exacerbation

The pathophysiologymechanism of acute asthma results when bronchial airways are affected leading to resistance in the airway.  Many cells often lead to hypersensitivity of the airway in acute Asthma such as basophils, eosinophil, neutrophils, mast cells, B lymphocytes, T helper 2 lymphocytes, and dendritic (Lemanske & Busse, 2010). These cells react differently causing inflammatory that may lead to increase in secretions, edema, and bronchospasm. The arterial blood gas in chronic asthma also results due to short inspirations and long expirations due to lack of oxygenation. Patients often trap air due to short and long inspirations that cause respiratory acidosis due to respiratory disadvantage increase in carbon dioxide and a decrease intidal volume (Lemanske & Busse, 2010).

Impact of Age Factor

Asthma as a chronic pulmonary infection affects both adults and children. However, researchers have shown that it is more affected by children below the age of 17 years old (Hasegawa et al. 2015).  Therefore, asthma affects people of all ages, from infants to older adults.  Although treatment may be challenging due to detailed assessment, the inability to distinguish the signs and symptoms of asthma and manage treatments may occur (Ponikowski et al. 216). When assessing patients with respiratory issues, nurses and physicians must conduct analysis of the vaccination, history and physical records to help understand the patient condition and present re-infection of other diseases.

Asthma may be acute or chronic in both children and adults leading to inflammation and increase level of mucus affecting the flow of air. Exacerbation is caused by inflammation and sensitivity. However, it is sometimes due to asymptotic attacks (Ponikowski et al. 216). During exacerbation, patients may experience the use of accessory muscles, increased heart rate, prolonged expiration, expiratory wheezing, nonproductive cough, dyspnea, inability to breathe, and tightness of the chest (Ponikowski et al. 216). Thus, many factors can lead to exacerbation, in all ages including not get enough inhalers, not using medication properly, second-hand smoking in children, allergy season, and flowering season.

 

 

Mind Maps

Acute Asthma

Chronic Asthma and Acute Asthma

 

Chronic Asthma

Acute and Chronic Asthma

Summary

Asthma clinical presentation may be challenging to understand but identifying its signs and symptoms early is important to prevent acute or chronic asthma. Asthma is primarily linked with recurrent of episodes of dyspnea and wheezing, hyper-responsiveness of the airway to stimuli and physical of allergies. Asthma can be prevented through compliant with medications and treatments since its pathophysiology is similar in adults and children.  If it remains untreated, it can lead to death making prevention of recurrence asthma critical.

 

References

Wenzel, S. E., Jayawardena, S., Graham, N. M., Pirozzi, G., & Teper, A. (2016). Severe asthma

and asthma-chronic obstructive pulmonary disease syndrome–Authors’ reply. The Lancet, 388(10061), 2742. DOI:https://doi.org/10.1016/S0140-6736(16)31720-2

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & Jessup,

  1. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.

https://doi.org/10.1002/ejhf.592

Hasegawa, K., Cydulka, R. K., Sullivan, A. F., Langdorf, M. I., Nonas, S. A., Nowak, R. M., …

& Camargo Jr, C. A. (2015). Improved management of acute asthma among pregnant women presenting to the ED. Chest, 147(2), 406-414. https://search.proquest.com/openview/dced603cde8234803185d32130a4b1ba/1?pq-origsite=gscholar&cbl=40575

Evans, R. L., Nials, A. T., Knowles, R. G., Kidd, E. J., Ford, W. R., & Broadley, K. J. (2012). A

comparison of antiasthma drugs between acute and chronic ovalbumin-challenged guinea-pig models of asthma. Pulmonary pharmacology & therapeutics, 25(6), 453-464. DOI: 10.1183/09031936.00057710

Lemanske Jr, R. F., & Busse, W. W. (2010). Asthma: clinical expression and molecular

mechanisms. Journal of Allergy and Clinical Immunology, 125(2), S95-S102. https://www.sciencedirect.com/science/article/pii/S0091674909016133

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Assessing Client Family Progress

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Assessing Client Family Progress

Learning Objectives

Students will:

  • Create progress notes
  • Create privileged notes
  • Justify the inclusion or exclusion of information in progress and privileged notes
  • Evaluate preceptor notes

To prepare:

  • Reflect on the client family you selected for the Week 3 Practicum Assignment.

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The Assignment

Part 1: Progress Note

Using the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following: (My week 3 practicum assignment had to do with a 26 year old male, who is in drug and alcohol rehab who uses IV heroin, snorts oxycodone and alcohol.  He uses all of his family’s money to buy drugs and alcohol.  This particular client makes jokes about everything, he does not take take anything serious.  He has a daughter whom he says that is sad that he can’t see. Behavioral therapy is the treatment modality used.  The client needs help with self esteem issues and I feel as though he is immature and needs to grow up.)

  • Treatment modality used and efficacy of approach
  • Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the treatment plan for progress toward goals)
  • Modification(s) of the treatment plan that were made based on progress/lack of progress
  • Clinical impressions regarding diagnosis and or symptoms
  • Relevant psychosocial information or changes from original assessment (e.g., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job)
  • Safety issues
  • Clinical emergencies/actions taken
  • Medications used by the patient, even if the nurse psychotherapist was not the one prescribing them
  • Treatment compliance/lack of compliance
  • Clinical consultations
  • Collaboration with other professionals (e.g., phone consultations with physicians, psychiatrists, marriage/family therapists)
  • The therapist’s recommendations, including whether the client agreed to the recommendations
  • Referrals made/reasons for making referrals
  • Termination/issues that are relevant to the termination process (e.g., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
  • Issues related to consent and/or informed consent for treatment
  • Information concerning child abuse and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
  • Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

Part 2: Privileged Note

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.

