Cultural Group Exploration Assignment
Cultural Group Exploration Assignment (in-text citation and APA format 7th edition) Required.
Understanding the impact of culture on the health beliefs / practices of a client is an important component of assessing, planning, implementing and evaluating comprehensive nursing care. To provide culturally competent care is a worthy goal. Insensitivity to a client’s culture may render interventions fruitless.
Purpose: The PURPOSE of this assignment is to develop in the learner an awareness of the health beliefs / practices of a culture different from their own.
Guidelines: Download the Cultural Exploration Guidelines before you start the activity and refer to it as you work. Submit completed table along with reference page to your faculty mentor through the Submissions tab and then post it in your group discussion.
Legal and Ethical Considerations for Group and Family Therapy
According to Locher et al. (2019), psychotherapy is an evidence-based psychological intervention that tackles behavioral or psychiatric disorders. Several different approaches may be used to take form in either individual or group/ family psychotherapy. Group psychotherapy typically involves a clinician and a set of persons who have similar mental health or psychiatric disorders, who meet at specified times to discuss, process, or listen to persons dealing with similar issues (Exhumalai et al., 2018). Whether psychotherapy is in the individual or group setting, ethical or legal implications may arise.
Confidentiality is a significant concern not only in the individual setting but especially in the group setting. With individual psychotherapy, it is only the clinician and the client, and the patients are less concerned about this aspect being breached. It involves other individuals in a group or family setting; thus, the therapist cannot promise or guarantee that confidentiality will be maintained (McClanahan. 2014). However, the practitioner can urge the group members to keep what is discussed or processed confidentially.
Informed consent is another ethical consideration that will differ with a group versus individual psychotherapy. Shah et al. (2020) define informed consent as the process in which a provider educates a patient about the risks, benefits, and alternatives of an intervention. In psychotherapy, the provider will inform the patient about expected behaviors and set limits or boundaries, which is done before commencing therapy. The patient can then make an informed decision about whether they wish to participate. Breeskin (2011), in his article “Procedures and guidelines for group therapy,” gives an example of how this may be presented to a client. When a client signs the document, it can be legally binding. Therefore, it is essential to know the laws of your state and how they impact your practice.
Impact on therapeutic Approaches
An important fact to remember is the consequences of breaching confidentiality and failing to inform patients properly. For example, if there is a patient in group therapy that you see individually, that client’s information should never be disclosed in the group. Similarly, not informing the patient of how group therapy may impact them negatively (not just positively) can have a lasting effect on the client. The patient should be educated on what they may encounter so they can decide on whether to be a part of group therapy or not.
Finally, the provider must realize that he/she is catering to the entire group and not a specific client. The responses given by the clinician must benefit the group as a whole and not just one patient. Exhumalai et al. (2018) remind us that group therapy aims to be corrective, educational, therapeutic, developmental, preventative, and recreational. To meet these criteria, the clinician should aim to cater to all group members.
References
Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.asp
Ezhumalai, S., Muralidhar, D., Dhanasekarapandian, R., & Nikketha, B. S. (2018). Group interventions. Indian Journal of Psychiatry, 60(Suppl 4), S514–S521. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_42_18
Locher, C., Meier, S., & Gaab, J. (2019). Psychotherapy: A World of Meanings. Frontiers in Psychology, 10(460). doi:10.3389/fpsyg.2019.00460
Inter-professional team
What strategies can be implemented to ensure that all members of the inter-professional team know their roles and respect the contributions made by others for the betterment of patient outcomes? What influence would this have on patient care?
Discussion
The Center for Medicare and Medicaid Services (CMS) publishes a list of health care-acquired conditions (HACs) that reasonably could have been prevented through the application of risk management strategies. What actions has your health care organization (or have health care organizations in general) implemented to manage or prevent these ""never events"" from happening within their health care facilities? Support your response with a minimum two peer-reviewed articles.
Interprofessional Collaboration
Medication errors can occur in any setting. Much has been done to eliminate this problem, yet there is much more than need be done to provide safe patient care. If I were asked to gather an interprofessional collaborative (IPC) team, in response to a recurring medication error and to prevent future mistakes in the inpatient medical-surgical unit where I work, I would put together a team from different disciplines within the institution. I would gather an IPC team to include members who can contribute to the solution, have expert advice, and who can help lead the change in a quality improvement project. According to Dang and Dearholt, (2018), the IPC team should be precise enough to be effective, yet large enough to have expert knowledge of the presenting problem. The IPC team would include a pharmacist, nurse educator, nursing manager, unit head nurse, a registered nurse, a physician, an informatics specialist, and a practicing scholar.
