Florence Nightingale: A Pioneer in Evidence-Based Practice

Florence Nightingale: A Pioneer in Evidence-Based Practice


  1. Introduction
  2. Florence Nightingale’s Early Life and Background
  3. Florence Nightingale’s Contributions to Nursing a. The Crimean War and Nursing Reforms b. Statistical and Epidemiological Pioneering c. The Influence of Nightingale’s Work on Modern Nursing
  4. What Is Evidence-Based Practice?
  5. Florence Nightingale’s Impact on Evidence-Based Practice
  6. Frequently Asked Questions
  7. Conclusion


In the world of healthcare, the term “evidence-based practice” has become increasingly significant in recent years. It represents a crucial approach to healthcare decision-making that relies on the best available evidence to guide clinical practice. However, evidence-based practice is not a new concept; it has roots dating back to the 19th century, and one of its pioneers was none other than Florence Nightingale.

This blog post will delve into the life and contributions of Florence Nightingale, a remarkable figure in nursing history who played a pivotal role in shaping modern nursing practices, particularly in the context of evidence-based practice. We will explore her early life, her contributions to nursing during the Crimean War, her statistical and epidemiological pioneering, and her enduring influence on the field of healthcare. Let’s embark on a journey through history to understand how Florence Nightingale laid the foundation for evidence-based practice in healthcare.

Florence Nightingale’s Early Life and Background

Florence Nightingale was born on May 12, 1820, in Florence, Italy, to a wealthy British family. She received a well-rounded education, which was unconventional for women of her time. Florence’s strong desire to pursue nursing as a profession was met with resistance from her family, who expected her to conform to the societal norms of a woman’s role.

However, Nightingale was undeterred by societal expectations and felt a calling to serve humanity through nursing. She enrolled in the Lutheran Hospital of Pastor Fliedner in Kaiserswerth, Germany, where she received formal training in nursing. This training laid the groundwork for her future contributions to the field of healthcare.

Florence Nightingale’s Contributions to Nursing

a. The Crimean War and Nursing Reforms

Florence Nightingale’s most significant contributions to nursing came during the Crimean War (1853-1856). When she heard about the deplorable conditions in military hospitals and the high mortality rates of soldiers due to infections and poor sanitation, Nightingale volunteered her services to lead a group of nurses to Crimea.

Transforming Healthcare in the Crimean War

Upon arrival in Scutari, Turkey, Nightingale was confronted with appalling conditions. Overcrowded and unsanitary hospitals, lack of clean water, and inadequate supplies posed significant challenges. Despite these obstacles, Nightingale and her team worked tirelessly to transform healthcare practices. They implemented rigorous sanitation measures, ensured proper ventilation, and improved the quality of food and nutrition for patients.

Statistical Analysis and Record Keeping

One of Nightingale’s most notable contributions during the Crimean War was her meticulous record-keeping and statistical analysis. She collected extensive data on patient outcomes, including mortality rates, causes of death, and other health-related information. These data-driven insights allowed her to identify key factors contributing to the high mortality rates.

b. Statistical and Epidemiological Pioneering

The Rose Diagram

One of Florence Nightingale’s most famous statistical innovations was the “Rose Diagram” or “Coxcomb,” which she used to visually represent the causes of mortality among soldiers in the Crimean War. This diagram provided a clear and compelling way to convey complex statistical information to policymakers and the public. It highlighted the predominant causes of death, with preventable diseases and infections being the most prominent. This visualization played a crucial role in advocating for healthcare reforms.

Advocating for Evidence-Based Practices

Florence Nightingale’s statistical analysis and use of evidence laid the groundwork for what we now recognize as evidence-based practice. She believed that healthcare decisions should be guided by empirical evidence rather than tradition or conjecture. Her work in Crimea demonstrated the effectiveness of evidence-based interventions in improving patient outcomes and reducing mortality rates.

c. The Influence of Nightingale’s Work on Modern Nursing

Florence Nightingale’s pioneering efforts in nursing and her emphasis on evidence-based practice had a profound and lasting impact on the field of healthcare. Her work laid the foundation for modern nursing standards and practices, emphasizing the importance of hygiene, sanitation, and data-driven decision-making.

What Is Evidence-Based Practice?

Before we delve further into Florence Nightingale’s impact on evidence-based practice, let’s clarify what evidence-based practice means in contemporary healthcare.

Evidence-based practice is an approach to healthcare decision-making that involves the integration of the best available evidence from research, clinical expertise, and patient values and preferences. It is a systematic process that ensures healthcare professionals make informed decisions based on the most current and reliable evidence.

Florence Nightingale’s Impact on Evidence-Based Practice

Pioneering Data-Driven Decision-Making

Florence Nightingale’s work in the Crimean War was a prime example of evidence-based practice in action, long before the term was coined. Her emphasis on collecting and analyzing data to inform healthcare decisions set a precedent for modern healthcare professionals.

The Role of Data in Nursing

Nightingale recognized the significance of data in improving patient care. She believed that healthcare professionals should systematically collect data on patient outcomes, treatment efficacy, and the prevalence of diseases to identify best practices and areas in need of improvement. This commitment to data-driven decision-making aligns perfectly with the core principles of evidence-based practice.

Emphasis on Preventive Measures

One of Nightingale’s key insights during the Crimean War was the importance of preventive measures in healthcare. She observed that many soldiers were dying from preventable diseases and infections, often due to unsanitary conditions. This realization led her to advocate strongly for cleanliness, proper sanitation, and infection control measures. These principles are central to evidence-based practice, which emphasizes preventing harm and optimizing patient outcomes.

Advocacy for Continuous Learning

Florence Nightingale was not only a practitioner but also an advocate for education and continuous learning in nursing. She believed that nurses should stay updated on the latest advancements in healthcare and adapt their practices accordingly. This commitment to lifelong learning aligns with the spirit of evidence-based practice, which encourages healthcare professionals to stay current with the latest research and incorporate new evidence into their clinical decision-making.

Frequently Asked Questions

How did Florence Nightingale’s work impact nursing during her time?

