Powerlessness in the Critical Care Patient

Powerlessness in the Critical Care Patient

Project instructions:
Patients who require critical care must cope with a variety of stressors. The patient?s response to those stressors depends on the individual differences, such as age, gender, hospital course, and prognosis. In addition, the patient?s perception of self and relationship with others also plays a major role in how they respond to stress and illness. For this paper, you want to think of a patient or a scenario where you were the nurse for a patient that experienced powerlessness in their disease process and how powerlessness develops in the critically ill patient. You also want to explain the concept of locus of control and its relationship to powerlessness. In addition, you want to identify learned helplessness/excessive dependence and how the critical care nurse can assist the patient in abandoning this behavior. Finally, discuss a nursing management plan for powerlessness and discuss implementation in the clinical setting. Follow appropriate APA, References within past 5 years, appropriate scholarly sources.

Differences in competencies between associate degree prepared nurses and baccalaureate degree prepared nurses.

Differences in competencies between associate degree prepared nurses and baccalaureate degree prepared nurses.

Abilities to deliver the most safe, total proficient and excellence of care to different groups in healthcare. Due to many actions and modifications in healthcare role of nurses is transformed. Nurses have to be competent to make critical decisions, information, educate and coordinate with patients their families and other health care professionals, and they have to perform research to make progress in nursing and patient care consequences. There are four main causes which define the differences in competencies between associate degree prepared nurses and baccalaureate degree prepared nurses.

Examining the diagnosis and Treatment of Septic Shock

Disease Process and Disease Concept

Septic shock is a serious condition caused by an infection that leads to low blood pressure, diffident tissue perfusion and oxygen delivery.

Pathophysiology

Septic shock occurs most often in the very young, very old and very sick. The main cause of septic shock is bacterial infection however fungi and virus can also cause it too. Toxins released by the bacteria or fungi cause tissue damage. The body produces a strong inflammatory response to the toxins. The tissue damage and inflammatory response can lead to organ damage. The CDC put septic shock as the 13th leading cause of death in the United States, and the #1 cause of death in the ICU. The mortality rate is between 20% to 50% depending on how sever the disease is. (Michael R Filbin) The morbidly of septic shock can be quite significant. Due to the tissue and organ damage things like acute respiratory distress syndrome(ARDS) can occur. ARDS leads to a longer stay in the ICU as well as increase the possibly of ventilator-associated pneumonia. ARDS also has a mortally rate that can reach 50%. Myocardial dysfunction, acute renal failure and chronic dysfunction, disseminated intravascular coagulation (DIC), and liver failure are some other possible complications caused by septic shock. Another compilation is Long-term neurologic and cognitive sequelae caused from prolonged tissue hypoperfusion. “Poor outcomes often follow failure to institute early aggressive therapy (eg, within 6 h of suspected diagnosis). Once severe lactic acidosis with decompensated metabolic acidosis becomes established, especially in conjunction with multiorgan failure, septic shock is likely to be irreversible and fatal.” (68. SEPSIS AND SEPTIC SHOCK) “Many people who survive severe sepsis recover completely and their lives return to normal”.(sepsis facty sheet)

Labs and Diagnostics

There isn’t one laboratory test that can confirm Septic shock. Bacteria found in the blood can help support the diagnosis of septic shock. All bodily fluids need to be tested such as blood, urin, sputum and any other drainage. An elevated WBC and differential leukocyte count may be increased indicating infection. Normal adult values should be 5000-10,000/mm3. Another possible indicator of septic shock is low levels of activated protein C. Normal levels are 70%-150% of normal activity. Protein C helps prevent blood clots when there isn’t enough protein C then thousands of small clots form in the capillaries of vascular organs. Decreased Protein C can indicate the begging of sever septic shock.

Medications and treatments

I.V. antibiotics are given to treat the bacterial infection. The most common drugs used for septic shock are vancomycin, aminoglycosides, systemic penicillin or cephalosporins, macrolides, and quinolones. Low-dose corticosteroids like IV hydrocortisone and oral fludrocortisone (Florinef) are given for adrenal insufficiency. Insulin therapy is used for maintain. Synthetic activated protein C is given to stop inflammatory responses while preventing small clots formation and halting the progression of the disease. Drotrecogin alfa (Xigris) is the only approved synthetic protein C. the patient may need fresh frozen plasma, whole blood, or packed red blood cells to replace lost blood from hemorrhaging. Breathing machine (mechanical ventilation) may need to be used to enhance oxygenation.