The responsibilities of each team member begin by the team coming together, and being prepared to share evidence-based content to help resolve the practice problem. For a team to be effective, the members of that team need to be able to share and understand each other roles (Etherington et al 2019). The role of the IPC members is to understand the impact the practice problem has on patients’ outcome, staff morals, and healthcare cost and to research ways to solve the problem. Members need to be knowledgeable about the topic presented. The team should be committed to the project and should be motivated to resolve the practice focus problem. I would have weekly meetings with team members to follow up and feedback.
Medication errors are listed under patient safety, which is one of the eighth practice problem burden in the United States of America (Chamberlain College of Nursing 2020). According to the World Health Organization (WHO), a medication error can occur during any step of the medication process, from prescribing to administering (2016). Therefore, the team should be looking into all potential medication error aspect. The team leader should distribute tasks accordingly, and hold each team member accountable for the task assigned. The team of ICP shall strategize a plan to prevent medication errors in the unit.
The nurse researcher and educator would establish policies, protocols, and training modules for unit nursing staff. The Informatics specialist will review the current technology and improve the system to identify and create alert as soon as a medication is written by the prescriber. The pharmacist would work within it department to establish a clear protocol for requesting clarification before any questionable medication is dispensed to the unit. The nurse manager and unit team will work on reeducating the staff on safe medication administration. Nursing leaders need to create a culture of confidence among staff, that it is appropriate to question a provider’s order if deemed unsafe. In a pilot study by Boscart et al., (2017) they found that interprofessional teamwork, education, and open communication promote best practice and improve quality of care in heart failure patients in a long-term care setting. I believe respectful communication among disciplines is beneficial in all clinical practices.
It is well known, that there is no I in team. For a team to be successful it members have to be able to work well alongside each other. Mutual respect for each other opinions is a must for the team to succeed. Ineffective communicating is the root cause of misunderstanding. It happens in personal relationships, boardrooms, and of course in healthcare settings. Often, the failure to communicate can have life-changing impacts of patients, family, nurses, insurances providers and healthcare systems. Clapper (2018) indicated that debriefing allows team members time to critique performance and discuss ways for improvement. To facilitate effective communication and collaboration, there should be frequent feedback from team members.
References
Boscart V.M., Heckman, G.A., Huson, K., Brohman, L., Harkness, K.I., Hirdes, J., McKelvie, R.S., & Stolee, P. (2017) Implementation of an interprofessional communication and collaboration intervention to improve care and capacity for heart failure management in long-term care. Journal of Interprofessional Care. 31 (5), 583-592. Doi.org/10.1080/13561820.2017.1340875
Chamberlain College of Nursing (2020) NR-701 Week 1: Application of Analytic Methods (Online Lesson) Adtalem Global Education
Clapper, T (2018). TeamSTEPPS is an effective tool to level the hierarchy in healthcare communication by empowering all stakeholders. Journal of Communication in Healthcare 11 (4) 241-244. Doi.org/10.1080/17538068.2018.1561806
Dang, D., & Dearholt, S. (2018) John Hopkins nursing evidence-based practice model and guidelines (3rd ed.). Sigma Tetu Tau Intentional.
Etherington N., Wu M., Cheng-Boivin O., Larrigan S., Boet S. (2019) Interprofessional communication in the operating room: a narrative review to advance research and practice Canadian Journal of Anesthesia 66 (10) 1251-1260 doi.org/10.1007/s12630-019-01413-9
Medication Errors. Technical series on safer primary care. (2016) World Health Organization. License: CC BY-NC-SA 3.0 IGO. www.WHO.org
Discussion of Triaxial of Action
Policy,Politics, and Nursing Discussion of Triaxial of Action: Policy,Politics, and Nursing","1- What is Policy?
2- Explain each of them: Public policy—
Private policy—
Health policy—
Social policy—
Organizational policy?
3- Who was Florence Nightingale, and what was her contribution to the Nursing Field?
4- Who was Lillian Wald?
5- Who was Margaret Sanger, and in what way she helped to the developments of Nursing Field?
6_ what is (ICN), and what they do?
7- What is s (NLCA) and they do?