Florence Nightingale’s work had a profound impact on nursing during her time. She transformed healthcare practices in military hospitals during the Crimean War, reducing mortality rates through improved sanitation and evidence-based interventions. Her statistical analysis and data-driven approach laid the foundation for modern nursing and evidence-based practice.

What is the significance of Florence Nightingale’s Rose Diagram?

The Rose Diagram, created by Florence Nightingale, visually represented the causes of mortality among soldiers during the Crimean War. Its significance lies in its ability to convey complex statistical information in a clear and compelling way. It highlighted the predominant causes of death, emphasizing the importance of preventable diseases and infections. This diagram played a crucial role in advocating for healthcare reforms and evidence-based practices.

How did Florence Nightingale’s work influence modern nursing?

Florence Nightingale’s work laid the foundation for modern nursing. Her emphasis on hygiene, sanitation, data-driven decision-making, and preventive measures became integral components of nursing practice. Her commitment to evidence-based practice continues to influence healthcare professionals today, guiding them in providing the best possible care to patients.


Florence Nightingale, a visionary nurse and statistician, made lasting contributions to healthcare that continue to influence nursing practices today. Her pioneering efforts during the Crimean War, including improved sanitation, data collection, and evidence-based interventions, set the stage for modern nursing and the concept of evidence-based practice.

As healthcare professionals strive to provide the best care possible, they can look to Nightingale’s legacy as a reminder of the power of evidence-based practice. By integrating the best available evidence with clinical expertise and patient preferences, healthcare practitioners can make informed decisions that improve patient outcomes and enhance the quality of care provided.

Florence Nightingale’s dedication to evidence-based practice serves as a timeless example of how data, research, and innovation can shape the future of healthcare. Her legacy reminds us that even in the face of adversity, one person’s commitment to improving healthcare can leave an indelible mark on the world.

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The Evolution of Evidence-Based Practice in Nursing

The Evolution of Evidence-Based Practice in Nursing

In the ever-evolving field of healthcare, evidence-based practice (EBP) has become the gold standard for providing high-quality patient care. As the cornerstone of modern nursing, EBP empowers nurses to make informed decisions based on the latest scientific evidence, clinical expertise, and patient preferences. In this comprehensive guide, we will delve into the history, significance, and implementation of evidence-based practice in nursing.


  1. Introduction
  2. Historical Context of Nursing Practice
    • Florence Nightingale: Pioneering the Art of Nursing
    • The Evolution of Nursing Education
  3. The Emergence of Evidence-Based Practice
    • The Cochrane Collaboration: A Catalyst for Change
    • Defining Evidence-Based Practice in Nursing
  4. Steps in the EBP Process
    • Formulating Clinical Questions
    • Searching for Evidence
    • Appraising Evidence
    • Integrating Evidence with Clinical Expertise and Patient Preferences
    • Evaluating Outcomes
  5. Benefits and Challenges of EBP in Nursing
    • Advantages
    • Common Challenges
  6. Frequently Asked Questions (FAQs)
  7. Conclusion


In the realm of healthcare, evidence-based practice (EBP) has become a driving force behind clinical decision-making, ensuring that patients receive the best care possible. This approach combines the most current and relevant research evidence with the clinical expertise of healthcare providers and the unique preferences of individual patients. Evidence-based practice is not a new concept, but its systematic integration into nursing practice has evolved over time.

Let’s embark on a journey through history to uncover the roots of evidence-based practice in nursing and explore its significance in today’s healthcare landscape.

Historical Context of Nursing Practice

Florence Nightingale: Pioneering the Art of Nursing

The history of evidence-based practice in nursing can be traced back to the early 19th century when Florence Nightingale, the founder of modern nursing, revolutionized healthcare. During her service in the Crimean War, Nightingale introduced data-driven practices by meticulously collecting and analyzing patient outcomes. Her work demonstrated the critical importance of sanitation, hygiene, and nursing care in improving patient survival rates. This marked the beginning of a more scientific approach to nursing care.

The Evolution of Nursing Education

As nursing continued to evolve, the standardization of education became paramount. The Flexner Report of 1910, which assessed medical education in the United States and Canada, also had a profound impact on nursing education. This report emphasized the importance of scientific knowledge and research in nursing education, pushing nursing schools to incorporate evidence-based principles into their curricula.

The Emergence of Evidence-Based Practice

The Cochrane Collaboration: A Catalyst for Change

The Cochrane Collaboration, founded in 1993, played a pivotal role in promoting evidence-based practice in healthcare, including nursing. This international network of researchers and healthcare professionals is dedicated to synthesizing and disseminating high-quality evidence for clinical decision-making. The Cochrane Library, a repository of systematic reviews and meta-analyses, has become an invaluable resource for nurses seeking evidence to inform their practice.

Defining Evidence-Based Practice in Nursing

Evidence-based practice in nursing is a process that integrates the best available research evidence, clinical expertise, and patient preferences to guide nursing care decisions. It is a dynamic approach that requires nurses to continuously update their knowledge and adapt to new evidence. The core components of EBP in nursing include:

  • Formulating Clinical Questions: Nurses identify specific questions related to patient care that can be answered through evidence.
  • Searching for Evidence: Comprehensive literature searches are conducted to locate relevant research studies, systematic reviews, and clinical guidelines.
  • Appraising Evidence: Nurses critically assess the quality and relevance of the identified evidence, considering factors like study design and sample size.
  • Integrating Evidence with Clinical Expertise and Patient Preferences: EBP requires nurses to balance research evidence with their own clinical expertise and the unique needs and preferences of their patients.
  • Evaluating Outcomes: After implementing evidence-based interventions, nurses evaluate patient outcomes to determine the effectiveness of their interventions and make adjustments as necessary.

Steps in the EBP Process

Now that we have a clear understanding of the components of evidence-based practice, let’s dive deeper into each step of the EBP process.

Formulating Clinical Questions

The EBP journey begins with the formulation of clear and concise clinical questions. These questions typically follow the PICO(T) framework, which stands for:

  • P – Patient or Population
  • I – Intervention
  • C – Comparison (if applicable)
  • O – Outcome
  • T – Timeframe (optional)

For example, a clinical question might be: “In adult patients with type 2 diabetes (P), does regular exercise (I) compared to medication alone (C) result in better glycemic control (O) over a six-month period (T)?”

