Archive for month: March, 2018

Case Assignment
Read the case story about how a Nurse Manager helps her staff become more culturally competent. http://support.mchtraining.net/national_ccce/case0/case.html

After reading the case story, click on the Learning Activities link on the left side. Complete Activities 1, 2, and 4.

You may complete Activity 3 if you like, but it is not required.

In a paper:

Reflect upon what you learned after completing the Learning Activities.
Your comments should show thoughtful reflection about how you have assessed your own personal development as you strive for cultural competence.
Consider the following questions:
After reading about Christy’s situation, how have your thoughts about and/or expectations of other cultures changed, if at all?
What changed, if anything?
Describe how Christy can handle the situation better the next time she encounters a Romani patient.
Identify at least one thing an organization can do to improve cultural competence.
Assignment Expectations
Length: 3 pages (excluding the cover page and the reference list)

Assignment 1: Decision Tree

For this Assignment, as you examine the client case study1 (See Below) in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

Learning Objectives

Students will:

· Evaluate clients for treatment of mental health disorders

· Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

THE ASSIGNMENT

Examine Case 1: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

· Which Decision did you select?

· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

· Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

· Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

PLEASE INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 5 YEARS OLD

Case #1 A woman with personality disorder

A woman with personality disorder

SUBJECTIVE

Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help.

Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!”

Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.”

Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.”

OBJECTIVE

Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail.

Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police.

MENTAL STATUS EXAM

Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation.

Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO RHONDA?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

Borderline Personality Disorder

Histrionic Personality Disorder

Antisocial Personality Disorder

Answer Chosen:

Antisocial Personality Disorder

Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/img/pill-red.pngRefer to psychologist for psychological testing

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/img/pill-blue.pngBegin Haldol 5 mg orally daily

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/img/pill-yellow.pngRefer for psychodynamic psychotherapy

Answer Chosen:

Refer to psychologist for psychological testing

RESULTS OF DECISION POINT TWO

· Client returns to clinic in four weeks

· The psychologist’s report indicates that a comprehensive psychological battery was performed for the purposes of diagnostic clarification. The end result suggested that Rhonda has traits of multiple personality disorders, but scores highest in antisocial personality traits, suggesting antisocial personality disorder.

· When Rhonda returns to the office, you review the psychologist’s report with her. Rhonda seems upset, but also states “well, that’s why I am here, to get better … what do I need to do?”

Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/img/pill-red.pngRefer to group-based cognitive behavior therapy

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/img/pill-blue.pngBegin Latuda 40 mg orally daily

https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/03/mm/decision_tree/img/pill-yellow.pngRefer for dialectical behavior therapy

Answer Chosen:

Refer to group-based cognitive behavior therapy

Some Guidance and Rationale for Answer to Chosen

Rhonda has APD; however, as you can see, she has signs/symptoms of other personality disorders. In many cases, individuals with personality disorders can demonstrate features of several personality disorders.

Referral to a psychologist was appropriate for the purposes of diagnostic clarification. Psychological tests can help tease out the actual personality disorder that Rhonda has. In this case, Rhonda’s symptoms are most consistent with antisocial personality disorder, but as you can see, she has signs/symptoms of other personality disorders.

There are currently no FDA-approved medications to treat APD, thus Risperdal would not be useful. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Of the available choices, group-based cognitive behavior therapy may be useful in treating individuals with this personality disorder, but all “improvement” in signs/symptoms should be met with great skepticism.

Beginning Latuda is not appropriate, as there are currently no FDA-approved medications to treat APD. Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.

Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

· Chapter 22, “Personality Disorders” (pp. 742–762)

· Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”

· Chapter 69, “Antisocial Personality Disorder”

· Chapter 70, “Borderline Personality Disorder”

· Chapter 71, “Histrionic Personality Disorder”

· Chapter 72, “Narcissistic Personality Disorder”

· Chapter 73, “Cluster C Personality Disorders

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

· “Personality Disorders”

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Rees, C. S., & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1), 45–55. doi:10.1037/a0035158

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Required Media

Laureate Education. (2017a). A woman with personality disorder [Interactive media file]. Baltimore, MD: Author. (See Case 1 (Rhonda)Above)

Kernberg, O. (n.d.). Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

#775865 Topic: Part 2 – Assignment: Assessing and Treating Clients with With Bipolar Disorder

Number of Pages: 2 (Double Spaced)

Number of sources: 1

Writing Style: APA

Type of document: Research Paper

Academic Level:Master

Category: Nursing

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In an emergency evacuation of patients, training plays an important role. Here is an incidence of emergency evacuation of Phillips County Regional Medical Center discussed by Vogt and Sorenson (1999):

Shortly after 1:00 p.m. on Thursday, May 8, 1997, clouds of foul-smelling smoke began pouring from an herbicide and pesticide packaging plant in West Helena, Arkansas. An alert was sounded, employees evacuated, and the West Helena fire department was called. As three firefighters prepared to enter the plant, the chemical compounds exploded, collapsing a solid concrete block wall, and killing all three firefighters. As the odorous smoky cloud drifted away from the plant, authorities ordered residents in a 2-mile area downwind of the plant to evacuate and those in the 2- to 3-mile zone to shelter in . . . The findings indicate that 90% of those that were told to evacuate did so but only 27% of those told to shelter-in-place did so, with 68% opting to evacuate instead. The implications of these findings for emergency managers is that people will likely choose to evacuate when both warnings to evacuate and warnings to shelter are issued to residents in close proximity to each other (Abstract section, para. 1).

The evacuation of the medical center was facilitated by efforts taken 6 months earlier to update the hospital’s evacuation plan and reconfirm support agreements for relocation sites and supplies. At that time of updating the plan, the entire staff had also participated in a mock drill. When the safety officer observed the buildings across the highway being evacuated and started questioning officials on the possibility of also being evacuated, evacuation plans familiar to staff were in place and had been practiced. When the Director of Nursing gave the “Code White” alert (the signal that an evacuation to an off-site facility would follow) staff was amply prepared to move patients (p. 11).

Interviews with staff indicated that all patients that could be discharged were sent home with a physician’s nurse. Another four or five patients (the most seriously ill) were transferred to a hospital about a half hour away. The majority of the patients 11 (approximately 17) in the rehabilitation unit were transferred to a vacant wing of the Crestpark Nursing home accompanied by hospital support staff. Only one maternity patient evacuated to the Phillips College—Community College where the hospital staff had evacuated and opened emergency room services. The evacuation of patients began at 1:40 p.m. and all patients (except for two on ventilators and one being stabilized in the emergency room) were out 55 minutes later. The remaining three patients were evacuated 15 minutes later. A variety of vehicles transported patients—vans, school buses, ambulances, private cars, and mortuary services. As a precaution, National Guard personnel provided security at the evacuated hospital (pp. 11–12).

On the basis of your understanding on the topic, answer the following questions regarding the incidence of emergency evacuation mentioned above:

What does this study tell you about the lack of training for the community?
Why is communication and education of the community important in saving lives?
Was the community clear on what the procedures were? How?
Why was the evacuation of the hospital so successful?
How important are external relationships with other agencies to having an efficient evacuation plan?
Your review should be at least 2- to 3-page Microsoft Word document, not counting the cover page or the reference page.

Support your responses with reasoning and examples.
Cite any sources in APA format

Please pay attention to the questions, Proper in-text citation, references, use of English and the use of subheadings.

Directions:

Write a 1,000-1,250 word paper examining how the Conceptual – Theoretical – Empirical (CTE) structure translates into nursing practice based on one of the middle range theories that has been formulated or derived from your preferred conceptual model of nursing. Translate and apply the selected theory to nursing practice using actual examples. Evaluate the theory using the CTE steps below:

1. Evaluation of the conceptual-theoretical-empirical linkages.

2. Evaluation of the selected theory.

3. Evaluation of the empirical indicators.

4. Evaluation of research findings.

5. Evaluation of the utility and soundness of the practice theory.