Subjective and Objective Data

A possible patient for septic shock would be a 78 year old male who lives alone and doesn’t take good care of himself. He doesn’t eat well and doesn’t drink much fluids. One day he wakes up and doesn’t feel well he has chills and thinks he might have a fiver. He calls his doctor and goes to the office. The doctor tells him he has a fever of a 101 degrees the doctor admits him to the ICU. The patients face was flushed, skin is warm, and his urin was cloudy a test was done on the urin E-coil was found. The patient was place on I.V. fluids for rehydration. His mental status is altered. The patients’ temperature rose to 103 degrees pulse is 110, respiration is 28, and Blood Pressure is 125/65 and his O2 is 89 on room air. The patient is placed on 3l/min nasal canula. The patient WBC was elevated. The patient was put on antibiotics. The patient’s condition continues to deteriorate. The patient’s skin becomes cool and clammy he struggles to breath. His respirations are 10 per/min B/P is 80/50 temp 104, pulse 140. The doctors decide to intubate and place the patient on a ventilator. The Patient is diagnosed with acute renal failure due to hypovolemia. The doctor places the patient on hemodialysis. The patient does finally improve after being in the ICU for two weeks he gets better and is sent to the medical floor. He stays for another two weeks and is released home. This is a good out come in most case when sepsis causes organ failure the patient dies. This patient has a full recovery and doesn’t suffer any prolong organ damage.

Nursing Diagnoses

The Patient is at risk for deficient fluid volume related to abnormal loss of fluid through capillaries, pooling of blood in peripheral circulation as evident by low blood pressure, low urian output and raspatory depression. The patient is at risk for ineffective protection related to inadequately functioning immune system as evident by fever, chills and infection. The patient is at risk for injury related to prolonged shock resulting in multiple organ failure as evident by renal failure and respiratory failure.

Nursing Interventions

Watch for early signs of hypovolemia, including restlessness, weakness, muscle cramps, headaches, inability to concentrate, and postural hypotension. Monitor for the existence of factors causing deficient fluid volume (e.g., difficulty maintaining oral intake, and fever). Monitor vital signs of clients with deficient fluid volume every 15 minutes if unstable or every 4 hours if stable. Observe for tachycardia, tachypnea, and decreased pulse pressure, which will occur first, followed by hypotension, decreased pulse volume, and increased or decreased body temperature. Observe nutritional status (e.g., weight, serum protein and albumin levels, muscle mass, usual food intake) work with the dietitian to improve nutritional status if needed. Complete a head-to-toe assessment twice daily, including inspection of oral mucosa, invasive sites, wounds, urine, and stool; monitor for onset of new reports of pain. Provide frequent oral care. Help the patient bathe daily. Ensure that the client is well nourished, provide food with protein and consider vitamin supplements. If appetite is suppressed, institute a dietary referral. Keep track of serum albumin levels as well as transferrin and prealbumin levels. Reduce the risk of infections by following Centers for Disease Control (CDC) hand hygiene guidelines. Ask family to stay with the patient to prevent the patient from accidentally falling or pulling out tubes. If the client experiences dizziness because of orthostatic hypotension when getting up, teach methods to decrease dizziness, such as rising slowly, remaining seated several minutes before standing, flexing feet upward several times while sitting, sitting down immediately if feeling dizzy, and trying to have someone present when standing.

Health Promotion and Prevention

Teach the patient that healthy eating can prevent illness. Getting the recommended amount of daily fluids can prevent sickness. As Mrs. Mcbride says “the solution to pollution is dilution”. Fluids can flush the system of toxins. Avoid crowds and people who are ill. Monitor for weakness and possible fall hazards. Injures related to falls can lengthen the time in the hospital and increased the risk of getting another sickness from the hospital stay.

Collaborative Efforts

Consult with a dietitian to help the patient learn a diet adequate in nutriens and to teach the patient the important s of adequate fluid intake and to promote overall healthily living. Social Services consult to help the patient in finding and utilizing community resources to promote independence such as transportation, possible meals on wheels, and home health agencies to aid in ADL’s and overall health maintenance. As the patients’ health improves, refer the patient to Physical therapy for gait training, strengthening, and balance training. Refer Occupational therapy services to Assess home environment for factors that create barriers to physical mobility. Assist the patient in restructuring home and daily living patterns as need. Refer to home health aide services to support the patient and family through changing levels of mobility as tolerated.

