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Practicum Journal Entry

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Practicum Journal Entry

Learning Objectives

Students will:

  • Apply documentation skills to examine family therapy sessions *
  • Develop diagnoses for clients receiving family psychotherapy *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

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.

NOTE TO WRITER:  You can make up any two clients that are related that were seen for drug or alcohol addiction therapy along with making up their histories or medications.  And please use the group therapy progress note in the additional materials.

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 (without violating HIPAA regulations) each client, and identify any pertinent history or medical information, including prescribed medications.
  • Using the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), explain and justify your diagnosis for each client.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature

 

SAMPLE ANSWER

Practicum Journal Entry

The journal entry focuses on documentation skills during a therapy session. The paper diagnoses two clients under psychotherapy and analyzes the legal and ethical implications of the therapy used to counsel the patients.

Client #1

Michael Darwin is a 30-year-old Caucasian male working at APS. He was raised by a single parent, and her mother is dead after committing suicide due to anxiety and depression.

Presenting Problems: Depression and Mood Disorders

Michael is a withdrawn individual during therapy sessions. His hair and clothes are clean, and he denies suicidal ideation. However, he admits struggling working due to lack of concentration due to lack of enough sleep.

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Medical History

The patient struggles with depression and often isolates himself from friends and family members. There are no issues of both psychological and physical abuse, but he was diagnosed with depression at 17 years old.  The patient uses Zoloft 100mg daily for depression.

 Diagnosis

The patient has experienced a loss of pleasure and depressed mood for about two weeks. The symptoms cause lack of concentration at work and other activities during the day.  Impairment in social work-related activities is caused by depressed mood, recurrent thoughts of death, insomnia, diminished interest and agitation (American Psychiatric Association, 2013).

 

Group Therapy Progress Note

Client:  Michael Darwin                                                       Date: 9-21-2019

Group name: Psychological Health Group

 Minutes: 45 

Group session: # 2    

Meeting attended is #: 4 for this client.

Number present in group: 2 of 4 scheduled

Start time:  11: 00 AM         

 End time: 11: 50 AM

Assessment of client

  1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

  1. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  2. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other:_______________
  3. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other:__________________

  1. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  2. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  3. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  4. Change in symptoms: ❑ Same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse

 

  1. Other observations/evaluations:_________________________________

In-session procedures

Expression of feelings experienced

Discussion on coping skills

Home Work

Provision of a book on psychological and physical coping mechanisms

Other Comments

Anger management, loss of mood, and withdrawal are critical issues that the patient need to manage through Cognitive Behavioral Therapy.

Practicum Journal Entry

 

 

Client #2

Lynn Turner is a 34-year-old Hispanic female working as a nurse in a Community Center of Trauma. She has two children and lives in a gated community with low levels of crime.  Her husband died in a rock accident while working as a truck driver.

Presenting Problem: Depression, Anxiety, and PTSD

The patient is alert, oriented, and attentive during therapy sessions. His mood seems depressed and anxious. However, she denies having thoughts of committing homicide or suicide. But the client admits having memory problems and lack of awareness during work.

Medical History

The client mentions that she has seen a psychological therapist as a child. Ever since there have never been issues with depression and anxiety until she lost her husband in a truck accident. The client uses Xanax 1 mg and Paxil 40mg daily to relieve severe stress.

Diagnosis

The client is suffering from a Posttraumatic Stress Disorder due to the psychological trauma and other clinical symptoms she faces. PTSD is caused through the following experiences of traumatic events: exposure to stressor, intrusion symptoms, persistent avoidance, and negative alterations in mood and cognition (American Psychiatric Association, 2013).

Group Therapy Progress Note

Client:  Lynn Turner                                                  Date: 9-21-2019

Group name: Psychological Health Group

 Minutes: 45 

Group session: # 2    

Meeting attended is #: 3 for this client.

Number present in group: 2 of 4 scheduled

Start time:  11: 00 AM         

 End time: 11: 50 AM

Assessment of client

  1. Participation level: ❑ Active/eager ❑ Variable ❑ Only responsive ❑ Minimal ❑ Withdrawn
  2. Participation quality: ❑ Expected ❑ Supportive ❑ Sharing ❑ Attentive ❑ Intrusive

❑ Monopolizing ❑ Resistant ❑ Other: _____________________________________

  1. Mood: ❑ Normal ❑ Anxious ❑ Depressed ❑ Angry ❑ Euphoric ❑ Other: _______________
  2. Affect: ❑ Normal ❑ Intense ❑ Blunted ❑ Inappropriate ❑ Labile ❑ Other:_______________
  3. Mental status: ❑ Normal ❑ Lack awareness ❑ Memory problems ❑ Disoriented ❑ Confused

❑ Disorganized ❑ Vigilant ❑ Delusions ❑ Hallucinations ❑ Other:__________________

  1. Suicide/violence risk: ❑ Almost none ❑ Ideation ❑ Threat ❑ Rehearsal ❑ Gesture ❑ Attempt
  2. Change in stressors: ❑ Less severe/fewer ❑ Different stressors ❑ More/more severe ❑ Chronic
  3. Change in coping ability/skills: ❑ No change ❑ Improved ❑ Less able ❑ Much less able
  4. Change in symptoms: ❑ same ❑ Less severe ❑ Resolved ❑ More severe ❑ Much worse
  5. Other observations/evaluations:________________________________________________________

In-session procedures

Expression of feelings experienced

Discuss what relaxation means

Discussion on coping skills

Nursing Paper Help

Home Work

Provision of a book on psychological and physical coping mechanisms

Practicum Journal Entry

Other Comments

Anger management, loss of mood, and withdrawal are critical issues that the patient need to manage through Cognitive Behavioral Therapy.

Legal and Ethical Implications

The Health Insurance Portability and Accountability Act (HIPAA) is a health care act that ensures client health information is protected during the provision of healthcare services. Confidentiality is critical during the provision of group therapy. However, psychiatrists do not have control of the patient’s information and ensuring patients privacy often become challenging. Therefore, the psychiatrists need to educate their patients on the importance of group therapy. Trust among group members ensures good relations and flow of information to guarantee quality care and counseling.

Appropriateness of Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a critical therapy for clients with psychological needs. It aims to develop coping requirements that help in the management of anxiety, PTSD, and depression (Keane, 2018). CBT is made up of three levels: negative automatic thoughts, core beliefs, and dysfunctional assumptions (McLeod, 2015). Thus, CBT focuses on self-discovery and help patients conceptualize and understand the reason behind their mental conditions and thoughts, thereby encouraging positive changes.

 

References

 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders.

Washington, DC: Author.

Fenn, K., & Byrne, M. (2013). The key principles of cognitive-behavioral therapy. Education

and inspiration for general practice, 6(9), 579-585. DOI:10.1177/1755738012471029

Keane, H. (2018). Facing addiction in America: The Surgeon General’s Report on Alcohol,

Drugs, and Health U.S. Department Of Health And Human Services, Office Of The Surgeon General Washington, DC, USA: U.S. Department of Health and Human Services, 2016 382 pp. Drug and Alcohol Review, 37(2), 282-283. DOI:10.1111/dar.12578

 

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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.

Research Paper Help

 

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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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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Research Critique – Part II

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Research Critique – Part II

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

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

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

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

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

SAMPLE ANSWER

Research Critique – Part II

Quantitative Studies

Article 1

Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler,

  1. P. (2015). Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial. JAMA, 313(4), 369-378. Doi:10.1001/jama.2014.18400
  2. Research Critique – Part II

Study Problem

Infections acquired during hospitalizations are the major causes of high mortality rates and increased the length of stay, which leads to increased healthcare costs for both patients and the health institutions. Health associated infections also result in increased healthcare system costs in the nation. The skin of patients in the Intensive Care Unit acts as a reservoir for pathogens (Noto, et al. 2015). Significant efforts are put to prevent and reduce the rate of infections through health practices designed to decrease the transmission of pathogens. Such practices 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.

Significance of the Study to Nursing

Nurses should consider Chlorhexidine as a significant intervention in reducing the rate of infections for hospitalized patients. 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). Various studies have reported that 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.

Purpose of the Study

The main objective of the study was to assess if daily bathing with Chlorhexidine reduces associated healthcare infections for patients in the intensive care unit.

Research Question

Does daily bathing with Chlorhexidine reduce associated healthcare infections for patients in intensive care units?

How does the Article Answer the PICOT Question?

The PICOT question compares the effectiveness of daily bathing with Chlorhexidine and the effectiveness of daily bathing with soap and water in reducing the rate of Central Line-Associated Bloodstream Infections in patients admitted in the intensive care unit. The article answers the PICOT question by examining whether daily baths with Chlorhexidine reduces the rate of health-associated infections in patients admitted to the intensive care unit.

How the intervention and Comparison Groups in the Article Compare with those Identified in the PICOT Question

The PICOT question uses Chlorhexidine as an intervention. Chlorhexidine and soap and water are the comparison groups in the PICOT question. On the other hand, the article uses Chlorhexidine as the intervention group in reducing the rate of hospital-acquired infections.

 

Article 2

Holder, C., &Zellinger, M. (2009). Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections. JCOM, 16(11), 509-13. https://pdfs.semanticscholar.org/ace2/d11dfa4fab260bb5639c782b9baa0a1addad.pdf

Study problem

Approximately 80,000 patients in the intensive care unit in the United States are reported to have Central Line-Associated Bloodstream Infections every year. The cost of treating one patient is approximately 40,000 US dollars per patient every year. Most of the infections are preventable. Recent studies report that the use of Chlorhexidine wipes in hospitals reduces the rate of Central Line-Associated Infections (Holder & Zellinger, 2009). 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.

Significance of the Study to Nursing

An academic medical center called Emory University conducted research that found out that the use of Chlorhexidine wipes for daily baths reduced the rate of postoperative sternal wound infections for patients in the cardiovascular surgery intensive care unit. As a result, interdisciplinary teams from various hospitals decided to incorporate a 2% chlorhexidine in daily baths for patients in the ICU(Holder &Zellinger, 2009). 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.

The Objective of the Study

The primary purpose of the study was to define a quality intervention for the acquisition of multidrug-resistant organisms and reduction of rates of Central Line Bloodstream Infections by using chlorhexidine wipes in daily baths of patients in the Intensive Care Unit.

Research Critique – Part II

Research question

Does the use of chlorhexidine wipes in daily baths act as a quality initiative in the acquisition of multidrug-resistant organisms and reduction of Central Line-Associated Bloodstream Infections for patients in the Intensive Care Unit?

Research Critique – Part II

How does the Article answer the PICOT Question?

The PICOT question researches the effectiveness of using Chlorhexidine in daily baths in reducing the rate of Central Line-Associated Bloodstream Infections in patients in the Intensive Care Unit. The article answers the PICOT question by describing the use of chlorhexidine wipes in daily baths in reducing the rate of Central Line Bloodstream Infections in patients admitted in the Intensive Care Unit.

How the Intervention and Comparison Groups in the Article Compare to those in the PICOT Question

The PICOT question considers the use of Chlorhexidine in daily as an intervention in reducing the rates of Central Line-Associated Bloodstream Infections in patients admitted in the ICU. Similarly, the article considers the use of chlorhexidine wipes in daily baths as an intervention in reducing the rate of Central Line Bloodstream Infections for patients admitted in the Intensive Care Unit.

Methods used in the Two Studies and how different they are

The article on Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial by Noto, et al. (2015) used a pragmatic cluster randomized crossover study method. The study used patients admitted in five different intensive care units for medical centers in Tennessee, Nashville between 2012 and 2013.

On the other hand, the study on Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections by Holder and Zellinger, (2009) used a study method where nurses came up with a bathing procedure which included bating frequency, technique, contraindications, required documentation, and bathing technique.

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Benefits and Limitations of the two Study Method

The main benefit of the study by Noto, et al. (2015) is that the crossover events enabled the assessment of control periods and two separate interventions which allowed intercluster variability as well as seasonal outcome variations. However, the main limitation of the study is that the method of the study did not give a chance for multiple comparisons of the results.

On the other hand, the main benefit of the study by Holder and Zellinger, (2009) is that the study method was controlled by advanced nurses and nursing leaders that ensured the accuracy of the findings. However, the limitation of the study is that use of chlorhexidine wipes was cumbersome to the patients, and they would also not feel as clean if they used it as an antiseptic liquid. As a result, it was difficult to make patients accept the use of chlorhexidine wipes.

Results of the Two Studies and their Implications to Nursing Practice

The results on Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial by Noto, et al. 2015 showed that during the chlorhexidine daily baths period; there was an occurrence of 55 infections. During the controlled bathing, there was an occurrence of 60 infections. No difference in the primary outcome between the two groups was observed after baseline adjustment. After the analysis of the results, there was no difference in primary outcome in individuals in the Intensive Care Unit.

The Implication to Nursing Practice

According to the findings of the pragmatic trial, daily chlorhexidine baths did not reduce the rates of Central Line Bloodstream Associated Infections in the Intensive Care Unit. The results did not support daily showers with Chlorhexidine for patients admitted in the Intensive Care Unit.

The results of the study on Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections by Holder and Zellinger, 2009 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.

Implications to nursing practice

According to the findings of the study, 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.

Ethical Considerations

Informed consent is one of the significant ethical considerations when conducting clinical research. Informed consent states that patients involved in research should voluntarily, intelligently, and knowingly give consent to the researchers to use their information in their study. Beneficence is another ethical consideration that includes professional; the mandate of the researchers to do significant and effective research that can better promote the welfare of the community health. The Institutional Review Board approved the two studies. Also, patient confidentiality was maintained. Besides, the patients that participated in the studies voluntarily gave consent to the researchers

References

Holder, C., &Zellinger, M. (2009). Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections. JCOM, 16(11), 509-13. https://pdfs.semanticscholar.org/ace2/d11dfa4fab260bb5639c782b9baa0a1addad.pdf

Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial. JAMA, 313(4), 369-378. Doi:10.1001/jama.2014.18400

 

 

 

 

 

 

 

 

 

 

 

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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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Vargas Family Case Study Fourth Session

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Vargas Family Case Study Fourth Session

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

Be sure to answer the following questions in your paper:

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

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

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

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

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

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

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

 

SAMPLE ANSWER

Vargas Family Case Study Fourth Session

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

Current Presenting Problems for the Vargas Family

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

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

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

Vargas Family Case Study Fourth Session

Structural Interventions to be used

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

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

Role of the Counselor in the Change Process

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

 

References

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

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

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

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

 

 

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The Future of Nursing

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The Future of Nursing

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

 

a. Research the future of nursing.

 

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

 

b. Identify the major recommendations.

 

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

 

c. Explain key terms.

 

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

 

SAMPLE ANSWER

The Future of Nursing

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

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Major Recommendations

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

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

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References

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

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

 

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