Searching for Evidence

Once clinical questions are formulated, nurses embark on the search for relevant evidence. They access databases like PubMed, CINAHL, and the Cochrane Library to identify research studies, systematic reviews, and clinical guidelines that address their questions.

Appraising Evidence

Critical appraisal is a crucial step in evidence-based practice. Nurses evaluate the quality and validity of the evidence they find. This involves assessing the study design, sample size, potential bias, and the relevance of the research to the clinical question.

Integrating Evidence with Clinical Expertise and Patient Preferences

Evidence-based practice recognizes the importance of not only scientific evidence but also the expertise of the nurse and the preferences of the patient. Nurses must synthesize these three components to make informed decisions about patient care.

Evaluating Outcomes

After implementing evidence-based interventions, nurses continuously monitor and evaluate patient outcomes. This step allows them to assess the effectiveness of their interventions and make adjustments as needed to optimize patient care.

Benefits and Challenges of EBP in Nursing


Evidence-based practice in nursing offers numerous advantages:

  1. Improved Patient Outcomes: EBP is associated with better patient outcomes, including reduced mortality rates, shorter hospital stays, and improved quality of life.
  2. Enhanced Patient Safety: By relying on evidence-based guidelines, nurses can reduce the risk of medical errors and adverse events.
  3. Increased Job Satisfaction: Nurses who practice EBP report higher job satisfaction as they feel more confident in their ability to provide effective care.
  4. Efficient Resource Allocation: EBP helps healthcare organizations allocate resources more efficiently by focusing on interventions that have been proven effective.
  5. Professional Growth: Engaging in evidence-based practice fosters continuous learning and professional growth among nurses.

Common Challenges

Implementing evidence-based practice in nursing is not without its challenges:

  1. Limited Access to Evidence: Some nurses may struggle to access the latest research evidence due to subscription costs or limited institutional resources.
  2. Time Constraints: Nurses often face time constraints in their daily routines, making it challenging to engage in the extensive literature searches and critical appraisal required for EBP.
  3. Resistance to Change: Embracing EBP can be met with resistance, as it may require changes in established practices and workflows.
  4. Complexity of Evidence: Understanding and interpreting research evidence can be challenging for nurses without advanced training in research methods.
  5. Patient Variability: EBP emphasizes individualized care based on patient preferences, but accommodating these preferences can be complex in a healthcare system with multiple constraints.

Frequently Asked Questions (FAQs)

1. Is evidence-based practice only applicable to clinical nurses?

No, evidence-based practice is relevant to all nurses regardless of their specialization. It is a fundamental approach that guides nursing care in various settings, including clinical, community, research, and educational roles.

2. How can nurses stay updated with the latest evidence?

Nurses can stay updated by regularly accessing reputable databases like PubMed, subscribing to nursing journals, attending conferences and workshops, and collaborating with colleagues who are knowledgeable about EBP.

3. Are there specific tools or resources for evidence-based practice in nursing?

Yes, there are several resources and tools designed to support EBP in nursing, including online databases, critical appraisal checklists, and evidence-based practice guidelines.

4. Can EBP be applied in resource-limited healthcare settings?

Yes, EBP can be adapted to resource-limited settings by focusing on interventions that are feasible and cost-effective while still adhering to evidence-based principles.

5. What role do nurse educators play in promoting EBP?

Nurse educators have a critical role in preparing future nurses to embrace EBP. They teach EBP principles, provide resources, and foster a culture of inquiry among students.


The history of evidence-based practice in nursing is a journey that spans centuries, evolving from the visionary insights of Florence Nightingale to the systematic integration of research evidence, clinical expertise, and patient preferences in modern nursing care. As healthcare continues to advance, evidence-based practice remains an essential framework for ensuring the delivery of high-quality, patient-centered care.

Nurses are at the forefront of this movement, driving innovation and improvement in patient outcomes. While challenges may exist, the benefits of evidence-based practice in nursing are undeniable, making it an indispensable tool in the nurse’s toolkit for providing optimal care to patients and communities around the world. Embracing evidence-based practice is not just a choice; it is a commitment to excellence in nursing care.

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Evidence-Based Practice in Nursing

Evidence-Based Practice in Nursing: A Comprehensive Guide

In the ever-evolving field of healthcare, nurses play a vital role in patient care, and their decisions can have a profound impact on patient outcomes. To ensure that these decisions are informed and effective, nurses rely on evidence-based practice (EBP). In this comprehensive guide, we’ll delve into the world of evidence-based practice in nursing, exploring what it is, why it’s crucial, examples of its application, potential topics, the step-by-step process, and the numerous benefits it offers to both patients and healthcare professionals.

Table of Contents

  1. Introduction
    • Defining Evidence-Based Practice
    • Significance in Nursing
  2. What is Evidence-Based Practice in Nursing?
    • Core Principles
    • Historical Context
  3. Why is Evidence-Based Practice Important?
    • Enhancing Patient Outcomes
    • Reducing Medical Errors
    • Cost-Effective Care
  4. Examples of Evidence-Based Practice in Nursing
    • Fall Prevention Strategies
    • Pain Management Protocols
    • Pressure Ulcer Prevention
  5. Nursing Evidence-Based Practice Topics
    • Chronic Disease Management
    • Infection Control
    • Patient Education
  6. Steps of Evidence-Based Practice
    • Formulating a Clinical Question
    • Searching for Evidence
    • Critical Appraisal
    • Implementation
    • Evaluation
  7. Benefits of Evidence-Based Practice
    • Improved Patient Safety
    • Enhanced Quality of Care
    • Professional Growth
    • Increased Job Satisfaction
  8. Frequently Asked Questions
    • How do I start implementing EBP in my nursing practice?
    • What challenges do nurses face when adopting EBP?
    • Are there any resources to support EBP in nursing?
    • How can EBP impact healthcare policy?
  9. Conclusion


Defining Evidence-Based Practice

Evidence-Based Practice (EBP) in nursing is an approach that integrates the best available evidence from research, clinical expertise, and patient preferences and values to inform clinical decision-making. It emphasizes the use of scientifically sound research to guide nursing practice, ensuring that the care provided is effective, safe, and patient-centered.

Significance in Nursing

Nursing is a dynamic field that requires constant adaptation to new information and technologies. EBP serves as the compass guiding nurses through the ever-changing landscape of healthcare. By grounding their decisions in evidence, nurses can provide the highest quality of care to their patients, ultimately improving patient outcomes and safety.

What is Evidence-Based Practice in Nursing?

Core Principles

Evidence-Based Practice in nursing is founded on three core principles:

  1. Integration of Best Evidence: Nurses should incorporate the most up-to-date and relevant research findings into their clinical decision-making processes.
  2. Clinical Expertise: The experience and expertise of the nurse play a vital role in EBP. This expertise is used in conjunction with research evidence to make informed decisions.
  3. Patient Values and Preferences: EBP recognizes the importance of considering each patient’s unique values, preferences, and individual circumstances when making clinical decisions.

Historical Context

The concept of EBP emerged in the early 1970s but gained significant momentum in healthcare in the 1990s. It was initially introduced as a means to improve patient outcomes and reduce variations in care. Since then, it has become a cornerstone of modern healthcare, influencing policy, education, and practice across the globe.

Why is Evidence-Based Practice Important?

Enhancing Patient Outcomes

The primary goal of nursing is to provide the best possible care to patients. EBP is a powerful tool for achieving this goal by ensuring that nursing interventions and treatments are rooted in solid scientific evidence. This, in turn, leads to improved patient outcomes, reduced complications, and shorter hospital stays.

Reducing Medical Errors

Medical errors can have serious consequences for patients, ranging from minor complications to life-threatening situations. EBP helps nurses make informed decisions that reduce the likelihood of errors, enhancing patient safety and trust in the healthcare system.

Cost-Effective Care

In an era of rising healthcare costs, EBP can also lead to cost savings. By focusing on interventions that have been proven effective, nurses can reduce unnecessary tests, treatments, and hospital readmissions, ultimately lowering the overall cost of care.

Examples of Evidence-Based Practice in Nursing

To better understand how EBP is applied in nursing, let’s explore some real-world examples:

Fall Prevention Strategies

Falls are a common and serious concern in healthcare settings, especially among elderly patients. Nurses can use evidence-based fall prevention strategies such as regular assessment of patient fall risk, maintaining a clutter-free environment, and using bed alarms when appropriate to reduce the incidence of falls.

Pain Management Protocols

Managing pain is a fundamental aspect of nursing care. Evidence-based pain management protocols guide nurses in selecting the most appropriate pain relief interventions based on the patient’s condition, history, and the latest research on pain management.

Pressure Ulcer Prevention

Pressure ulcers, also known as bedsores, can develop when patients remain immobile for extended periods. EBP provides guidelines on repositioning patients, using pressure-relieving devices, and implementing comprehensive skin care routines to prevent pressure ulcers.

Nursing Evidence-Based Practice Topics

EBP is a versatile approach that can be applied to a wide range of nursing topics. Here are some common areas where evidence-based practice is particularly relevant:

Chronic Disease Management

Nurses often play a central role in managing chronic diseases such as diabetes, hypertension, and asthma. Evidence-based guidelines help nurses develop effective care plans, monitor patients’ progress, and adjust treatments as needed to achieve optimal outcomes.

Infection Control

Infection control is crucial in healthcare settings to prevent the spread of pathogens. EBP informs nurses about the most effective methods for hand hygiene, personal protective equipment (PPE) use, and isolation procedures to minimize the risk of healthcare-associated infections.

Patient Education

Patient education is a cornerstone of nursing practice. EBP assists nurses in providing patients with accurate and up-to-date information about their conditions, treatments, and self-care. This empowers patients to actively participate in their healthcare decisions and improve their health outcomes.

Steps of Evidence-Based Practice in Nursing

Implementing EBP in nursing involves a systematic approach. Here are the key steps to follow:

1. Formulating a Clinical Question

The first step is to identify a clinical issue or problem that requires attention. Nurses formulate clear and concise questions based on the PICO(T) framework:

  • P: Patient or problem
  • I: Intervention
  • C: Comparison
  • O: Outcome
  • T: Time

For example, a clinical question could be, “In diabetic patients (P), does regular exercise (I) compared to medication alone (C) lead to better glycemic control (O) within six months (T)?”

2. Searching for Evidence

Once the question is formulated, nurses conduct a thorough literature search to find relevant research articles, systematic reviews, and clinical guidelines. Databases such as PubMed, CINAHL, and the Cochrane Library are valuable resources for accessing high-quality evidence.

3. Critical Appraisal

Nurses critically evaluate the gathered evidence to assess its validity, relevance, and applicability to the clinical question. This step involves considering factors like study design, sample size, and the quality of the research methods used.

4. Implementation

After determining the best available evidence, nurses integrate it into their clinical practice. This may involve modifying care plans, treatment protocols, or patient education materials to align with the evidence-based recommendations.

5. Evaluation

Nurses continually monitor and evaluate the outcomes of their practice changes. This step ensures that the implemented interventions are achieving the desired results and allows for adjustments if necessary.

Benefits of Evidence-Based Practice

The adoption of EBP in nursing offers a multitude of benefits to both patients and healthcare professionals:

Improved Patient Safety

By relying on evidence-backed interventions and practices, nurses can reduce the risk of medical errors, adverse events, and complications. This leads to safer care environments and better patient outcomes.

Enhanced Quality of Care

EBP encourages nurses to provide care that is both effective and efficient. Patients receive treatments and interventions that have been proven to work, resulting in improved health and overall satisfaction with their care.

Professional Growth

Engaging in evidence-based practice encourages nurses to stay current with the latest research and developments in healthcare. This ongoing learning enhances their professional knowledge and skills, making them more effective practitioners.

Increased Job Satisfaction

Nurses who practice EBP often report higher job satisfaction. Knowing that their decisions are based on the best available evidence gives them confidence in their abilities and a sense of accomplishment in their role.

Frequently Asked Questions

How do I start implementing Evidence-Based Practice in my nursing practice?

To begin implementing EBP in your nursing practice, start by identifying a clinical question or issue you’d like to address. Then, follow the steps of EBP, including formulating a clear question, conducting a literature search, critically appraising the evidence, implementing changes, and evaluating outcomes. Collaboration with colleagues and mentors can also be helpful in this process.

What challenges do nurses face when adopting EBP?

Nurses may encounter challenges such as limited access to research resources, time constraints, resistance to change, and the need for additional education and training. Overcoming these challenges often requires dedication, support from healthcare organizations, and a commitment to lifelong learning.

Are there any resources to support Evidence-Based Practice in nursing?

Yes, numerous resources support EBP in nursing. These include online databases like PubMed and organizations like the Joanna Briggs Institute (JBI) and the Agency for Healthcare Research and Quality (AHRQ), which provide evidence-based guidelines and tools. Additionally, many universities and healthcare institutions offer EBP workshops and courses.

How can EBP impact healthcare policy?

EBP has the potential to influence healthcare policy by providing a solid foundation of evidence for decision-makers. When policymakers are informed by high-quality research and clinical evidence, they can develop policies that prioritize patient safety, quality of care, and cost-effectiveness.


Evidence-Based Practice in nursing is a fundamental approach that empowers nurses to provide the best possible care to their patients. By integrating the best available evidence, clinical expertise, and patient values, nurses can make informed decisions that enhance patient outcomes, reduce medical errors, and contribute to cost-effective healthcare. As the field of healthcare continues to evolve, EBP remains a critical tool for ensuring the highest quality of nursing care. So, whether you’re a seasoned nurse or just starting your nursing career, embracing evidence-based practice is a pathway to success in delivering optimal patient care.

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Strategic goal statements and outcomes

Strategic goal statements and outcomes

Note: You will use your care setting environmental analysis as the basis for developing your strategic plan in this assessment.


The feedback you received on your care setting environmental analysis has been positive. Consequently, you have been asked to select one of the potential improvement projects you noted in your analysis and create a full, 5–10-year strategic plan to achieve the desired quality and safety improvement outcomes. You will develop your strategic plan, using either an AI approach (addressing the design stage), or by building on your SWOT analysis and applying a strategic planning model of your choice.

How you structure your plan should be based on whether you are taking an appreciative inquiry approach or using a specific strategic planning model. Regardless of the approach you choose, the requester of the plan has asked that you address the key points outlined below in the strategic plan requirements. In addition, your plan should be 5–8 pages in length.

Note: Remember, you can submit all, or a portion, of your draft plan to Smarthinking for feedback before you submit the final version for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

Strategic goal statements and outcomes


Note: The requirements outlined below correspond to the grading criteria in the scoring guide, so at a minimum, be sure to address each point. In addition, you are encouraged to review the performance level descriptions for each criterion to see how your work will be assessed.

Writing, Supporting Evidence, and APA Style
  • Write clearly, with professionalism and respect for stakeholders and colleagues.
  • Integrate relevant sources of evidence to support your assertions.
    • Cite at least 3–5 sources of scholarly or professional evidence.
  • Format your document using APA style. An APA Style Paper Template and associated tutorial, linked in the Resources, are provided for your use. Be sure to include:
    • A title page and reference page. An abstract is not required.
    • A running head on all pages.
    • Appropriate section headings.
    • Properly formatted citations and references.
  • Proofread your writing to minimize errors that could distract readers and make it more difficult to focus on the substance of your analysis.

Strategic Plan

  • Develop strategic goal statements and outcomes that reflect specific quality and safety improvements for your care setting. You should have at least one short-term goal (just-in-time to one year) and one long-term goal (five years or longer).
    • Determine realistic timelines for achieving your goals.
    • Explain how your short-term goals support your long-term goals.

Note: For plans based on an AI approach, the goal statements and outcomes are provocative propositions that may be refinements of the positive, yet attainable, goals that you proposed during the dream phase of your inquiry. For plans based on a SWOT analysis, the goal statements and outcomes are specific, measurable, and applicable to the area of concern in your analysis for which you proposed pursuing improvements.

Strategic goal statements and outcomes

  • Justify the relevance of your proposed strategic goals and outcomes in relation to the mission, vision, and values of your care setting.
  • Analyze the extent to which your strategic goals and outcomes, and your approach to achieving them, address:
    • The ethical environment.
    • The cultural environment.
    • The use of technology.
    • Applicable health care policies, laws, and regulations.
  • Explain, in general, how you will use relevant leadership and health care theories to help achieve your proposed strategic goals and outcomes.
    • Consider whether different theories are more applicable to the short-term or long-term goals of your strategic plan.
  • Evaluate the leadership qualities and skills that are most important to successfully implementing your proposed plan and sustaining strategic direction.
    • Identify those leadership qualities and skills that are essential to achieving your goals and outcomes and sustaining strategic direction.
    • Identify those leadership qualities and skills that will have the greatest effect on the success of your plan.


As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Strategic planning models aid in setting goals, establishing time frames, and forging a path toward achieving those goals. Consider the strategic planning models you are familiar with:

  • Which model would you choose to create goals and outcomes that could address the area of concern you identified in your Assessment 1 SWOT analysis?
  • Why is this model the best choice among alternatives?
  • How does goal setting through appreciative inquiry provocative propositions differ from goal setting in the strategic planning model you selected?



Strategic Planning


Selection of an ideal strategic plan involves establishing attributes that define its contribution to solving a target crisis. In this case, the objective of the strategic plan is to improve quality of healthcare and advance safety prospects in a healthcare institution. As a result, the input of the selected strategic plan comprises of the potential possibility of enhancing service delivery while ensuring the protection of interests shared by parties involved. According to Wolf and Floyd (2017), a strategic plan should focus on aspects such as operation depth, resource availability, and ease of policy implementation. Hence, deciding on an ideal strategic plan involves evaluating the demand for resources and the practicability of attached ambitions. Most healthcare organizations would further reflect on the nature of support associated with the model while aligning expectations on the performance perspectives and input of validated service models.

Developing Strategic Goal Statements and Outcomes

Deciding on a strategic plan involves appreciating depth of developed deliverables concerning the expectation and execution of the project. Perspectives such as identification of areas of need, formulation of implementation plan, and subsequent appraisal of enforcement mechanism would allow attainment of established execution period (Noble & Nwanekezie, 2017). However, impression of the strategic plan extends beyond expectations of performance to include further perspectives such as formulating anticipated outcomes through the input of appraisal mechanisms.

Strategic goal statements and outcomes

The main strategic goal of the strategic plan is to improve quality of healthcare and advance safety prospects in a healthcare institution. The plan would involve appreciating depth of concerns in regards to implementation of operational tactics and subsequent improvement of healthcare needs. Wolf and Floyd (2017) support those introducing requirements that assist in achieving to improve quality healthcare and increase patient safety in the healthcare institution. In the current case, since conditions associated with the plan include safety and quality, their attainment involves advancing skills of the staff through training as well as improving available resources (Newman, 2016). Thus, the strategic plan would ensure improved aspects in features such as healthcare delivery and provision of health care services. The organization would provide nurses and physicians with skills that match the expectations of required services (Wolf & Floyd, 2017).

There are weaknesses and gap that would affect setting the long-term and short-term goals. Some of the factors to consider include the level of technology, customer relations and quality of management in the organization. Besides, getting to know your competitors’ investment level is also critical when setting the future goals of a company. The level of investment in the goals should be higher than that of the competitors in order for the organization to have a competitive advantage. Thus, setting realistic and achievable goals based on the competition, current goals of the organization and the recent results and trends is important.  Involving the company’s lower level manager and employees into decision making may prove to be important in developing strategies that can ensure the company achieves the long term and short-term goals.

Long-Term and Short-Term Goals

The long-term goal is to improve the quality and safety of health care services. The main derivable is to improve safety levels and improve service quality based on the mission and vision of the company. The mission statement aims to provide quality patient care with implacable attention to an unparallel commitment and passion, patient safety, and clinical excellence in order to provide the best health care services. The vision statement is to provide supportive and excellent health care services, that enrich patient’s life in terms of safety, holistic care, and quality care and services.
It is important to consider a variety of factors that might affect the achievement of the set goals. Considering the information given by the senior management and employees during benchmarking may be critical in setting future goals that would guarantee organizational performance and success. The recent results and trends of the company should be used to develop future goals. For example, the statement of financial position of the organization can help in setting goals that are measurable, achievable and realistic by ensuring that they are not beyond the company’s capabilities to attain them. Therefore, if the organization is not updated on the trends, it may end up setting future goals that are difficult to achieve.

Strategic goal statements and outcomes

The short-term goal that would guide the strategic plan includes

  1. Study quality challenges in healthcare delivery
  2. Study safety challenges in healthcare delivery
  • Develop possible solutions
  1. Identify a team to implement developed solutions.
  2. Test efficiency of the team
  3. Test comprehension for the task
  • Improve productivity through training nurses
  • Promote access to quality services
  1. Involve stakeholders as part of the project

Timelinefor Achieving Goals

Efficiency of the developed strategic plan manifests the appraisal mechanism that allows possibility of making adjustments while ensuring set performance goals are attained. Ideally, implementation process would follow a cyclic model that spans across the ten years of execution. Each complete cycle will take 40 months to complete, with their distribution across the four phases of strategic plan taking a 1:1:2:2 ratio models. The short-term goals would help to integrate the expectations of practitioners and health care administration through a continuous exchange of feedback. Baumgartner and Rauter (2017) assert that feedback would allow realization of prospective attributes such as insight development and expectations of performance by respective practitioners. Adjustments in goals such as allow the participating teams stakeholders to focus on implementation criterion, would help to achieve the achieving the strategic results (Baumgartner & Rauter, 2017). Modeling such expectations on the demands of health care facility would allow the eventual attainment of routine long-term goals and objectives associated with the strategic plan.

Perspectives, which include the outcomes and their relation to established deliverables, tend to manifest through detailed evaluation of the plan. At the same time, an appraisal of the project through a SWOT analysis allows visualization of its potential additions towards realization of elemental objectives of quality and safety.

SWOT Analysis of the Strategic Plan

The strategic plan may need to reflect on expectations of the health care facility, along with features of quality and safety. As a result, SWOT analysis of the plan would reflect on expectations of each input along with the two models. According to McDonald (2016), proposing adjustments along such dynamics allow appreciation of the potential associated with the task and adopted strategic plan. A further reflection on interlocking dynamics of quality and safety enables visualization of the ideal input of the project from an operational perspective. Concepts geared towards attainment of the program need to manifest their interchange potential when reflected against aspects such as quality and safety.


The strengths of the identified strategic plan manifest through the input of advanced study on the challenges and the availability of adequate resources to address their management. In essence, the strategic plan comprises a testing phase that assists in identification of shortcomings of the effective solution, along with dynamics of quality and safety. Also, the ratio adopted in guiding implementation model allows allocation of adequate time to involve phases such as execution and testing.


The plan comprises of time-consuming phases that challenge the effectiveness of the implemented measures. Additionally, the input of ideal strategic data, such as the need to identify a reliable team may face challenges of obsoleteness during execution due to changes in the expected outcomes. Ideally, such changes may manifest from the advances in the industry. Similarly, the plan does not focus on redefining the execution process about changes associated with the external environment.


The concern of adjustment rigidity stands to benefit from the autonomous prospects associated with each phase. Primarily, the operations within a period involve inputs that distinguish the implementation course along a zoned process. Thus, the operations of each stage only fetch guidance from the previous phase. As a result, there exist viable possibilities of making adjustments through invoking fast-tracked modifications through the earlier steps. The engaged changes would then initiate the execution phase as structural or operational adjustments.