Patient Education

Teach precautions to take to decrease the chance of infection (e.g., avoiding, uncooked fruits, and vegetables, using appropriate self-care, ensuring environment) teach the patient to avoid crowds and contact with persons who have infections. Teach the need for good nutrition, avoidance of stress, and adequate rest to maintain immune system function. Teach the patient how to measure and record intake and output accurately. Teach measures instituted to treat hypovolemia and prevent or treat fluid volume loss. Instruct the patient about signs of deficient fluid volume that indicate they should contact the healthcare provider.

Employment for Adults with an Intellectual Disability

This essay is going to discuss the discrimination faced within all aspects of employment by adults with disabilities. Employment has been defined as the right to work ‘on an equal basis with others, which includes the right to the opportunity to gain a living by work freely chosen or accepted in a labour market and work environment that is open, inclusive and accessible to disabled people’ (United Nations 2007). While being a universal human right, gaining employment is also a rite of passage in the majority of people’s lives and often marks the beginning of adulthood, however, living as an adult with an intellectual disability, this can prove immensely challenging. Employment holds a large influence on a person’s social inclusion making it an important issue for people with disabilities, along with the economic benefit of holding employment. According to the National Disability Authority (NDA) if you have a disability, you are only half as likely than others to be employed by the time you reach the working age. From looking at previous research, it indicates a lower employment rate among people with a disability, also shows high instability of employment for those that hold a job (Holmes, 2007). This research essay will discuss the various barriers and discrimination that people with disabilities are faced with while gaining and retaining employment in Ireland including the prevalent employment process of sheltered workshops. Statistics will be discussed to get a view of where people with disabilities are placed in society. It will also look to relevant policy and legislation are in place regarding employment for people with a disability and how it affects them.

Enshrined in Article 23 of the United Nation’s Declaration of Human Rights is that everyone has the right to work with a free choice of employment and unfortunately this is not the case for everyone, a large number of people are not receiving this human right due to them having an intellectual disability. There is a considerable amount of ways people define a ‘disability’ resulting in skewed statistics, Census 2006 indicated approximately 400,000 people reported a disability, which is 9% of the population. While five years later, the census 2011 showed about 600,000 people reported having a disability, or about 13% of the population, these change in numbers was a result of what a disability was defined as. Participation in the labour market for disabled people remain lower than participation rates for the general population (Banks et al., 2018: p.2). Regardless of the type of employment, sheltered or paid, too few of adults with disabilities are experiencing it (Andrews & Rose 2010; Migliore et al. 2008).

In terms of the employment statistics for people with disabilities, 6.6% of the population were in real paid employment, 7.4% in perceived employment, 12% in sheltered employment and 73.5% were unemployed (McGlinchey et al., 2013). Perceived employment relates to individuals associating a certain place they go every day as their job or work, such as a day service they attend. The small percentage of people in real paid employment were receiving an average of 77 euro as their weekly wage, which is dismal, comparing this to the 12% in sheltered workshops the average weekly wage was 26 euro. These minuscule monetary amounts represent wages that would simply not be accepted by an individual without a disability, therefore people with disabilities are not being treated equally and receiving the right of employment they are entitled too.

In Ireland, a sheltered workshop is defined as ‘work undertaken by people with disabilities in workshops specifically established for that purpose. It is known in Europe, it is the most broadly used employment method of people with intellectual disabilities (Mallender et al., 2015). A great disadvantage along with the low-income levels of sheltered work is the large segregation it creates from the community. An area that has been neglect by research is the effect of this segregation on the individuals working in these types of sheltered organisations, being separated from the wider community resulting in no level of social inclusion. Jobs that return low psychosocial rewards and also hold a poor-quality work environment have been reported to carry equal risk of depressive symptomatology as being unemployed (Butterworth et al. 2011). It is also suggested that those who source real paid employment have a higher quality of life than those without and also increased social incorporation (Kober & Eggleton 2005). Many reports have shown that individuals with an intellectual disability enjoy going to their ‘job’, giving them a routine and structure to their weeks. There has always been strong debate on the process of these workshops being effective or being a means of exploitation. While there are numerous negatives associated with aspects of sheltered workshops it is impossible to say it doesn’t also hold some positive properties. One of the biggest arguments includes that without the facilities of the sheltered workshops, people with intellectual individuals would be completely isolated without anything to do. The workshops do provide an outlet for people to go to providing them with an opportunity to socialise and to meet other people with disabilities. In the case of people with disabilities being unable to provide substantial work of economic value, sheltered workshops adhere to it being possible for these individuals to work (Corley,2014). It is argued that the debate of the wage level is disputable as it is not an adult’s single income, it acts as an added payment, as sheltered workshops pay is extra to money already being received in the form of social welfare disability benefits (May-Simera, 2018). However, despite the few positives that are seen from the process of sheltered workshops they are still viewed by disability experts in a negative light, claiming these workshops adhere to old fashioned expectations that people with IDs are unfit for work and as a result have no impact on society (May-Simera, 2018: p.4).