Assessing Client Family Progress

In your progress note, address the following:

  • Include items that you would not typically include in a note as part of the clinical record.
  • Explain why the items you included in the privileged note would not be included in the client family’s progress note.
  • Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

 

SAMPLE ANSWER

 

Assessing Client Family Progress

Part 1: Progress Note

DSM-5 diagnoses

Substance abuse: Alcohol, IV heroin and oxycodone
ASAM dimension

Dimension 3: emotional behavioral and cognitive conditions

Subjective The patient is twenty-six years of age and was involved in substance use. The diagnosis shows that he used alcohol as well as IV heroin and oxycodone.

He reports being afraid of a relapse because the withdrawal symptoms are overwhelming. He says “I have strong cravings and I should get something stronger which sill manage these cravings” However, he makes so many jokes and especially about the issue at hand. He also says “ I don’t believe in treatment”

He is also sad because he misses his daughter
Objective Patient has self-esteem issues and does not feel confident about the decisions that he makes. He is not able to effectively identify the triggers because he does not seem to take the treatment seriously. However, he believes that being in rehab has helped him stay away form triggers such as being around people that sue the substances.

There is improvement in withdrawal symptoms and most of them have resolved. He however still has strong cravings despite being on Acamprosate (Campral®).

The patient is still sad that he is unable to see his daughter because she is away.
Assessment There has been minimal progress towards the agreed-upon goal, which was to help him take life seriously and embrace life fully. Clinical symptoms of self-esteem issues are improving and the patient is becoming more confident in the process although there are several cases where there is relapse and he becomes unserious. Self-esteem issued has been established to have a connection to abuse of drugs and therefore need to be properly addressed so as to help in recovery from substance and alcohol use (Alavi, 2011).

Clinical consultations have been made with Dr. Xavier through a phone call and there was an agreement that he continues with the procedure. A consultation was made with Dr. Emma, marriage/family therapists and there is a need to have his close family support him through the session.

He should be on close observation and if he continues to exhibit depressive symptoms and sadness, it would be appropriate to provide further mental and physical health follow up.

 
Plan The diagnosis shows that he used alcohol as well as IV heroin and oxycodone. Psychotherapy is the approach that is used for treatment and the modality used is behavioral therapy.

Plan for substance use

There has been minimal progress towards the agreed-upon goal, which was to help him take life seriously and embrace life fully.

Client will continue with the medication that is provided. The patient is taking medication, which is important for two main reasons; to manage the withdrawal symptoms and to prevent a relapse (National Institute on Drug Abuse, 2019). This patient is currently taking Acamprosate (Campral®), to help with the treatment of the addiction. The main role of this drug is to reduce the symptoms of withdrawal such as anxiety and insomnia as well as dysphoria (Mason, 2015).

The patient complies with the treatment regimen although he needs to be assessed due to lack of seriousness and the tendency to view everything as jokes.

Plan for mental health

Mental health assessment is required.

 
Provider name and signature

……………………………….

…………………………

  

Date ………/……/……..

 

Part 2: Privileged Note

The privileged notes include the observations made such as the fact that this patient acts immaturely and needs to grow up and start acting like an adult. It also includes hypotheses on the treatment plan and especially how to go about the next sessions with the patient. It also includes questions to ask other consultants such as the medication options and whether to increase or decrease the dosage. The privilege notes are different from the progress notes and do not include information such as the laboratory test results, or details on medication. It also does not have information regarding the diagnosis and treatment plan summaries as well as a summary of progress.

Assessing Client Family Progress

The items listed in the privilege note are not included in the client family’s progress note because the information is usually private and is not supposed to be accessed by the patient. It is required under HIPAA that the information is not disclosed to other colleagues unless with the consent of the patient. The notes are only important to me as the counselor and they are not used by any other party including the insurance.  My preceptor made use of privilege notes. It included information such as the preceptor‘s observations and an outline of the information that occurred during the counseling session. The aim may have been to document the thoughts and feelings that they have and also come up with a hypothesis that will be useful in exploring the next sessions with the patient.

 

References

Alavi H. R. (2011). The Role of Self-esteem in Tendency towards Drugs, Theft and Prostitution.

Addiction & health, 3(3-4), 119–124

Mason, B. J. (2015). Acamprosate, alcoholism, and abstinence. The Journal of clinical

psychiatry, 76(2), 224-225.

National Institute on Drug Abuse, (2019). Treatment Approaches for Drug Addiction. Retrieved

from: https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

 

 

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Group Therapy Progress Note – Mr & Mrs WW

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Group Therapy Progress Note – Mr & Mrs WW

Students will:

  • Develop effective documentation skills for family therapy sessions *
  • Develop diagnoses for clients receiving family psychotherapy *
  • Evaluate the efficacy of solution-focused therapy and cognitive behavioral therapy for families *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

NOTE TO WRITER:  You can make up the family session and please use initials when talking about the individuals

Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session. Do not select the same family you selected for Week 2.