Jeanne Blum, RN, is a nurse on a LDRP unit. Recently, the policy and procedures manual for Jeanne’s unit included the premature rupturing of membranes of a laboring patient as a practice acceptable for nurses to perform. Jeanne and some of her coworkers shared their concern over lunch about this new responsibility.They felt uncomfortable with the possibility of cord prolapse and other potential medical complications resulting from this practice. Jeanne gathered data from her state and many others states and noted that her hospital was not in compliance with her professional organization practice standards. Jeanne shared this information with her coworkers. She volunteered to contact the state board of nursing on their behalf to request a declaratory statement on the nurse’s role in the initiation of premature rupturing of uterine membranes. Her state board’s clinical practice committee reviewed her request for a declaratory statement and gathered information from other states. A formal declaratory statement was drafted by the board and made it available on its Web site. A letter from the board was sent to Jeanne’s institution, informing it of the declaratory statement, which stated that the task nurses were requested to perform was beyond their scope of practice based on the Nurse Practice Act.
8-Which stage of the policy model does this scenario represent?
Advanced Pharmacology
I have worked in an outpatient behavioral health clinic for the past seven years with many different providers. I live in a rural community, many patients wait six to twelve months to be seen. Patients being treated for Attention Deficit Disorder must be officially tested before being seen by a Psychologist. For this discussion board post, I have changed the name of my patient to Paul to ensure patient confidentially. The provider I worked with this particular patient will also be referred to as PMHNP to ensure provider confidentiality.
Paul was a ten-year-old Caucasian male referred to our clinic diagnosed per DSM criteria, confirmed via Psychologist testing with ADHD. When he saw the Psychologist, he was also diagnosed with mild depression and anxiety. He struggled with concentration, hyperactivity, impulse control, and disorganization. He presented to his appointment with his mother and father, clean, well-nourished, pleasant, interactive with staff, reported no medication allergies, current medication Zyrtec for seasonal allergies. Paul just had his well-child exam and is current on vaccinations and his primary care provider completed lab work to include CBC, CMP, TSH, Vit D, B12, and A1C, all have returned normal. Family history reported father has a history of ADHD (never medicated), brother has a history of depression and anxiety (never medicated treating with psychotherapy), no other significant family history to report. Paul’s current weight at his appointment was 30kg.
PMHNP spent one hour with Paul and his parents for the initial new patient appointment (Thursday). It was decided Paul would be prescribed Strattera (atomoxetine) 40mg once a day for one week then increase to 80mg once a day. I returned to work on Monday and received a call from Paul’s mom, she said he was acting strange. He was tearful, had been in his room with the door closed for most of the weekend, she stated on Sunday she went into his room and he was crying and said he was just thinking about dying and his parents dying. She stated he had already had his meds Sunday so she kept him with her that entire day and made Sunday night a campout night in the Livingroom so he would think it was fun and she could keep a close eye on him. I had a cancelation that morning for him to come to see PMHNP and he was in to see her within twenty minutes and removed from Strattera. His parents decided medications were no longer the route they wanted to try for treatment and a referral was made for psychotherapy.
The only medication Paul takes on occasion is Zyrtec which is in an antihistamine drug class, Strattera is a selective norepinephrine reuptake inhibitor; there is no known drug interaction between the two medications. Reflecting on his age and the medication, Strattera has a black box labeled for suicidal ideation with adolescents diagnosed with ADHD (Eli Lilly and Company, 2003). Reviewing Paul’s labs, I also do not see that a prior ECG or LFT was complete before starting Strattera. Looking at the Pharmacokinetics of Strattera, it is metabolized in the liver and has been known to cause liver damage. Strattera can also raise blood pressure and has been reported to cause sudden cardiac death (Eli Lilly and Company, 2003). Reviewing Pharmacogenetics and the videos from our resources this week, we should have tested Paul’s CYP2D6, as it is essential for metabolization of Strattera and proper dosing (Speed Pharmacology, 2015).
As a practitioner, I would have started treatment with an antidepressant, Wellbutrin (Bupropion) is often utilized off label for ADHD and might also assist with the treatment of his depression. Since most antidepressants work by increasing the levels of brain messenger chemicals (neurotransmitters), such as norepinephrine, serotonin, and dopamine, it makes sense that they might have effects similar to other ADHD stimulant and non-stimulant treatments that appear to work by similar mechanisms (Cleveland clinic, 2016). I would have also recommended Psychotherapy to go alongside the medication regimen.
