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Vargas family-Narrative Therapy

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Vargas family-Narrative Therapy

Identify one member of the Vargas family whose dominant story could use some rewriting. Read the workshop notes on Reauthoring Conversations.

Part 1: In 250-300 words, write a counseling note for the client’s file. In this note, describe any exceptions to the problem that you have identified and develop scaffolding questions to ask the client in your next session, one in their landscape of action and one in their landscape of identity.

Part 2: Put yourself in the client’s shoes and, as the client, write a reauthoring version of their story that is 500-750 words in length. It should incorporate the exceptions and responses to the scaffolding questions from Part 1. Use narrative language when applying this reauthoring technique.

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

This assignment uses a 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 directions in the Student Success Center.

AttachmentsPCN521-RS-SubmittingMultipleAttachments.pdf PCN521-R-T7CaseStudy.docx

 

SAMPLE ANSWER

Vargas Family Case Study: Narrative Therapy

Part 1

Counseling note

Patient’s name: Elizabeth Vargas

Type of session: family session

Date: 17th September 2019

The progress of the patient since the last session: the patient seems agitated and concerned about everybody else in the family but herself. The patient reports progress in the family’s weekly soccer matches. She reports seeing Bob Vargas more and Frank’s behavior is improving. Today, she reports that her father in-law and mother in-law Linda and Tim, are affecting their grandson’s drug use treatment process. She specifically requested for the entire family including Linda and Tim, to come for this session.

Observations about the patient: the patient looks tired and a bit disheveled. Her eyes are red and her cheeks are flushed indicating that she has been crying. She is always on time for the family sessions but complaints when other family members are late.

Vargas family-Narrative Therapy

Review of action items: the patient reports that the family has been hosting the weekly soccer matches as directed. She also notes that Frank and Heidi are getting along much better. However, she confesses to not enjoying the soccer matches. She does not like outdoor activities.

Session Description: the family session involves the entire family including Linda and Tim. The main issue in question is Geoff’s near drug overdose and how his father’s death has affected him. Elizabeth further states that Linda and Tim are not helping the situation by giving their opinions about what should be done. Elizabeth also thinks that Linda should not have called Geoff’s school therapist since she was not his mother. Linda disagrees and tells Elizabeth that she knows what is best for her grandson. This sentiment angers Elizabeth who asks to leave the session.

Main Issue of the session: The main issue is Geoff’s drug overdose and the resulting effect on the family.

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Scaffolding Questions

Landscape of action question: do you think Geoff’s father’s death resulted in Geoff taking drugs and finally overdosing?

Landscape of identity question: what if Linda and Tim stopped trying to help Geoff control his grief, will this help him become better and hopefully stop using drugs?

Vargas family-Narrative Therapy

Part 2

Thank you very much for agreeing to see the entire family. I am concerned about my nephew Geoff and his recent drug use. Geoff has been moody and has also been performing poorly in school. We thought that this change in behavior was due to his father’s death. Therefore, we did not pay any extra attention to it seeing that everyone handles grief differently. However, Geoff was recently rushed to the hospital after a near overdose. I think that Geoff’s father’s death resulted in him taking drugs and nearly overdosing. Since that day, our family has been in a crisis. Linda decided to call Geoff’s school therapist to find out more about Geoff’s behavior but was turned down. Tim on the other hand, despite his good intentions, is making matters worse. He took Geoff out for camping against Katie’s wishes. I believe that Linda and Tim’s involvement is not helping Geoff. Linda being headstrong is already telling Katie about her disappointing encounter with the school therapist. This in turn forced Katie to contact the school therapist who informed her that she was not ethically allowed to disclose Geoff’s information to Linda since she has to maintain the patient’s confidentiality. In addition to informing Katie about the therapist’s encounter, Linda continued to offer alternatives and interventions she believes will help Geoff. I think Linda’s influence and persuasive nature has convinced Katie to disregard the therapist’s advice of helping Geoff forget his grief. If Linda and Tim stopped trying to help Geoff control his grief, he would be able to stop taking drugs.

Vargas family-Narrative Therapy

I called you earlier to request you to see our family including my father-in law and mother-in law because I am familiar with you and I have seen tremendous changes in my family more specifically, in Frank. I have been struggling with taking care of Frank and his special needs for a while now. Bob has not made it any easier for me. He thinks that I am exaggerating everything. He still thinks that Frank is just being a boy. I am getting frustrated by his comments when all I want is for our family to get better. Since our last visit, we have been meeting up at the local park and playing football for at least an hour a day. I personally do not like outdoor activities but I have found the football matches beneficial for the entire family. For example, last Wednesday, we divided ourselves into two teams and for the first time, Frank requested to be paired with Heidi and not with Bob. Normally, Frank is aggressive towards Heidi and often physically pushes her around. Overall, I appreciate our sessions as a family and by including Linda and Tim; I foresee tremendous progress in our future.

 

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Floating Improvement Program

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Floating Improvement Program

In this assignment, you will propose a quality improvement initiative from your place of employment that could easily be implemented if approved. Assume you are presenting this program to the board for approval of funding. Write an executive summary (750-1,000 words) to present to the board, from which the board will make its decision to fund your program or project. Include the following:

  1. The purpose of the quality improvement initiative.
  2. The target population or audience.
  3. The benefits of the quality improvement initiative.
  4. The interprofessional collaboration that would be required to implement the quality improvement initiative.
  5. The cost or budget justification.
  6. The basis upon which the quality improvement initiative will be evaluated.

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

I wanted it to be written over nurses floating to other units and them getting properly trained. I work on a mom/baby unit

nurses get stressed from floating to other units

 

SAMPLE ANSWER

Floating Improvement Program

Introduction

Quality health improvement programs are proven ways health organizations can deploy to meet the competitive demands of patient protection frameworks such as Medicare. The need for efficient supply chain processes that improve patient outcomes as well as limiting treatment costs imply strategic alternatives to traditional healthcare delivery. This essay discusses alternative approaches to nurse floating; outlining improvement approaches aimed at benefiting both the nurses, patients and the health organization. Also discussed is the required interprofessional collaboration, budget justification and the basis for evaluation.

Floating Improvement Program

Program’s Purpose and Target Population

Floating of nurses across different units in my health organization has proved a key challenge for most of the nursing staff. Moving these caregivers from their units of specialization to provide services in unfamiliar units presents most health workers with different concerns that range from anxiety and uncertainty to severe challenges such as inability to provide timely and adequate care (Trossman, 2014). This indeed compromises the overall quality of health outcomes thereby necessitating floating interventions that relieve nurses of the pressure as well as providing patients with quality care.

Adopting a Nursing Float Development Program admits that nursing shortages are a reality in most care units and that effectively managing floating allows deprived units the benefit of additional nurses from different units during their time of need (Larson, Sendelbach, Missal, Fliss, & Gaillard, 2012). The knowledge gap seen in nurses working in new environments will be addressed by developing a skills acquisition program that aims at training nurses in common skill sets. This directly boosts the confidence of float nurses away from their professional units (Trossman, 2014). Pediatric and cardiac nurses, for example, will receive training in emergency care resulting in quality emergency outcomes. This approach will be adopted for individual or groups of nursing units on a voluntary basis allowing nurses to train in skill sets of their preferences. This approach assures better nurse participation in floating programs.

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Establishing a dedicated pool of floating nurses will also be mandated under the nursing quality improvement program. This initiative will require the health organization to hire additional nursing personnel who will be imbued with the scarce nursing resources within the facility such as cardiac and emergency care skills. Having no home unit implies that this pool of caregivers will be easily programed to meet the day to day care requirements in most of the units. Ensuring that highly qualified and skilled nurses form this pool promises efficient services even in highly technical circumstances.

Developing a comprehensive floating resource plan will equally contribute to the efforts of addressing floating challenges. The resource plan primarily equips the float nurse with the unit’s information including team contact addresses, documentation protocols, safety procedures, and shift routines (Larson et al., 2012). Adequate training in some of these standard procedures ensures that floating nurses integrate positively with the unit nurses for improved health delivery and patient satisfaction.