The implementation of the suggested strategic plan faces the threat of inadequate resources, which may lead to the potential inclusion of incompetency elements during execution. Arguably, the concern of resources manifests during the commissioning of the plan’s actualization phase. However, the issue remains relevant after the development phase since the strategic plan suggests different inputs to redefine the solution development and established deliverables.

Strategic goal statements and outcomes

The Relevance of the Proposed Strategic Goals and Outcomes

The main goal in a healthcare setting is to provide the best treatment interventions and promote meaningful outcomes thus improving the quality of life. To improve the safety and quality of goals in a healthcare setting, essential components for quality improvement programs must be considered. For the goals to be attainable they have to be safe, equitable, efficient, and be centered on patient needs. The goals will ensure high-quality medical services. This is another positive aspect of the healthcare clinic. Therefore, the need for the plan is to ensure that the main aspects and dimensions get achieved. It, therefore, increases the need to improve the quality of healthcare and reduce the readmission of patients, improve patient satisfaction, ensure patients are not left without being seen, ensure cleanliness and quietness of hospital, reduce outpatient wait time, reduce clinical error ratios, and reduce occurrence of hospital-acquired infections, within different departments within the organization.

The Ethical, Cultural, Technological Environment and Applicable Health Care Policies, Laws, and Regulations

Cultural diversity is a critical factor that must be considered when caring for patients. The health care facility would consider the concept of cultural competence to guarantee patient collaboration with the nurses during treatment to improve the company’s rate of underperformance (Dreachslin et al., 2017). The strategic goals would improve cultural competency since diversity of the patients within the organizations would be critical in providing quality and safety care. However, a lack of a sustainable culture that guarantees cultural competence and lack of cultural beliefs and values of patients would influence effective delivery of care and achievement of the strategic goals.

Strategic goals and outcomes will also ensure the confidentiality, ethics, and feasibility of the treatment process (Dreachslin et al., 2017). The health care institution must figure out how issues around care of patients and their privacy, consent, and the operability of the intervention to reduce the readmission rate in the organization. However, lack of informed consent and autonomy of patients may influence the strategic goals since nurses are required to ensure ethical practices during healthcare delivery.

The strategic goals and outcomes will be ensured through implementing EMR system as a Health Information Technology in the health care institution. EMR helps to manage patient’s information, including medical history and treatment, which will meet the objectives of quality and safety.  However, lack of cooperation and technical training of nurses and physicians on how to use the EMR system to improve healthcare delivery may influence the achievement of strategic goals.

The Public Health Act advocates for quality and holistic care from both the local and state government in order to improve quality of life (Health, 2018).  Besides both the local and state government are tasked with funding healthcare institutions, and developing policies that assesses and evaluates patients’ outcomes, which are based on federal and local government goals (Health, 2018).  Therefore, healthcare delivery must be aligned to legal and ethical standards based on the federal, state, and local legislations to act as an oversight to ensure all the strategic goals and outcomes are achieved.

Relevant Leadership and Health Care Theories to Help Achieve Proposed Strategic Goals and Outcomes

Relevant leadership and health care theories can help achieve proposed strategic goals and outcomes in the organization. Theories ought to be related to explicit petitions as well as mediation segments to be actualized in the plan. The tools selected also need to coordinate negotiations and link back to the theory.

Transformational leadership is the leading theory that will help achieve proposed strategic goals and outcomes in the organization. The theory was developed by James MacGregor Burns (Wolf& Floyd,2017). The theory states that transformational leadership links the leaders and their supporters to ensure they cooperate and support each other to bring about respectful relation between the leader and the follower.  MacGregor Burns also provides critical issues that were provided by Bernard M. Bass, who consider that transformational leaders should be visionary. Leaders must urge their followers to change their motivations, suppositions, and desires to ensure they share similar goals and objectives to improve health care delivery (Wolf & Floyd, 2017).  MacGregor mentioned that original thought, scholarly incitement, solid inspiration, and perfect effect are the main parts of transformational leadership that can help improve the quality and safety of care (Wolf& Floyd, 2017).


Participative leadership or vote based leadership is another leadership theory that can help achieve proposed strategic goals and outcomes in the organization. The theory requires followers to take interest in leadership positions and ensure everything goes as planned (Wolf& Floyd, 2017). The style of leadership is primarily used in organizations such as educational institutions, health care institutions, pharmaceutical firms, and data innovation organizations. Therefore, the theory encourages the nurses and physicians to share their thoughts and objectives on the path the leadership should follow. Researchers have shown that nurses and physicians who are part of participative leadership style are capable of performing their roles and responsibilities efficiently.

Transactional leadership is based on developing specific objectives and goals to spur supporters and empower them towards a course (Xu, 2017). The theory considers that leaders and their teams of employees or followers enter an agreement by giving rewards to the most performing team members by offering virtually a check in return, time off, compensation, and benefits.  In cases where the goals are not met, the leadership uses negative rewards such as providing severe punishment for team members who do not complete their duties. Thus, transformational leadership considers that leadership desires should be achieved by their devotees to keep up their vision and social standard being pursued (Wolf & Floyd, 2017). Transactional leadership also portrays duties and desires of the leaders and devotees. Likewise, the style guarantees that the way of life inside a unit is kept up, with the guidelines and social standards carefully pursued to help achieve proposed strategic goals and outcomes in the organization.

Strategic goal statements and outcomes

The major gap of transformational leadership and transactional leadership theory are that the relationship between the leader and the follower may lead to power struggles and oppositions, which reduce the value system congruence between the leader and the follower. Evidence has shown that transformational leadership requires agents to convince people about a shared vision, without which followers may lack motivation to achieve their goals. Building a connection of trust with their followers may not be established if the leadership is not open, fair, and honest, and does not involve them in decision-making processes.

When comparing the two theories, it is important to note that participative leadership has low motivation, and it takes a long time for decision-making (Xu,2017). On the other hand, transactional leadership theory cannot be successful without providing positive rewards such as a bonus, time off, health benefits, or simply a paycheck in exchange for the completion of a task.