As a practicing PMHNP, I plan to focus my areas of focus on adolescents. It will be of the standard of care in my practice for all patients to be properly evaluated and diagnosed via official testing for ADHD and my patient will need to be actively utilizing psychotherapy while undergoing a medication regimen treatment if under my care. I have found through experience involving parents and patients in the treatment plan and education as a mental health case manager to assist with compliance and a more successful outcome for the adolescent.
References
Cleveland clinic. (2016, July 18). ADHD medications: Strattera, antidepressants & more.
Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/12959-attention-deficit-hyperactivity-disorder-adhd-nonstimulant-therapy-strattera--other-adhd-drugs
Eli Lilly and Company. (2003). Medication Guide Strattera. www.strattera.com. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021411s035lbl.pdf
Speed Pharmacology. (2015). Pharmacology – Pharmacokinetics (Made Easy) [Video]. https://www.youtube.com/watch?v=NKV5iaUVBUI&t=16s
Kyle Johnson Discussion week oneCOLLAPSE
Many factors play a role in how medications effects each individual including Pharmacokinetics and pharmacodynamics. According to Rosenthal & Burchum (2018), “Pharmacokinetics is the study of drug movement throughout the body”(p.4). Whereas Pharmacodynamics is the study of the response from medication entering the body (Rosenthal & Burchum, 2018). As a behavioral health nurse, I have seen patients that have been on antipsychotics for years, and even adolescents placed on their first antipsychotic.
Our psychiatrists try and use the newer antipsychotics such as Abilify, Risperdal, or Zyprexa as they are less likely to cause adverse reactions. Even with the atypical antipsychotics, patients can still be sensitive to these medications. One of my memorable admissions was a 40 year old female diagnosed with schizophrenia who comes in with command hallucinations to kill herself and is non-med complaint. She has shown to be sensitive to antipsychotics. During this patient's stay, her medications were restarted including Risperdal with Cogentin to help combat unwanted side effects such as neck stiffness. Shortly after the medication was restarted the patient became catatonic. Risperdal has been identified as a medication that can cause catatonia (Huang, et al., 2018). Risperdal was quickly discontinued and Ativan was started on this patient. Ativan has been shown to bring patients out of the catatonic state (Sienaert, at al., 2014).
After a few days the patient came out of the catatonic state the patient's hallucinations came back and the patient tried to hang herself. Zyprexa and Clozaril were started. Shortly after the initiation of these medications the patient started to get better, but not for long. A week after starting the Clozaril the lab called with a critical lab value indicating agranulocytosis with a decreased neutrophil count (Voulgari, et al., 2015). The medication was stopped and the patient was sent to the medical center for further evaluation. After a week the patient was sent back to behavioral health. She was restarted on Zyprexa and Cogentin to good effect and was later discharged. Medications affect each individual differently requiring their providers to monitor them for adverse reactions. With the increased sensitivity with this patient, I would make sure to start any medication change with the lowest possible dose to monitor for side effects. I would choose medications with less potential for adverse reactions such as Zyprexa. I would lean towards choosing a depo preparation as the patient has a tendency to be non-compliant with treatment.
References
Huang, M. W., Gibson, R. C., Moberg, P. J., & Caroff, S. N. (2018). Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms. The Cochrane Database of Systematic Reviews, 2018(10), CD013100. https://doi.org/10.1002/14651858.CD013100
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Sienaert, P., Dhossche, D. M., Vancampfort, D., De Hert, M., & Gazdag, G. (2014). A clinical review of the treatment of catatonia. Frontiers in psychiatry, 5, 181. https://doi.org/10.3389/fpsyt.2014.00181
Voulgari, C., Giannas, R., Paterakis, G., Kanellou, A., Anagnostopoulos, N., & Pagoni, S. (2015). Clozapine-Induced Late Agranulocytosis and Severe Neutropenia Complicated with Streptococcus pneumonia, Venous Thromboembolism, and Allergic Vasculitis in Treatment-Resistant Female Psychosis. Case reports in medicine, 2015, 703218. https://doi.org/10.1155/2015/703218
2 resources for each discussion, thank you
Amoeba Discussion
Give a narrative about what you are doing in the body from the pathogen's( amoeba) point of view. How did you get into the body? In other words, how did the body inherit you? How do you move through the body? What path of destruction are you on? How will you wage battle against the body? How do you plan to win that battle? What will the body try to do to stop you? How will you fight back? Who wins?
Use a scholarly article and cite APA format
Psychpathology
Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology
Discussion
Describe a national health-care issue/stressor and explain how the health-care issue/stressor may impact your work setting.,"Then, describe how your health system work setting has responded to the health-care issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples
