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 I NEED A RESPONSE TO THIS ASSIGNMENT

ZERO PLAGIARISM

2 REFERENCES

Diagnosis to Consider and Codes

            Major Depressive Disorder, recurrent moderate F33.1

            Generalized anxiety disorder 41.1

Rationale for Diagnosis

            Major Depressive Disorder, recurrent moderate-The patient meets at least the required five criteria needed for a MDD diagnosis (American Psychiatric Association, 2013). He is in a low mood for a better part of the day (American Psychiatric Association, 2013), most days as he spends the day lying on the couch. He has stopped volunteering at a nursing home, which meets marker number two: a decrease of pleasure in activities (American Psychiatric Association, 2013). He also has both insomnia and hypersomnia because he cannot fall asleep and then spends the day on the couch (American Psychiatric Association, 2013). Next, he has a fatigue in which he believes himself to be moving in slow motion (American Psychiatric Association, 2013).  Lastly, he has been having recurrent thoughts regarding death, as he has had a recent diagnosis of prostate cancer, and his father’s current health status (American Psychiatric Association, 2013).

            GAD- He meets the criteria for this because he has had anxiety and worry for over six months, he has difficulty controlling the anxiety, and the anxiety is manifested by being fatigued easily, with sleep disturbances, and restlessness when he attempts to fall asleep (American Psychiatric Association, 2013).

Tests and Tools

            For MDD, I would use the Hamilton Depression Rating scale or the Patient health Questionnaire.  I would also check the T3, T4, CBC, CMP, and A1C of the patient to rule out any external factors.  For GAD, I would use the Beck Anxiety Inventory (BAI) or the GAD-7 for measurement of the symptom’s severity.

Differential Diagnosis to Consider

For MDD I would consider Posttraumatic Stress disorder and adjustment disorder (American Psychiatric Association, 2013). I would also consider anxiety disorder due to another medical condition (American Psychiatric Association, 2013).

Treatment Strategy and Rationale

            For this patient, I would recommend therapy, to include CBT, and possibly family therapy. Recommendation of these items addresses the depression head on, including the family may be beneficial to the patient’s treatment (Depression, 2020). I would like to trial bupropion with this patient and recommend an increase of activity with alternative approaches like seeking religious counseling (if he is religious). I would also recommend attending a support group for the loss of his wife and the impending death of his father. 

Safety

With this patient, I would develop a safety plan to put in place in case the patient developed and SI.  I would also identify a person close to the patient, who would be willing to listen to the patient in a crisis or would be able to hold possible weapons for the patient.  I would also provide crisis line numbers to the patient in the event of a crisis occurring after hours.

Psychopharmacology

             Since this patient has trialed Effexor, Prozac, Zoloft, Lexapro and duloxetine, I would trial bupropion for this patient I would titrate up to 300mg per day to see if there has been any improvement in mood and adjust or switch from that point. 

Diagnostic Tests

            I would use the PHQ depression scale and the HAM and the GAD-7 tests to monitor and track the progression or the digression of the diagnosis.

Psychotherapy

            I would begin with supportive listening and CBT.  If after a few sessions, this did not provide any relief, I would adjust my approach to fit the patient’s needs.

Psychoeducation

            This would be most advantageous to the patient because this would empower the patient to understand about depression, giving the patient an opportunity to talk about their experiences and to be a part of their treatment plan (Depression an Information Guide, 2020). If he includes his family, it would also be beneficial to them by learning about the signs and symptoms of depression and what they can do to assist them (Depression an Information Guide, 2020).

Standard Guidelines

            For MDD, I would establish a therapeutic alliance, complete a psychiatric assessment, evaluate the patient’s safety, establish an appropriate treatment setting, coordinate and collaborate with other providers (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020). I would continue to monitor and adjust treatments as necessary to his psychiatric status and integrate measurements such as the PHQ (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020). I would also provide education to both the patient and with approval, the patient’s family (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020).

Clinical Note: Is depression a normal part of aging?

Some would consider depression to be a normal part of aging. However, that is a common misconception because people become more susceptible to sadness and anxiety (CDC, 2020). This increased risk may be from chronic health conditions, misdiagnosis, and undertreatment of symptoms (CDC, 2020). Being able to accurately identify and treat depression in an aging person needs to be a fundamental part of a PMHNP’s repertoire. Knowing the signs and the symptoms in an aging patient is key to identifying and accurately diagnosing depression.  

Reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders             (5th ed.). Washington, DC: Author.

Depression an Information Guide (2020). [Ebook]. Retrieved from http://www.camh.ca/-  /media/files/guides-and-publications/depression-guide-en.pdf

Depression is Not a Normal Part of Growing Older | Healthy Aging | CDC. (2020). Retrieved 28 October 2020, from https://www.cdc.gov/aging/mentalhealth/depression.htm

Depression | NAMI: National Alliance on Mental Illness. (2020). Retrieved 28 October 2020,      from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Depression

Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice     Guidelines for the management of Depression. Indian journal of psychiatry, 59(Suppl 1),                   S34–S50. https://doi.org/10.4103/0019-5545.196973

Practice Guideline for the Treatment of Patients with Major Depressive Disorder. (2020).             [Ebook]. Retrieved from             https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.p              df

reply 1

The term “negotiate” implies conferring with another to reach a compromise. Conflict exists if health professionals blindly advise patients, expecting them to follow the recommendations without understanding patients’ feelings or identifying barriers to patient adherence. Negotiation identifies areas of agreement and disagreement and provides a forum for discussion of solutions. (Falvo, 2011). Patient education is one of the important roles of nursing. Patient teaching can be effective only if patient understand and agrees to follow the instruction. Negotiation is a way to work collaboratively with the patient to establish mutually acceptable goals and problem solve to assist patients’ ability to reach them. Negotiation helps to create effective teaching learning environment. Back in the day, the doctor was considered the last word when it came to a patient’s decision making. Today, physicians share the decision-making with their patients because patients have other things going on in their life that they must include in their healthcare decisions such as careers, families, time constraints and other realities. They need to work with physicians to establish effective, individualized treatments that works for the patient and the provider. The term negotiation, when applied to health care, indicates that a back and forth discussion is occurring where proposed treatment options are presented by the health care professional, considered by the patient, and either accepted, rejected, or altered to fit the patient’s needs (Falvo, 2011). By negotiating with patients, physicians and patients can reach a healthy decision for both parties.

In my practice with the increase of social media on the public’s decisions on healthcare matters, it is important to talk to the patient about their fears and reasons why they want or do not want. By educating them and providing them with evidence-based practice but still letting them make the decision will make them feel more included in the decision process.

Falvo, D. R. (2011). Effective patient education: A guide to increased adherence. (4th ed.). Jones & Bartlett Publishers. Retrieved from: https://viewer.gcu.edu/RQBKXW

reply2

According to the reading “negotiate implies conferring with another to reach compromise” (Falvo, 2011). The reading also points out there are different levels of negotiation by providers. Some (providers) may feel that negotiation interferes with what they consider to be the major goal of patient teaching: to offer information that will help patients improve or maintain health (Falvo, 2011).

Negotiation is part of building a partnership between the provider and patient. Negotiation is a way to work collaboratively with the patient to establish mutual goals and identify problems. Identifying the problems will allow patient’s the ability to reach the goals (Falvo, 2011). Providers also can find areas in the treatment plan the patient may not agree with, this important because this correlates with compliance as well as expectations of outcomes.

I would say that negotiation is a tool that can better or assist in relationships/partnerships between providers and patients. When providers are willing to accept that patients as partners, listen to their side of things and negotiate or meet somewhere in between there is responsibility on both parties. Patients must be honest with providers however and providers must be more flexible. Although the provider is expected to communicate and educate the patient is also responsible for their actions such as following the treatment plan.

An example would be a patient sees a physician the physician says the patient has high cholesterol. Educates on what this finding means, the risks, and suggests medication to correct the problem. The patient voices that she doesn’t want to take medication for the high cholesterol. The physician than explains alternatives to decrease the cholesterol. The patient chooses a non-medication route, the physician then based off this tells the patient they have one month to decrease their cholesterol. The patient and provider agree on the number expected for cholesterol in one month. The physician suggests that the patient decreases trans fats in their diet, adds fiber, adds exercise, and completes smoking cessation (Thorpe, 2017). If the patient goes back and there is not a change the physician tells the patient the medication will need to be started. The patient agrees. The key is now that the patient must be honest whether or not they held them self-accountable and made changes or not when following up. The patient also must express any concerns or difficulties they face with the provider. If the cholesterol is not lower the patient must also follow through on their part of the negotiation.

Critical thinking: Negotiation works in healthcare like it would in any type of relationship. If you tell someone everything is my way and I don’t care about what you think. Most likely that person isn’t going to do what you ask compared to if you said ok, I could see your point can we find a common ground to a solution we agree on. This type of relationship is beneficial for the provider and patient to increase better patient outcomes. Another benefit is the responsibility on the patient as well as the provider. The roles of patient and provider have changed and allows many different levels of acceptance as well as ways to in cooperate better health and patient centered care.

References:

Falvo, D.R. (2011) Effective patient education: A guide to increased adherence. Retrieved from http://gcumedia.com/digital-resources/jonesandbartlett/2010/effective-patient-education_-a-guide-to-increased-adherence_ebook_4e.php

Thorpe, M. (2017). 10 ways to naturally lower cholesterol. Retrieved from https://www.healthline.com/nutrition/how-to-lower-cholesterol

please write at least 200 words about : 

Staffing is such an integral part of leading and managing in nursing.  There are many factors to consider when deciding how many nurses are needed to provide safe patient care.  Look at the models in your reading in Chapter 13.  Reference a professional nursing journal article within the last 5 years supporting a model’s staffing efficacy and discuss key points of how that model takes patient safety into consideration.  

Upload your article with your post. 

Please see the attachment 

1 discussion

1 journal 

What’s your response to this dq??

During my practicum, the safe transition of medical was a problem faced by the organization. Transition of care refers to the movement and coordination of care from one setting to another (AHRQ, 2018). How can we provide a safe transition of care for all patients? The whole team (doctors, nurses, case managers, PT/OT, pharmacist, dieticians, and specialist) plays a critical role in planning for a safe discharge and ensuring a smooth transition of care from hospital to home or other care settings, which should start on the day of admission. Care providers must communicate important information to the patient, families, caregivers, and among themselves in a timely manner. Physicians must ensure that patient understand their medical conditions/plan of care, coordinate patient’s health care to various settings and providers and receive enough knowledge and resources upon discharge to home or other healthcare settings (The Joint Commission, 2012). Case managers collaborate with the interdisciplinary team to discuss patients’ needs such as SNF placement, home health care, DME, transfer to high level of care, home PT/OT, order medical supplies, IV antibiotics, and ensure patient has a safe place to recover. Nurses must ensure that patient/families/caregivers receive a clear discharge instruction including recommendations, medication regimens, follow-up care, education on self-care, warning signs of worsening conditions, who to contact in case of emergency, and how to promote health and prevent illness in the patient’s preferred language (The Joint Commission, 2012). Providing a safe and effective transition of care from the hospital to home or other health care settings prevent readmission and adverse events, which is the care team’s responsibilities.

  The IOM published report, “Future of Nursing: Leading Change, Advancing Health,” makes recommendations for lifelong learning and achieving higher levels of education.

In 1,000-1,250 words, examine the importance of nursing education and discuss your overall educational goals.

Include the following:

1. Discuss your options in the job market based on your educational level.

2. Review the IOM Future of Nursing Recommendations for achieving higher levels of education. Describe what professional certification and advanced degrees (MSN, DNP, etc.) you want to pursue and explain your reasons for wanting to attain the education. Discuss your timeline for accomplishing these goals.

3. Discuss how increasing your level of education would affect how your competitiveness in the current job market and your role in the future of nursing.

4. Discuss the relationship of continuing nursing education to competency, attitudes, knowledge, and the ANA Scope and Standards for Practice and Code of Ethics.

5. Discuss whether continuing nursing education should be mandatory. Provide support for your response.

 Try to avoid using first person, but this can be difficult as you are talking about yourself. You can instead say “a person has…” or “one has interests”…or “this writer…” 

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.  

Prepare this assignment according to the guidelines in the APA Style Guide.

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.

I NEED A RESPONSE TO THIS ASSIGNMENT

2 REFERENCES

ZERO PLAGIARISM

Group psychotherapy is a psychotherapeutic treatment modality in which a group of people with the same or similar psychological and/or psychiatric disorder are composed and come together in a group, with the guidance of a professional therapist, to help one another to effect behavioral and/or personality change. “It is a modality that employs a professionally trained leader who selects, composes, organizes, and leads a collection of members to work together toward the maximal attainment of the goals for each individual in the group and for the group itself.” In group psychotherapy, certain group properties such as mutual support can be used to help provide relief from psychological and/or psychiatric disorders/problems and also afford support to group members with feelings of isolation and desperation. 

Group therapy with older adults can be a challenging moments owing to the fact that aging can be a moment or stage in the development of humans which is marked by a decline in not just the physical well-being, but it is also characterized by multiple social, emotional and psychological impairments. “This focus on extraordinary losses and the potential for diminished functional capacity may be a major hurdle in confronting our own biases and countertransference reactions as group psychotherapists working with older adults.” Despite the various types psychotherapeutic approaches in group psychotherapy, certain core principles as well as assumptions remain peculiar to it and these core principles and assumptions must be respected for a therapeutic progress to be made. 

Group Description.

The psychotherapy group is made of 4 participants who started psychotherapy group with a duration of 10 weeks. Group members met once a week with each session lasting for about 45 minutes. Group members had diagnosis with a DSM-5 criteria ranging from Schizophrenia, bipolar disorder, anxiety disorder, major depression. Age ranges between 60 to 70 years old. two of the group members had attended a group psychotherapy before while the rest were all new to group psychotherapy. Yalom, notes “Although the frequency of meetings varies from one to five times a week, the overwhelming majority of groups meet once weekly.” the group was a closed group because once it’s creation was done, no new membership was allowed.

Stage of group.

This psychotherapy group was at the norming  stage because group members had become more aligned with the group, and can work together toward the realization of the group goals common to all members and to the group in general. Wheeler, K. (2014) note “Group members become more aligned as a whole, and identify and work to a common goal.” Members at this stage of group existence have developed a sense of trust for each other and among group members. At this stage, members were contributing ideas and helping one another with their problems. They shared ideas on their individual problems and how they manage to solve their own problems. At this stage of the group, some members may form cliques and so exclude some other members of the group. The psychotherapist must be vigilant at this time to discourage the formation of such subgroups for the interest of the group.

Challenges or Issues of the group.

When people come together in a group, there is bound to be some form of challenges or problems within the group. Some of the challenges faced by psychotherapy group include the perceived goal incompatibility. The fact that different people with various psychological problems entails a different set of goals which may nit be compatible with the goals of the rest of the group members. “One important source of perplexity and discouragement for clients early in therapy is perceived goal incompatibility.” Yalom, D.I (2005). In such situation, group members may may not align the group goals with their individual goals. Some other challenges in group therapy may include lack of immediate comfort. “Clients may be frustrated by not getting enough air time in the first few minutes.” Yalom, D.I (2005). Subgrouping and extragroup socializing is another challenge that may be experienced at any stage of a group psychotherapy. The psychotherapist has the responsibility in such situations to acknowledge the differences that might exist within the group, encourage members to focus on the group goals as well as model group activity towards creative problem-solving approach. 

Therapeutic approach employed in the group.

Psychotherapeutic approaches used included cognitive behavior group therapy, in which group members had the opportunity to verbalize feelings, contribute to the problem-solving and group cohesiveness. The psychotherapist also help and guide group members through psychoeducation so group members can understand the effect of maladaptive thinking or thought process on individual behaviors. knowledge sharing among group members was also used to help group members achieve group goals. 

Recommendations.

In group psychotherapy, the therapist must identify factors that could impact group members contributions, affect group cohesiveness and attainment of group goals. Giving members the opportunity for a structured socialization helps to instill onto members the sense of positive fortification. Keeping group sessions short and brief will help group members stay focused as well as able to retain what is learned in the group.

References.

Bonhote, K., Romano-Egan, J., & Cornwell, C. (1999). Altruism and creative expressions in a long-term older adult psychotherapy group. Issues in Mental Health Nursing, 20(6), 603-617. Retrieved from 

https://doi-org10.1080/016128499248394

Sadock, J. B., Sadock, V.A., & Ruiz, P. (2015). Kaplan & Sadock’s Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry. 

             (11th ed.). Phialdelphia, PA: Wolters Kluwer.

Wheeler, K. (2014). Psychotherapy for the Advanced Practice Psychiatric Nurse. A How-to Guide for Evidence-based Practice.

             (2nd ed.). New York, NY: Springer Publishing Company.

Yalom, I.D. (2005). The Theory and Practice of Group Psychotherapy.

              (5th ed.). New York, NY: Perseus Books Group.

1) Identify a population to assess and develop an evidence-based, primary care health promotion recommendations to deliver in their own communities (Ex: Hispanics-Diabetes, African – Americans and Prostate Cancer, etc).

This an example of an student Posting: 

 Each population has some specific health issues that can require health promotion programs. American Indian population attracts attention in this context because of the specific state of affairs. Although this population has several main health issues for which health promotion can be required, all these issues can be solved by following the directions that cause a generally healthy lifestyle.

According to the U.S. Department of Health and Human Services (n.d.), the main issues in the American Indian population is diabetes, obesity, and tobacco use. Even though those are three different issues, the health promotion for solving them is quite similar. Such promotions have to be generally focused on a healthy lifestyle. This means healthy nutrition – less fat and sweet food and more healthy food and balanced nutrition. The next item is physical activity – starting with such common advice as more walking and ending with making sport a healthy habit. This advice is also helpful for coping with tobacco use. This habit often appears when a person has stress with which it is hard to cope. However, sport is helpful in decreasing the level of stress, and therefore, it can be useful to break the smoking habit. Therefore, one can see that advice directed on causing a healthy lifestyle is helpful for coping with health issues, widespread in the American Indian population.

This way, one can see that even though the American Indian population has several main health issues that can require healthcare promotion programs, all these issues can be solved by following the directions that cause a generally healthy lifestyle. The issues of diabetes, obesity, and tobacco can be solved with healthy nutrition and physical activity.

-PLEASE USE APA STYLE 6TH EDITION

-AT LEAST 300 WORDS

-2-3 REFERENCES NO MORE THAN 5 YEARS OLD

 Within your response you’ve shared, “My Nursing Philosophy mainly focuses on understanding the environment of the individual or the group at my care”. Reflecting on this theory and your role as a professional nurse, how have you demonstrated the incorporation of elements taken from this nursing theory? What does this look like and how has it influenced the care that you provide to your patients? 

1 page include at least 1 reference