Smart (2004:25-29) believes that the models of disability serve a number of difference purposes, such as providing definitions of disability and shaping the identities of people who have disabilities. There are two models of disability that are relevant to this topic of employment, the charity model and the medical model. The charity model depicts people with a disability as people to be pitied and sufferers. The types of work that are the most widely available to people with disabilities include sheltered workshops. The settings of these sheltered workshops are usually run by non-governmental organisations, for-profit or charitable organizations, either privately or on behalf of the State relating to both the charity and medical model (Samoy and Waterplas 1992). An outcome of these workshops can be the lack of transition with people remaining in these for long periods of time result in more segregation (Gottlieb et al. 2010). Looking back to the past and earliest history of sheltered workshops, its shown that the settings have largely evolved from religious or medical institutions and were therefore run corresponding to an ethos of the charity and medical models of disability.

There have been few changes to policy and legislation in recent years in relation to employment for people with disabilities. A key policy that covers many aspects of disability, including employment is the National Disability Strategy (2017-2021). The most recent policy initiative being The Comprehensive Employment Strategy for People with a Disability 2015–2024 (Department of Justice and Equality, 2015). This sets out a ten-year plan of action in being certain that people with disabilities, who can and want to work, are supported and enabled to do so. It is focusing on the importance of financial security and independence in employment, it aims to make sure people with disabilities who choose they want to work are enabled to do so.

From doing research on this topic, it is clear to see that discrimination towards people with disabilities is still prominent. High unemployment rates are a key reason for the strong link between disabilities and poverty. Both unemployment and poverty are likely to have a disproportionate effect on people with disabilities compared with other sectors of the population. Improved and renewed policies need to be put in place to ensure less exclusion and to get rid of the high chance of poverty on the person with a disability. To conclude, people with intellectual disabilities are not being treated fairly, facing high levels of discrimination in relation to their human right of employment. It would benefit the situation at hand to focus more on what the individuals are asking for, this may be done by more surveys, reports and in-depth research on the self-advocates. From working together with the self-advocates for this module, it was evident that some of them enjoyed when they previously attending a sheltered workshop, where they folded tea towels. I believe this may be the case due to their dependence on daily routine. Regarding the protection of people of individuals working in sheltered workshops, measures need to be implemented to introduce employment protection legislation to ensure the status of individuals is protected. Expenditure needs to be used on creating a maintainable way of creating an employment system for people with disabilities. What has been see is the Government Pilot Programme on Employment of People with Disabilities (PEP) has been a positive reaction from the government. This programme requires immediate and altered and improved as needed. I believe the quota in place regarding the percentage that ,must be employed in public service jobs but be increased as a matter of urgency, since being set at 3% in 1977, this quota target has only been hit for the first time in the last four years. In order for people with disabilities to gain more access to real paid jobs, managers and training staff of a business should be required to complete training to be more aware and educated on disabilities, this initiative could be done with the involvement of the individuals with disabilities.

As a future social care practitioner, with a keen interest in working with adults with disabilities, I believe there is a huge area available to create awareness and advocate for the individuals. From working with the self-advocates and having my own attitudes and perceptions changed within such a short time frame, I believe time needs to be taken with other people who hold negative perceptions of the abilities of people with disabilities.


References:

  • Andrews A. & Rose J. L. (2010) A preliminary investigation of

factors affecting employment motivation in people with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities 7, 239–244.