Group Therapy Progress Note – Mr & Mrs WW

Then, address in your Practicum Journal the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session. (See the progress note downloaded in the additional materials area).
  • Describe each client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether solution-focused or cognitive behavioral therapy would be more effective with this family. Include expected outcomes based on these therapeutic approaches.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.

 

SAMPLE ANSWER

Group Therapy Progress Note American Psychological Association

Client: Mr. and Mrs. WW                                                   Date: 10/10/19

Group name:  God’s people                                         Minutes: 45

Group session: 1                                                Meeting attended for this client: 1

Number present in group 2 of 2      scheduled Start time: 10:00 AM           End time: 10:45

Assessment of client

  1. Participation level: ❑ Active/eager ❑ Variable ❑ only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ sharing ❑ Attentive ❑ Intrusive ❑ monopolizing ❑ Resistant ❑ other: _____________________________________
  3. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  4. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other: _______________
  5. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ disoriented ❑ confused ❑ disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other: __________________
  6. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  7. Change in stressors: ❑ less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  8. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  9. Change in symptoms: ❑ same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
  10. Other observations/evaluations:

The group session is made up of two people who are an older couple and is experiencing challenges in their marriage. The presenting problem is that the couple have been having challenges in the past few years and arte unable to enjoy their marriage. Mrs. WW is a 59 year old woman who is a born again Christian and lives with her husband Mr. WW. She explains that the she feels neglected by the husband whom she accuses of preferring to be in church instead of being at home with her. This makes her to feel lonely and sad because there is no one else at home. She has been feeling depressed for some time and even had a session with a counseling psychologists and psychotherapy was offered. She was also given some pills and she confesses that she took more pills than prescribed. She also describes that she came from a family where the parents had a divorce that was turbulent and it has affected her over the years. She is so afraid of having a divorce because she does not want to go through what her parents went through.

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Mr. WW is a 60 year old man who is also passionate about serving Jesus Christ and is committed to the church. He has been married to Mrs. WW for the last thirty years and he says that although there have been challenges; the two have remained together because divorce has never been an option. He expresses that he prefers to stay away from home because his wife is always negative, which pushes him away. He therefore seeks solace in church by getting involved in church activities. He says that eh recently feels sad about his marriage as they are always arguing although he loves the wife so much. He has no history of substance abuse and has not been treated for any mental issue.

An assessment into the family genogram brings out that the two are from families that had experienced tumultuous divorces. The events in their life may have had an impact on them and may have caused trauma hence assessment will be done in consideration of stress-related issues. According to the diagnostic and statistical manual of mental disorders, (2013), the clients have mental issues that arise from their past. Mr. and Mrs. WW are both diagnosed with post-traumatic stress disorder, which is as a result of the tumultuous divorce that the parents went through. The first criterion for diagnosis of PTSD is when the clients have experienced an actual exposure to a stressful event. In this case, the couple has both been exposed to a situation where their parents had to separate and this may have had negative effects on them Individuals with PTSD have high chances of exhibiting another mental issue such as depressive disorders, anxiety-related disorders, and substance use (Smith, Goldstein, and Grant, 2016). It therefore come out that Mrs. WW also has anxiety and she is excessively worried that her marriage may come to an end.  For this session, there is anxiety and there are also some complains about the symptoms still being prevalent.

Group Therapy Progress Note – Mr & Mrs WW

In-session procedures:

For this couple Cognitive-behavioral therapy (CBT) will be employed and it involves activities that will aim at exploring the negative thoughts that an individual has and replaces them with thoughts that are positive and that will play a role in creating favorable behaviors and emotions ( Patterson, 2014). It expounds on the fact that numerous issues in the lives of people arise from the distortions that they have had.  The main goals is to establish better relationships by improving the quality of interpersonal relationships and social function (Cuijpers et al. 2016), the focus for these couple is on the  distress that they face and therapy seeks to will provide an opportunity for them to resolve their problems.

Nursing Paper Help

The in session procedures include:

  • After assessment and history taking, agenda-setting will be considered
  • Interviews that will focus on identifying the interpersonal issues that are prevalent and addressing them in order of importance.
  • The couple will verbalize the issues that they would like to be addressed. The family and the therapist will then have a collaborative decision about the issues that will be tackled and the time frames
  • Practice of interpersonal skills including leadership, active listening, teamwork and patience among others.
  • A religious item such as prayers since the couple is religious.

Homework:

  1. To think about the things that they love about each other and those that they don’t
  2. Come up with a comparison of the things they enjoy versus those that they dislike
  3. Carry out activities together to ensure that they tolerate each other and engage each other
  4. Appreciate each other more

Group Therapy Progress Note – Mr & Mrs WW

Other comments:

Legal and ethical issues have been considered. The couple has signed an informed consent and has shown that they are willing to go ahead with the treatment procedure. Privacy and confidentiality has been ensured as this is a requirement for psychotherapists hence everything that is discussed will be kept secret and will not be disseminated to any other person. In addition, although marriages have challenges, old age also presents challenges since the couple is older. There is a need to discuss the issue of the empty nest.

 

Signatures     …………………………                              Date………/………../……….

 

References

American Psychiatric Association (2013).   Diagnostic and Statistical Manual of Mental

Disorders, DSM-5.   (5th edition).   Washington, DC   American Psychiatric Association.    ISBN-13: 978-8123923796

Betan, E. J., & Binder, J. L. (2016). Psychodynamic Therapies in Practice: Time-Limited

Dynamic Psychotherapy. Comprehensive Textbook of Psychotherapy: Theory and Practice, 45.

Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal

Psychotherapy for mental health problems: a comprehensive meta-analysis. American Journal of Psychiatry, 173(7), 680-687. doi.org/10.1176/appi.ajp.2015.15091141

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of

Family Psychotherapy, 25(2), 132-144. DOI: 10.1080/08975353.2014.910023

Smith, S. M., Goldstein, R. B., & Grant, B. F. (2016). The association between post-traumatic

Stress disorder and lifetime DSM-5 psychiatric disorders among veterans: data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Journal of psychiatric research, 82, 16-22.

 

 

 

 

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Evidence-Based Practice Change

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Evidence-Based Practice Change

Basically, the paper involves revising and merging the previous papers into one, and doing the conclusion part. Please check the previous papers you did attached

 

Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question 

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

Prepare this assignment according to the APA 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

Evidence-Based Practice Change

Central Line-Associated Blood Stream Infection

Central Line-Associated Blood Stream Infection (CLABSI) is a bloodstream infection that causes increased mortality, morbidity, and length of stay in the Intensive Care Units (ICU), escalating health care costs. About 260,000 central line-associated bloodstream infections are reported in hospitals in the United States (Cleves et al., 2018). Also, approximately 29,000 death cases related to the central line-associated bloodstream infections are reported every year (Savage et al., 2018). 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 (Noto et al. 2015).  Multidrug-resistant organisms (MDROs) such as vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are the most endemic pathogens that cause CLABSI and other bloodstream related infections (Cleves et al., 2018). These pathogens are endemic in most acute and long term care areas, and their resistance makes it difficult to treat because of the decreasing armamentarium of active antimicrobials. Significant efforts are put to prevent and reduce the rate of infections through health practices designed to decrease the transmission of pathogens. Such methods include care of devices, bundles for insertion, isolation of multidrug-resistant organism’s patients, and hand hygiene (Noto et al. 2015). Chlorhexidine can be used as one of the interventions in reducing bacterial burden, thus decreasing the rate of infections.

PICOT Statement

In patients in the Intensive Care Unit (ICU) (P), how does daily chlorhexidine baths (I) compare to baths with soap and water (C) in decrease the rate of central line-associated bloodstream infections (CLABSI) (O) after one year of the intervention (T)?

Evidence-Based Practice Change

The utilization of antiseptic chlorhexidine gluconate (CHG) can be used as the primary intervention to fight bacterial load both in the central lines and central venous catheters. CHG daily baths are imperative compared to regular baths using soap and water in the ICU unit. Chlorhexidine has a broad-spectrum topical antibacterial agent, which decreases the bacterial burden, thus reducing the rate of infections when used daily during baths (Noto et al. 2015). The antibacterial activity is also essential in reducing microbes and pathogens in patient’s skin thereby preventing both primary and secondary infections. Therefore, daily baths with chlorhexidine wipes in traditional bathing procedures in the Intensive Care Unit should be considered as a significant intervention in the prevention of Central Line-Associated Bloodstream Infections.

Evidence-Based Practice Change

Many studies have also shown the efficacy of CHG in intensive care patients, and support is increasing in caring for non-ICU patients. Daily baths with Chlorhexidine are associated with reduced skin colonization with organisms that have multidrug resistance, reduced clostridium difficile infections, and reduced bloodstream infection rates (Savage et al., 2018).  Therefore, nurses should consider the use of Chlorhexidine as a primary intervention in the prevention and reduction of Central Line Bloodstream Infections in hospitalized patients.

A study by Holder and Zellinger (2009) used a research design where nurses came up with a bathing procedure, which included bating frequency, technique, contraindications, required documentation, and bathing technique. The study method was controlled by advanced nurses and nursing leaders that ensured the accuracy of the findings. The results of the study on Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections showed that the Bloodstream Infections reduced from 3.6 per 1000 patients to 1 per 1000 patients after six months of chlorhexidine bath procedure implementation. The study findings indicated that the use of chlorhexidine baths reduces the rates of Central Line-Associated Bloodstream Infections and resistant organism’s acquisition rates in patients admitted in the Intensive Care Units.

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Johnson et al. (2019) developed 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. The study showed 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. The bathing with Chlorhexidine decreases the bacterial burden on the skin. Nurses should be aware that CHG bathing twice a week may 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.

Evidence-Based Practice Change

The study by Savage et al. (2018) 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 units in 2006-2014. The research was subdivided in to post, peri, pre, and second peri-intervention periods depending on each bundle’s implementation status. The study showed 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 showed 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.

Conclusion and Recommendations

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. 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. 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. Therefore, chlorhexidine gluconate daily baths are imperative compared to regular baths using soap and water in the ICU unit.

It is recommended that four strategies can be used to help implement the use of CHG daily baths for patients in the surgical or medical units to reduce CLABS rates. The strategies include increased awareness and accountability, resource availability, leadership support, and staff education (Noto et al. 2015). Therefore, targeted interventions in the ICU can reduce the risk of CLABSI associated with the use of central lines and central nervous catheters. Hospitals need to 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.