Leadership Qualities and Skills Important for the Proposed Plan

Assessing the leadership characteristics and abilities that will be most critical to executing a strategic plan effectively is essential to guarantee that strategic plans are effectively actualized. There are necessary abilities and characteristics that leaders must have to set up a reasonable and crucial strategic planning process (Wolf & Floyd, 2017). McDonald (2016) considers that leaders should have a strong vision and personality to motivate their followers to adjust expectations, opinions, and inspirations to work toward common goals.  Leaders should act as facilitators rather than dictators to facilitate idea generation and sharing of information with the end goal of arriving at a decision. Besides, leaders should involve followers in the decision-making process, while still maintaining control. Leaders need to be open, fair, and honest with the staff and by motivating them to be independent in their decision-making (Wolf & Floyd, 2017). This impacts follower satisfaction and commitment to the organization. Leaders must also use effective communication to lead the staff to achieve ultimate goals. Lastly, leaders should possess great self-confidence to firmly believe in their vision (Wolf & Floyd, 2017). Thus, the leadership qualities and knowledge will help improve patient outcome through the provision of quality care and ensure patient safety.

Strategic goal statements and outcomes


Building up a dependable strategic plan includes recognizing the directing target to aid the assurance of the long-haul expectations. Deciding on an ideal strategic plan also involves evaluating the demand for resources and the practicability of the attached ambitions. Projections concentrating on the desires for security and nature of the offered administrations permit the enrolling of a practical procedure towards execution dependability. Viewpoints, for example, time and other substantial assets, would help with deciding the destinations to list under each period of the strategic plan. In any case, accomplishing the whole procedure would include valuing the elements of the administration conveyance strategy while analyzing the potential zones requiring conceivable modifications. Without a doubt, an effective strategic plan contains routine testing of the result as well as making adjustment through a full usage cycle.




Baumgartner, R. J., &Rauter, R. (2017). Strategic perspectives of corporate sustainability management to develop a sustainable organization. Journal of Cleaner Production, 140, 81- 92. Doi: 10.1016/j.jclepro.2016.04.146.

Dreachslin, J., Weech-Maldonado, R., Jordan, L., Gail, J., & Epané, J. P. (2017). Blueprint for Sustainable Change in Diversity Management and Cultural Competence: Lessons From the National Center for Healthcare Leadership Diversity Demonstration Project. Journal of Healthcare Management, 171-185.

Health, M. D. (2018, January 24). Local Public Health Act. Retrieved from

McDonald, M. (2016). Strategic marketing planning: Theory and practice. In M. J. Baker, & S., Hart (Eds.), The marketing book (7th ed., pp. 86-120). New York, NY: Routledge.

Noble, B., &Nwanekezie, K. (2017). Conceptualizing strategic environmental assessment: Principles, approaches, and research directions. Environmental Impact Assessment Review, 62, 165-173. Doi: 10.1016/j.eiar.2016.03.005.

Wolf, C., & Floyd, S. W. (2017). Strategic planning research: Toward a theory-driven agenda. Journal of Management, 43(6), 1754-1788. Doi: 10.1177/014920631347818

Xu, J., & Xu, L. (2017). Fault Diagnostics. Integrated System Health Management, 247-317. Doi:10.1016/b978-0-12-812207-5.00006-7


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Community Health in Nursing

Community Health in Nursing

A quality initial response to the Discussion Question should be roughly 400 words.

Discussion Question:

Answer the following questions honestly (safe space).

  1. How does a person’s difference in age, culture, race, gender and living situation impact your comfort as a nurse in communicating with them?
  2. While growing up, how were OAs treated in your family, culture, community and in society (identify the year range).

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.





Community Health in Nursing

Question One

Navigating the unique needs of patients is very unnerving. So much so, that I am in constant fear of offending my patients members of their families. The fear mostly stems from not knowing about the crucial cultural or religious practices of my patients or witnessing aspects of their culture that goes against my personal beliefs and convictions. This fear affects my everyday routines including maintaining eye contact, touch or observing verbal and non-verbal communication with patients. When interacting with patients from different cultures, I am mindful of my mannerisms and I try to be respectful. Communicating with the elderly is extremely challenging and requires special skills. To improve my communication techniques with this group, I took it upon myself to pursue extra training. I also acquired tips to effectively communicate with younger patients. Time is always a consideration when conversing with younger or older patients. To facilitate communication, I have learnt to be patient, explain myself clearly and involve family members in the decision-making process. As a nurse, I struggle with communicating or assessing individuals who identify outside the traditional gender binary of man or woman. When dealing with transgender patients, I have to respect their identity by using correct terminologies in all forms of communication (Walsh and Hendrickson, 2015). As a nurse, I play a critical role in delivering essential health services to my patients and the community in general. Effective communication is at the core of this goal. Therefore, I make a conscious effort to increase communication with patients and their families to lessen medical errors and create positive outcomes for everyone involved.


Question Two

I remember when growing up, my grandmother at 52 was still working in human resources, at a research company. Her fast-paced career required her to travel, set up meetings and participate in training activities. While a majority of her age mates were settling down and planning their retirement, my grandmother went back to school and completed evening classes in nursing. She refused to slow down and as such, was held in high regard in our family. However, there was a negative cultural attitude towards the elderly and aging while I was growing up. Society would glorify youth while the elderly were often associated with hostility and grumpiness. Growing up, comedies and movies in general painted a negative picture of the elderly. They were never conveyed as being full of life, of being the best employees like my grandmother, or in other myriad of roles that the youth were given. Age stereotypes were often accepted. Signs of natural aging were strongly fought against and were viewed as sources of shame and embarrassment. As such, I saw many people turn to plastic surgery to fight any appearance of aging. In our home, my grandparents’ experience and wisdom was highly respected. They were a source of wisdom and offered to support to all members of our family. When asked, my grandmother often reports that her life is more satisfying now that she is older than when she was younger. However, older adults are still subject to cultural attitudes that devalue them and make them feel invincible.




Walsh, D. and Hendrickson, S.G. (2015). Focusing on the “T” in LGBT: An Online Survey of Related Content in Texas Nursing Programs. J Nurs Educ, 54(6), 347-351.



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Vargas family-Narrative Therapy

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



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.


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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