Program Benefits and Interprofessional Collaboration

A major influence of the program is to relieve nurses of the tension and uncertainty they face whenever they encounter circumstances that significantly differ from their accustomed work stations (Trossman, 2014). This effort acknowledges that employee satisfaction is a major contributor to positive health outcomes. The Nursing Float Development Program achieves these aims by ensuring float nurses are well adapted to different units to help address the chronic challenge of nursing shortages. Reducing the stress and anxiety faced by float nurses by implementing and developing various resources that direct nurses in new environments ensures that float nurses are more confident of their skills and the resources at their disposal. This is a clear way of boosting their efficiency and responsiveness in unfamiliar units (Trossman, 2014).

Developing nursing competencies by addressing their knowledge gaps in different skill sets enhances their relevance in the healthcare setting. Being able to adequately provide services in more than a single specialist unit increases the demand of the individual nurse opening them up for better opportunities in their practice. Another significant benefit of the improvement program that contributes to a vibrant workforce is the program’s capacity to limit involuntary floating which acts as a key source of nurse’s dissatisfaction (Larson et al., 2012). Investing in a dedicated floating pool implies that floating needs are handled with a predetermined regularity which eliminates the uncertainty faced by both armature and experienced nurses.

Nursing Paper Help

All efforts towards improving the nursing experience during floating are a major contributor of lower turnovers since this lessens the burden faced by the nurses as well as creating enabling environments that ensure patients obtain the highest quality care (Trossman, 2014). Effectively covering the patient needs is a quality outcome that the improvement program is determined to achieve.

Interproffesional collaboration on the other hand admits that the nursing environment is a sophisticated area and that collaboration from other health professionals is pivotal for a sustainable healthcare system. Effective development and implementation of the floating program will involve the contribution of practically all nursing units within my care facility. Nursing teachers also play an essential role in the training of float nurses. Ensuring that float nurses are well versed in different skill sets required in the hospital’s health units signifies the role of interprofessional collaboration. Physicians working throughout the organization should also be aware of the presence of float nurses in their work stations and provide the adequate support needed for smooth operations. Technicians in all units also provide essential collaborative support by equipping float nurses with the technical knowhow required to operate equipment of different orientations.

Budget Justification and Evaluation Metrics

             A significant amount of the program budget will go towards the training of nurses in the organization and developing a float pool. Training programs will involve each nurse picking at least one unit which they would be confortable to serve as a float. The training aims to equip about 220 nurses, in the process incurring about $950,000. This amount will cater for all training needs including the allowances for the nurses. Another $1,200,000 will be utilized to establish a dedicated float pool of highly skilled nurses. 40 specialist nurses are to be hired to serve in this capacity.

Predominant evaluation parameters will include patient satisfaction scores, turnover rates, and the costs of care. Patient satisfaction is a key determinant of the program’s success enabling the organization to see its impact on patient welfare. A reduction in nurse turnover rates will demonstrate the impact of the program in improving the working conditions of the float nurses. The costs of administering basic healthcare should also be minimized through increased efficiency of service delivery. This makes the cost of healthcare after the program an important evaluation parameter.

Conclusion

The shortage of nurses in healthcare provision presents health organizations with a unique challenge. Floating is one strategy that institutions can adopt with increased chances to better patient outcomes and minimize instances of nurse turnovers. The Nursing Float Development Program aims to equip nurses with essential skills in several health units to increase their effectiveness in new care environments. Establishing a float pool of specialized nurses is an initiative that seeks to mitigate the consistent shortage of nurses throughout the different units of care in my health organization.

References

Larson, N., Sendelbach, S., Missal, B., Fliss, J., & Gaillard P. (2012). Staffing patterns of scheduled unit staff nurses vs. float pool nurses: A pilot study. Medsurg Nurs, 21(1), 27-39.

Trossman, S. (2014). On less familiar ground: Strategies aim to reduce random floating, improve the experience. Am Nurse, 46(1), 7. Retrieved from www.theamericannurse.org.

 

 

 

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Strategic Objectives Response Paper

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Strategic Objectives Response Paper

Need a peer respond to the selected posts.

 

Peer Post 1- Cornel Bedward

For this discussion I chose to discuss the strategic objectives of the Olympic Medical Center. The Olympic Medical Center is a public hospital district on the North Olympic Peninsula located in Port Angeles and Sequim, Washington. “Olympic Medical Center is responsible for proactively planning for the community’s health care need” (OMC, n.d.). Their strategic plan focuses on three areas:  quality, patient safety and satisfaction, Olympic Medical Center and community relationships, and organizational performance.

The first strategic objective Olympic Medical Center (OMC) has revolves around ensuring that they offer the safest, highest-quality health care with compassion. They will do so by continuing to standardize their care processes and fortify their systems in order to amplify patient safety and quality, and perfect their ability to deliver positive patient experiences (OMC, 2018-2020, p. 5).  OMC strategies include following evidence-based best practices through national quality initiatives, being a leader in adopting national patient safety initiatives, and encouraging a culture of service that constantly acknowledges the expectations and fulfills the needs of our patients, their families and our community in the services they provide (OMC, 2018-2020, p. 8). In order to implement these strategies OMC will continue to foster a culture of quality, patient safety and experience for their patients and staff. They will concentrate on explicit quality goals that will prevent unnecessary readmissions, and improve emergency department wait times. Lastly, OMC will ensure their Quality Management System will effectively sustain compliance with International Organization for Standardization (ISO) 9001: 2015 standards (OMC, 2018-2020, p. 8).

Strategic Objectives Response Paper

The second strategic objective Olympic Medical Center (OMC) has is to continue to work with their community partners and representatives and maintain recruitment and retention of the best doctors, advanced practice clinicians, clinical staff and employees to continue to achieve excellence in health care (OMC, 2018-2020, p. 5). The strategy OMC wants to achieve is to promote and inform the community about the services OMC provides. They will support public health, and promote health and wellness by discussing appropriate lifestyle choices, addressing social factors that negatively affect their community’s health and educating the community on chronic disease management. A third strategy they aim to achieve is to assist community partners to help support community development by “promoting health care access, advocacy and disaster preparation” (OMC, 2018-2020, p. 9). The goals they will implement to achieve this are: continue to meet with elected federal and state officials and their healthcare aides to further meet the needs of their healthcare system, organize annual goals and operating plans for the Swedish affiliation, to further enhance community health over time OMC will participate in agreed-upon Olympic Community of Health (OCH) programs and align with OCH-identified Medicaid measures with a focus on primary care access, continue to develop of wellness initiatives, and lastly preserve positive relationships with funding partners and donors (OMC, 2018-2020, p. 9).

Strategic Objectives Response Paper

The last strategic objective Olympic Medical Center (OMC) has is maintaining their organizational performance by sustaining financial solvency by achieving a positive net income (OMC, 2018-2020, p. 5). In order to do this OMC will maintain open communication within the organization and promote creative ideas from all staff. By sustaining prolific and respectful working relationships, OMC can encourage teamwork between employees, management, physicians and commissioners. They will contribute to employee development and education to advance quality, patient safety and experience, and financial stewardship. Lastly, OMC will continue to create a culture that reflects their Mission, Vision and Values (OMC, 2018-2020, p 10). OMC plans to “ implement “OMC Operational Excellence” across all divisions, prioritizing process improvements that result in improved operational efficiency, patient access, wait times, patient experience, and employee experience and engagement” (OMC, 2018-2020, p 10). They will put forth changes based on their 2015 employee survey and conduct a follow-up employee survey to further improve employee engagement. They will imbue a culture initiative to align

Their employees with the Mission and Values they have. OMC will also execute Workforce Development Plan (OMC, 2018-2020, p 10).

References

Olympic Medical Center (OMC). (n.d.). Strategic Plan. Retrieved August 31, 2019 from http://www.olympicmedical.org/default.aspx?ID=11

Olympic Medical Center (OMC). (2018 -2020). Strategic Plan. Retrieved August 31, 2019 from http://www.olympicmedical.org/pdfs/Strategic%20Plan%202018-2020.pdf

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning, implementation, and evaluation processes in hospital systems: A survey from Iran. Global Journal of Health Science, 7(2), 56–65. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/38626/22539

Walston, S. L. (2014). Strategic healthcare management: Planning and execution. Chicago, IL: Health Administration Press.