 

References

Cleves, D., Pino, J., Patiño, J. A., Rosso, F., Vélez, J. D., & Pérez, P. (2018). Effect of

chlorhexidine baths on central-line-associated bloodstream infections in a neonatal intensive care unit in a developing country. Journal of Hospital Infection, 100(3), e196-e199.Doi: 10.1016/j.jhin.2018.03.022

Holder, C., &Zellinger, M. (2009). Daily Bathing with Chlorhexidine in the ICU to Prevent

Central Line-Associated Bloodstream Infections. JCOM, 16(11), 509-13. Retrieved from https://pdfs.semanticscholar.org/ace2/d11dfa4fab260bb5639c782b9baa0a1addad.pdf

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. Retrieved from 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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Healthcare Information Technology Trends-Data

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Healthcare Information Technology Trends-Data

  • Reflect on the Resources related to digital information tools and technologies.
  • Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
  • Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

Post: Please follow This instructions.

  •       This is a discussion
  •       No tittle pages.
  •       No running heads.
  •       This is a Masters level class
  •       APA Format with intext citation
  •       Required to use the reading resources AT LEAST TWO. Outside resources should be peer review Articles.

Tittle : ( Healthcare Information Technology Trends )

Short Introduction with purpose statement

 

Headings:

Ø  Description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice.

Ø  Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described.

Ø  Describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described.

Ø  Explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why.

Ø  Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management.

Ø  Be specific and provide examples.

Conclusion/ Summary

Reference list in (APA FORMAT)

 

SAMPLE ANSWER

Healthcare Information Technology Trends

            Information and data are becoming increasingly important in the medical field. Collection, storage, and data analysis is becoming an integral part in the healthcare sector with the objective of enhancing the quality of healthcare services (Madon & Krishna, 2018). This discussion will explore some of the emerging trends in healthcare information technology, describe the potential benefits and risks, and explain the healthcare technology that is most promising, particularly in nursing practice.

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A general healthcare trend related to information technology is interoperability. This technology is changing how the organization that I work for works. With the technology, data is shareable and transferable between different stakeholders (Madon & Krishna, 2018). For instance, the healthcare facility is able to share data with patients since they have computer systems or programs that are interoperable. However, various challenges and risks exist in relation to this technology, one of the most notable being cyber security (McGonigle, & Mastrian, 2017). As interconnectivity increases, the risk of cyber security has become a major risk since healthcare facilities have become targets of high-profile attacks (Madon & Krishna, 2018). Interoperability can result in a single attack originating from one device spreading to the other devices connected to a system.

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A potential benefit associated with data safety, legislation, and patient care is increased access to information, which in return enhances quality of care and patient outcomes. Information is critical in the healthcare field, thus enhancing the speed at ease at which the right people can access it enhances quality of care (Carvalho et al., 2019). However, one of the risks is data breaches, which can comprise confidential patient information (Madon & Krishna, 2018). Furthermore, the healthcare information trends that I believe are the most promising for impacting healthcare technology include internet of things and augmented and virtual reality. These technologies will improve patient outcomes, data management, and efficiencies. They can be employed in different areas including consultation, physician training, and pre-surgical planning.

Healthcare Information Technology Trends-Data

Therefore, information technology has had a major impact in the healthcare sector. In my healthcare organization, interoperability is the most impactful technology. However, cyber security poses a major threat to the use of this technology. Potential benefits associated with use of healthcare information technology include ease of access to information and data, while challenges include data breaches (Rao-Gupta et al., 2018). Besides, the most promising technologies include Internet of Things, which is the interconnectivity of computing devices via the internet, and augmented reality, which enables a user to have an interactive experience of a real-world environment through computer generated display (McGonigle, & Mastrian, 2017).

 

References

Carvalho, J. V., Rocha, Á., van de Wetering, R., & Abreu, A. (2019). A Maturity model for hospital information systems. Journal of Business Research, 94, 388-399.

Madon, S., & Krishna, S. (2018). The Digital Challenge: Information Technology in the Development Context: Information Technology in the Development Context. Routledge.

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

Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). Leveraging interactive patient care technology to Improve pain management engagement. Pain Management Nursing, 19(3), 212–221. doi:10.1016/j.pmn.2017.11.002

 

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Group Therapy Progress Note

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Group Therapy Progress Note

Learning Objectives

Students will:

  • Develop effective documentation skills for family therapy sessions *
  • Develop diagnoses for clients receiving family psychotherapy *
  • Evaluate the efficacy of solution-focused therapy and cognitive behavioral therapy for families *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Select two clientsyou observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session. Do not select the same family you selected for Week 2.

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Then, address in your Practicum Journal the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session.
  • Describe each client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether solution-focused or cognitive behavioral therapy would be more effective with this family. Include expected outcomes based on these therapeutic approaches.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.
  • BLANK NOTES INCLUDED THAT NEED TO BE FILLED OUT

 

SAMPLE ANSWER

Group Therapy Progress Note American Psychological Association

Client: James Henry Date:  October 5th , 2019 Group name: Henrys Minutes: 40 minutes Group session # 5 Meeting attended is #: 5 for this client. Number present in group 2 of 2. Scheduled Start time: 10.40 am End time: 11.20am.

Assessment of client  1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn

  1. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive ❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________
  2. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  3. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑Other:_______________
  4. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑Other:__________________
  5. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  6. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  7. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  8. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse 10.

Other observations/evaluations:

 

The patient shows normal physical health

In-session procedures:

 

The session used cognitive behavioral therapy as a technique for enhancing counseling.

 

Homework: 1. 2. 3.

Other Comments:

The client is stabilizing  from his depression.

 

Group Therapy Progress Note American Psychological Association

Client: Adelide Henry Date:  October 5th , 2019 Group name: Henrys Minutes: 40 minutes Group session # 5 Meeting attended is #: 5 for this client. Number present in group 2 of 2. Scheduled Start time: 10.40 am End time: 11.20am.

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Assessment of client  1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn

  1. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive ❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________
  2. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  3. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑Other:_______________
  4. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused ❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑Other:__________________
  5. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  6. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  7. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  8. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse 10.

Other observations/evaluations:

 

The patient shows coherence in communication with a stable mental orientation

In-session procedures:

The session used cognitive behavioral therapy.

Homework: 1. 2. 3.

Other Comments:

The client depicts some anxiety symptoms.

 

 

 

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Organizational Development and Planning

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Organizational Development and Planning

Discussion: Organizational Development, Workforce Planning, and Succession Planning

 

Organizational development is focused on improving the efficiency and effectiveness of a workplace. As part of this process, strategic planning professionals often work with leadership teams to develop strategies for short-term and long-term organizational development, including workforce planning and succession planning. This helps ensure that health care organizations recruit, train, and retain employees that are capable of meeting strategic objectives. For this Discussion, examine the following scenarios and suggest strategies for organizational development, workforce planning, and succession planning.

 

Scenario 3: Myrtle Healthcare System is an integrated health care organization providing health care services in Colorado. Recently, an investigative reporter from the local television news station reported that leadership at Myrtle’s flagship hospital, Jackson Hospital, will be getting annual bonuses of $25k in December and a 10% increase in their salaries for the next year. This story comes at a time when frontline staff members have been complaining repeatedly about the deplorable working conditions and lack of pay increase in five years. Unfortunately, leadership has consistently refused to host an employee town hall meeting to discuss their concerns collectively. The employees are now asking for the union to intervene so that this matter may be quickly resolved to restore the employees’ trust in leadership and the public’s trust in the organization’s ability to provide quality patient care.

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To prepare:

  • Review the scenario assigned to you by the Instructor.
  • Consider strategies for short-term and long-term organizational planning, workforce planning, and/or succession planning.

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

By Day 3

Post: a cohesive response to the following:

Briefly describe the scenario assigned to you by the Instructor. Recommend strategies for short-term and long-term organizational development, workforce planning, and/or succession planning. Defend your recommendations. Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

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 to colleagues who were assigned different scenarios than you. For example, if you were assigned Scenario 1, respond to colleagues who were assigned Scenario 2 and Scenario 3.

 

SAMPLE ANSWER

Organizational Development and Planning

The current healthcare environment for healthcare facilities entails various issues that demand strategic planning. These issues include increased competition, government policies, poor management of funds, and employee payments among others (Payne et al., 2018). The scenario presents a case of Myrtle Healthcare System which operates in Colorado. A flagship hospital of Myrtle is reported to increase its leadership salaries at a time when its employees are opposing the firm’s working conditions and payment policies.

Strategies for Short-Term Development

The company should engage in developing cash-flow forecasts. This strategy is essential in estimating the facility’s cash collections within short periods. The facility’s leadership also needs to develop a situational analysis.  This strategy will enable the management to understand the problems that face the hospital. Moreover, the management needs to create communication with the employees. This move will eliminate doubt from the employees as it will provide answers for what the firm is planning. In addition, the facility can improve on its employee-leadership relations. This can be enhanced by creating a fair reward system such as promotions basing on merit. This strategy is prone to shift the management’s reputation in the eyes of the employees. As a result, there will be successful operations in the hospital (Maruyama & Braga, 2014).

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Strategies for Long-Term Development

In the long run, Myrtle needs to create a SWOT analysis to review its long-term viability. This act will enable the management to develop decisions basing on the analysis. This strategy will enable the leadership to make suitable payment and employee relations in the long run.  Moreover, the management needs to redesign its personnel objectives. This strategy enhances positive employee operations and relations in the long run. Engagement in employee training on leadership skills is suitable in creating future leaders for the hospital (Maruyama & Braga, 2014).

 

References

Maruyama, U.G.R., & Braga, M.A.B. (2014). Human resources strategic practices, innovation

performance & knowledge management. Proposal for Brazilian organizations. Independent Journal of Management & Production, 5(3), 710-732.

Payne, R. A., Hovarter, R., Howell, M., Draws, C., & Gieryn, D. (2018). Succession planning in

public health: addressing continuity, costs, and compliance. Nurse Leader, 16(4), 253-256.

 

 

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Phenomenology Research

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Phenomenology Research

The quest to understand the lived experience and the philosophical structures of experience and consciousness is the focus of a movement that began in the early years of the 20th Century. The movement is called phenomenology because the movement explores the lived experience of phenomena. Edmund Husserl and Martin Heidegger were two of the prominent philosophers who developed this method of inquiry though each took a significantly different philosophical approach to understanding human experience. In this assignment, you will discuss the psychology research methods that emerged from the philosophies of Husserl and Heidegger and the researchers who developed those methods.

General Requirements:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.

Directions:

Write a paper (1,250-1,500 words) in which you discuss both the phenomenological research methods in psychology that emerged from the philosophies of Husserl and Heidegger and the theorists/psychologists who developed those methods. Include the following in your paper:

  1. A discussion of at least two phenomenological research methods that emerged from the phenomenological philosophy of Husserl. What were the central tenets of each method? What is known about the theorists/psychologists who developed each method?
  2. A discussion of at least two phenomenological research methods that emerged from the phenomenological philosophy of Heidegger. What were the central tenets of each method? What is known about the theorists/psychologists who developed each method?
  3. A contrast of the primary differences among the phenomenological research methods identified above. How does each method address approaches to data gathering, data analysis, and the role of the researcher?
  4. A research-based statement of and rationale for the method you believe allows the best understanding of human experience.

 

SAMPLE ANSWER

Phenomenology Research

Introduction

Phenomenology in psychology involves studying subjective experiences at a personal level. Philosophers apply different research methods when it comes to studying individual experiences; however, it is always challenging to identify the quality of a particular experience for one to come up with effective conclusions (Horrigan-Kelly, Dowling & Millar, 2017). In most cases, it is hard to believe in the possibility individuals having similar experiences for a given phenomenon. As such, this indicates that the phenomenology research results can only be applied to one person and should not be a reflection of other people, despite the similarity (Sousa, 2014). Various philosophers, including Edmund Husserl and Martin Heidegger, have developed phenomenological methods of research to explain how experiences affect individuals separately. Husserl and Heidegger have significantly contributed to the study by proposing and examining various research methods hence providing a starting point for other philosophers. To get the most viable method of understanding human experiences, major emphasis will be placed on reviewing Husserl and Heidegger’s work and their contribution to development of phenomenological research methods.

Phenomenological Research Philosophy for Husserl

Edmund Husserl is regarded as one of the most significant philosophers when it comes to phenomenological studies. Compared to other studies, Husserl’s studies on phenomenology created a system to govern the science, hence forming a new perspective that separated it from other philosophies (Horrigan-Kelly, Dowling & Millar, 2017). He developed various research methods, one of them being the genetic concept, which was derived from inner-time consciousness theory. According to Applebee (2011), Husserl used this concept as a way of uncovering the beginning of intentional motivations, which can either be as a result of reason, or pre-predicative.

Husserl also applied Descriptive Phenomenological Method in studying psychology. The concept, which was initially proposed by Amedeo Giorgi, factors in both interpretive and descriptive moments that must be applied in any research process (Applebaum, 2011). the central tenant of this method is indicating the need to integrate descriptive and interpretive aspects of descriptive phenomenological research method. Husserl also applied neurophenomenology as another research method, which combines first person science with his phenomenology philosophies. The method applies scientifically verifiable methods in examining individual conscious experiences, as well as studying the mind by combining phenomenology with neuroscience (Sousa, 2014). Neurophenomenology was first introduced by Francisco Varela who was a trained biologist, a philosopher, as well as a mathematician. He supported the idea of human consciousness and cognition through enactive structures that may arise (Horrigan-Kelly, Dowling & Millar, 2017).

Phenomenology Research

Phenomenological Research Philosophy for Martin Heidegger

Husserl’s research methods are highly challenged by Heidegger, whose ideas are termed as a combination of contextualism and phenomenology. Unlike Husserl, Heidegger rejects the idea of human beings being regarded as spectators of objects, with his arguments being based on the assumption that objects and subjects are inseparable(Horrigan-Kelly, Dowling & Millar, 2017). From Heidegger’s perspective of philosophy, an individual’s existence involves being in the world where one is embedded and inseparable from the world. His work mostly disregards Husserl’s view of transcendental ego and one of his proposed methods of phenomenological reduction. He describes ‘being ‘ as a matter of choice, where individuals are in a position to investigate their kind of being, by first identifying ho they understand the factor of being(Horrigan-Kelly, Dowling & Millar, 2017).

Like Husserl, Heidegger also inspired various research methods of philosophy, one of them being Interpretative phenomenological analysis. The central tenet of interpretative analysis is to show how in certain phenomenon different individuals make sense of situations and how they respond to such situations. Such a phenomenon, according to Heidegger, may arise from personal issues such as life events. The interpretative phenomenological analysis applies qualitative research where data gathering techniques involve interviewing participants and from journal entries (Applebaum, 2011). As a philosopher, Heidegger identified these research methods as unique since it not only focuses on the psychological components affecting an individual, but also idiographic and interpretive components. Interpretive analysis has also been applied in other areas beyond phenomenology to be used in occupational psychology (Horrigan-Kelly, Dowling & Millar, 2017). The method was proposed by Jonathan smith with the aim of promoting qualitative research in social and health psychology.

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Heidegger also inspired phenomenological anthropology as a research method. He adopted an existentialist approach used in psychoanalysis, which argues that the existence of human beings involves being open to any experiences, if not all (Applebaum, 2011). the central tenet of this research method, as emphasized by Heidegger, is to show that that there is no gap between the human mind and measurable matter.  For the study, participants are meant to think of themselves as being alone with their self while being in the paradox of being in a relationship with other humans but that they are ultimately alone. He also combines phenomenological approach as proposed by Husserl with existentialism to analyze human experiences (Horrigan-Kelly, Dowling & Millar, 2017). He describes phenomenology as letting things be seen in the way they present themselves. Unlike Husserl, Heidegger did not use phenomenology as a tool to analyze consciousness. By seeing things in their natural form without further analysis, he implied separation form consciousness.

Contrasting Methods

Edmund Husserl and Martin Heidegger are regarded as two of the most influential philosophers that had significant mark in developing and inspiring other psychologists in phenomenology. Their studies have inspired other research methods in an attempt to understand how individuals experience and respond to different phenomena. Although both philosophers had a similar agenda to understand human experiences, they both had different journeys and perceptions, as observed by the different approaches they applied in explaining human experiences (Horrigan-Kelly, Dowling, & Millar, 2017). The methods and theories applied by both Edmund Husserl and Martin Heidegger have enabled development of more research methods in various areas, especially in phenomenology.

In both cases, Heidegger and Husserl applied similar themes in phenomenological research since they both use qualitative and inductive research methods. The ideas of the two philosophers indicate that applying quantitative measure is not sufficient to ensure that there is free flow of information between the participant and the researcher. Further, they agree that reality on subjectivity and it is not fixed (Horrigan-Kelly, Dowling & Millar, 2017). The methods used to gather data are also similar since they both use journal entries and interviews. As Horrigan-Kelly, Dowling and Millar (2017) note, interviewing is regarded as the best method of information gathering when working an individual basis. Nonetheless, in cases where research methods vary, they still aim at reaching a similar goal. Besides, the philosophers also agree on a type of psychology that looks within an individual instead of forcing medication on the said subject.

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Heidegger and Husserl’s ideas differ based on the applicability of individual experiences. While Husserl believed that phenomenology is rooted in an individual’s negated assumptions and perceptions of a given subject, Heidegger formed an interpretive approach whose main concept focused on being in the world, instead of striving to know it. Husserl focuses on a Descriptive Phenomenological Method, which incorporates interpretive and descriptive moments from an individual point. Heidegger, on the other hand, looks into Interpretative phenomenological analysis, which mainly interprets how individuals react in various situations (Sousa, 2014). He emphasizes on focusing on one’s self despite being surrounded by other people. Although both philosophers apply methods that are unique and different, they both focus on a common goal of offering assistance that focus on an individual and not on the surrounding.

Best Understanding of Human Experience

Heidegger provides the best understanding of human experience through interpretative phenomenological analysis. This form of qualitative research enables a researcher to understand how one would react if they are put in a set of circumstances and the reaction to certain phenomenon. By applying this method, one is able to use extensive research to get a better understanding of how people react to situations. Although phenomenologist understand and agree on the need to use medication for certain illnesses, the also provide other alternatives that reach similar conclusions as medication. Such alternatives have proven to be equally helpful in understanding human experiences, which are highly fascinating and are better understood through phenomenology.

 

References

Applebaum, M. H. (2011). Amedeo Giorgi and Psychology as a Human

Science. Neuroquantology, 9(3), 518-525.

Horrigan-Kelly, M., Dowling, M., & Millar, M. (2017). Understanding the Key Tenets of

Heidegger’s Philosophy for Interpretive Phenomenological Research. International Journal Of Qualitative Methods, 15(1),

Sousa, D. (2014). Phenomenological Psychology: Husserl’s Static and Genetic

Methods. Journal Of Phenomenological Psychology, 45(1), 27-60. doi:10.1163/15691624-12341267

 

 

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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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Termination of the Counseling Relationship

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Termination of the Counseling Relationship

In a 250-500-word essay, hypothetically terminate the counseling relationship with a client who has experienced trauma and abuse in the past and has now seen you, the counselor, for 8 months regarding this trauma.

1.      Describe the successful termination of the client relationship.

2.      Discuss strategies for helping the client to maintain change post-termination.

Include at least one scholarly reference 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

Termination of the Counseling Relationship

            For the past eight months, we have set goals, incorporated changes and worked through traumatic feelings. Now, we have come to end of the psychotherapy process. During this termination process, we will analyze the treatment plan to establish whether the treatment goals were met and we will also create a mental health wellness plan to maintain the positive change post-termination. You have undergone through several positive changes: you have a more positive body language, the severity of your symptoms has decreased, your relationships have improved, and you have a positive outlook on the present and the future. I remember the first session we had. You were terrified to talk about your trauma and you would get panic attacks when asked to recall the abuse you experienced. Now, you are more confident to talk about the painful experience amidst slight difficulties. You have truly come a long way! As we conclude our last session, we will collaboratively develop a wellness plan to prevent any relapse and maintain the positive progress we have established so far.

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To maintain the positive change, we have achieved in therapy, the following tips will be beneficial. Try to exercise for at least 45 minutes or more on most days. This will help you burn off adrenaline and release endorphins to make you feel better (Robinson, Smith & Segal, 2019). Make sure that you participate in social activities and connect with old friends. Connecting to others improves the healing process and helps you forget about the trauma. Mindful breathing will help you relieve anxiety and calm your nerves (Robinson, Smith & Segal, 2019). Like we discussed in our sessions, your physical health is very important. Therefore, get plenty of sleep, avoid drugs and alcohol and reduce stress by practicing relaxation techniques. Lastly, I commend you on your hard work in therapy and I take pride in what we have accomplished together.

 

Reference

Robinson, L., Smith, M. & Segal, J. (2019). Emotional and Psychological Trauma. HelpGuide. Retrieved from https://www.helpguide.org/articles/ptsd-trauma/coping-with-emotional-and-psychological-trauma.htm

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