 

Peer Post 2 – Mackenzie Rodriquez

Tampa General Hospital is a very well-known health care facility located in Tampa, Florida. Some of the strategic objectives of Tampa General Hospital are to ensure quality health care services for all patients, create a safe environment, as well as ensure all staff members are equipped with the needed skills (TGH, 2019). First, TGH wants to make sure that all patients that visit the hospital will receive the best quality care regardless of the patient’s race, religion, economic background, etc… (TGH, 2019). Secondly, the safety of all patients and staff members is extremely important. Offering a safe environment for all patients and staff members allows patients to feel comfortable and allows employees to work more efficiently. Lastly, the hospital wants to ensure that all staff members are equipped with the needed skills in order to provide quality services to all of their patients.

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Some of the tactical objectives that will help Tampa General Hospital to achieve each of the strategic objectives are to make constant improvements to the technology equipment, increase security services, as well as create an overall efficient training program for all staff members (Chron, 2019). First, by frequently updating all technology every year, helps to ensure that all machines and equipment are efficient and functioning properly in order to help ensure the quality of services that are provided to patients. Secondly, increasing the number of security members over a period of time, will help keep the hospital safe and secure. Lastly, by making improvements to the training program for staff members every single year helps to ensure that they will have a better understanding of what is expected of them and what skills are required by the hospital. In addition, some of the operational objectives that can be used in order to help TGH achieve their strategic objectives is to fix the day to day issues (Chron, 2019). For example, any technology glitches should be fix immediately in order to prevent any of the machines from shutting down. Also, if any patients or staff members feel that a particular person makes them feel unsafe, it should be addressed immediately, and action needs to be taken. Any employees that are not working properly and working towards the hospitals goals needs to be addressed and potentially removed if needed. Overall, each of these objectives helps Tampa General hospital to achieve all of their overall strategic objectives.

Chron. (2019, April 24th). Tactical and operational planning. Retrieved from;

TGH. (2019). Mission and goals.Retrieved from;

https://www.tgh.org/health-professionals/school-medical-laboratory-science/mission-and-goals

 

SAMPLE ANSWER

Strategic Objectives Response Paper

Dear Cornel Bedward,

Sadeghifar et al. (2014), describe a strategic as being made up of strategic objectives that are important to the organization and have been established to be a significant management practice. This comes out clearly in the strategic plans that have been set out by your institution. I agree with you that the objectives should always be geared towards making the organization better. I also agree with you that strategic plans can be achieved within a specified period of time and as seen in your organization, they are for the year 2018-2020. Olympic medical Centre also has clear operational goals that will be able to help them. However, there is a need to bring out the tactical goals which will aim in the delivery of the strategic plan. Tactical objectives involve objectives at an individual level and are focused on the individuals in the organization.

Reference

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning,

implementation, and evaluation processes in hospital systems: A survey from Iran. Global Journal of Health Science, 7(2), 56–65. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/38626/22539

 

Dear Mackenzie Rodriquez

Tampa General Hospital has established itself to have a strategic plan and set out objectives to achieve them. You have listed some of the objectives that are present in the strategic plan of the organization which is to ensure that all patients get better quality of treatment irrespective of their background. A strategic plan is composed of strategic objectives that are important to the organization and have been established to be a significant management practice (Sadeghifar et al. 2014). I agree with you that for the goals of Tampa General Hospital to be achieved, there is a need to have operational and tactical objectives that have been clearly outlined in your article. However, Strategic objectives are goals that are aimed at being achieved within three to five years, and it has not been brought out when Tampa General Hospital aims at achieving the set out objectives in their strategic plan.

Reference

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning,

implementation, and evaluation processes in hospital systems: A survey from Iran. Global Journal of Health Science, 7(2), 56–65. Retrieved from http://www.ccsenet.org/journal/index.php/gjhs/article/view/38626/22539

 

 

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