  • Banks (2018) study

    https://www.ihrec.ie/app/uploads/2018/09/Disability-and-Discrimination.pdf
  • Butterworth P., Leach L. S., Strazdins L., Olesen S. C.,Rodgers B. & Broom D. H. (2011) The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey. Occupational and Environmental Medicine 68, 806–812.
  • Corley, Cheryl. 2014. Subminimum Wages for the Disabled: Godsend or Exploitation?

    National Public Radio, Morning Edition

    , April 23.
  • Esri.ie. (2019). Disability and Discrimination in Ireland: [online] Available at: https://www.esri.ie/system/files/media/file-uploads/2018-09/IHREC4-Disability-and-Discrimination-FINAL-ONLINE-VERSION.pdf
  • Employment | The National Disability Authority.(2019). [online] Nda.ie. Available at:

    http://nda.ie/Publications/Employment/
  • Gottlieb, Aaron, William Myhill, and Peter Blanck. 2010. Employment of People with Disabilities. In

    International Encyclopedia of Rehabilitation

    . Buffalo: Center for International Rehabilitation Research Information and Exchange (CIRRIE).
  • Holmes J. (2007) Vocational rehabilitation. Oxford: Blackwell Publishing; p. 7.
  • Jang, Y., Wang, Y. and Lin, M. (2013). Factors Affecting Employment Outcomes for People with Disabilities Who Received Disability Employment Services in Taiwan. Journal of Occupational Rehabilitation, 24(1), pp.11-21.
  • Kober R. & Eggleton I. R. (2005) The effect of different types of employment on quality of life. Journal of Intellectual Disability Research 49, 756–760
  • Mallender, Jacqueline, Quentin Liger, Rory Tierney, Daniel Beresford, James Eager, Stefan Speckesser, and Vahé Nafilyan. 2015. Directorate General for Internal Policies of the European Parliament, Policy Department A. Economic and Scientific Policy, Employment and Social Affairs. ‘Reasonable Accommodation and Sheltered Workshops for People with Disabilities: Costs and Returns of Investments—Study for the EMPL Committee. Brussels: European Parliament.
  • May-Simera, C. (2018). Reconsidering Sheltered Workshops in Light of the United Nations Convention on the Rights of Persons with Disabilities (2006). Laws, 7(1), p.6.
  • McGlinchey, E., McCallion, P., Burke, E., Carroll, R. & McCarron, M. (2013) Exploring the Issue of Employment for Adults with an Intellectual Disability in Ireland. Journal of Applied Research in Intellectual Disabilities 2013, 26, 335–343.
  • Retief, M. & Letšosa, R.,2018, ‘Models of disability: A brief overview’, HTS Teologiese Studies/ Theological Studies 74(1),a4738.

    https://doi.org/

    10.4102/hts.v74i1.4738
  • Samoy, Erik, and Lina Waterplas. 1992.

    Sheltered Employment in the European Community

    . Leuven: Katholieke Universtieit Leuven & Hoger Instituut voor de Arbeid.
  • Smart, J., 2004, ‘Models of disability: The juxtaposition of biology and social construction’, in T. Riggar & D. Maki (eds.), Handbook of rehabilitation counseling, pp. 25–49, Springer, New York.

Create a recovery focused nursing care plan for the mental health patient

Create a recovery focused nursing care plan for the mental health patient.

Create a recovery focused nursing care plan for the mental health patient from case study 2

Order Description

no introduction and conclusion are required and that the word count is 1500 works with 20% over or under allowed

create a Recovery based nursing care plan for the patient in case study 2.
the assignment is to be completed in the format provided in the attached document including completion of HONOs
One goal per page
Requiring 22 Referances, UK english

Discipline of Nursing
Complex Mental Health & Recovery 1
Recovery Focused Nursing Care Plan
DUE: Sunday 19th April 2015 by 23:59 [End of Week 6].
Title: Recovery Focused Nursing Care Plan
1500 [approx.] Word Assignment
25 %
Please see the Recovery Focused Nursing Care Plan Information Package
for full details of the Assignment.
This document provides all of the necessary details for Case Study 2.
Case Study 2: The Client with Schizophrenia
Clinician Role: Case Manager (Nurse): Community Case Management
Team.
Identifying Information: Bernard is a 25-year-old single male currently
residing as an inpatient mother in the local Mental Health Unit where he has
been a patient for the past 14/7. Prior to this admission you had been casemanaging
Bernard in the community for the past 9 months. He was admitted
with worsening psychotic symptoms over a 4/52 period in the context of
poor compliance with his oral medication that he puts down to due to
increased stress at home and work. He has been re-established on his
medication with good effect and you are seeing him today to review him and
discuss his discharge plan before he is discharged home in 2/7 time. Bernard
is not religious, works part-time as a labourer for his uncle (who is a brick
layer). Bernard lives with his parents and his younger sister in the family
home.
Presenting Complaint: Bernard reports increased paranoid ideation in the
preceding 4/52 stating ‘they’ are watching him, following him and talking
about him. When asked who ‘they’ are he refuses to identify them, stating
that if he does “they’ will come after you too”.
History of Present Problem: Bernard reports first being diagnosed with first
onset psychosis at the age of 22. He was studying Engineering at University
and was half-way through his final year leading up to mid-year exams when
he first became unwell. At this time he experience paranoid ideation and
Discipline of Nursing
Complex Mental Health & Recovery 2
heard voices of a commentary nature. He was treated by the local First Onset
Psychosis Team and made a good recovery over time in the community.
Eventually he was discharged to ongoing treatment via a private psychiatrist
and his GP and everything had been going well until 11/12 ago when he
experienced a full relapse of symptoms whilst on a family holiday overseas.
He had returned to Australia and had been an inpatient in the local Public
Adult inpatient Unit for almost 2/12 at that time and had subsequently been
assigned a Case Manager to oversee his progress following this episode. He
had initially made slow but steady progress in the community and had
started to work for his uncle as a labourer to earn some extra money. This
had initially gone well however some of the other workers on the building
site had started to make fun of him leading to his becoming increasingly
stressed and subsequently more disorganised in his thoughts and actions. He
also reported beginning to feel quite paranoid about his co-workers, and
began to suspect that they were planning to harm him or his family. He
reports that his poor compliance with medication was accidental and he did
not mean to not take them. Bernard states that although his paranoia has
receded over the past fortnight he has experienced increasing anxiety,
feelings of helplessness and worthlessness, as well as feeling overwhelmed
by his situation, saying “I did my best last time and it all just fell to pieces;
what’s the point in trying now if that’s what’s going to happen?”.
Bernard sleeps 6-8 hours per night, experiencing some difficulty getting to
sleep as he tends to lie in bed worrying about his life and future. He denies
any middle-of-the-night or early-morning awakening. His appetite has
increased since recommencing medication and he report a weight gain of 4
kilograms in the past fortnight. He eats large meals and usually snacks on
top of this. Meals at home are usually prepared by his mother. Bernard had
been contributing to the running of the household prior to his relapse
however at present does not feel up to doing household chores. He has
become increasingly insular and has avoided social contact, tending to avoid
friends and family who have come to call: he states this is for fear of them
becoming targeted by the same people who were targeting him. Bernard
describes few interests or activities outside the home; he had been heavily
involved in the Drama and Soccer clubs whilst at University however he lost
contact with most of the people he knew from them once he became unwell.
He has been unable to establish a new social circle since then.
The evenings are most difficult for Bernard — he feels increased anxiety,
restlessness and finds that his pattern of negative rumination is markedly
worse during the evening. He describes feeling disconnected from his life
and unsure of what he is doing. He says he had a clear plan of what he
wanted to do with his life but “that is all gone now” and he is struggling to
Discipline of Nursing
Complex Mental Health & Recovery 3
come to terms with the loss. He admits to occasional suicidal ideation in the
form of a passive wish to be dead “because it would just be easier” however
he denies a history of suicide attempts or current suicidal plan, stating he
“could never do that to my Mum and Dad or Sister”. He denies any alcohol
or drug abuse; he reports some experimentation with Cannabis and Ecstasy
at parties in first year Uni but did not like the feeling and has not tried
anything since.
Current life stressors reported by Bernard include:
· Co-workers on the building site where he has been working with his
uncle making fun of him, calling him ‘freak’, ‘creep-show’ and ‘oddball’.
He has caught them several times laughing at him as well; he
knows it is directed at him because they stop when he gets within
earshot.
· His mother has recently been diagnosed with Diabetes and is having
a hard time coping with this. Whilst she has begun to adjust to this
Bernard is fearful that she will get unwell and might die in the future.
· The loss of his intended life; he had been enjoying studying and had
been doing extremely well in his course. He had begun to send out
letters of interest to obtain an internship after he finished his degree. He
had also begun to think about moving out of home into shared
accommodation with several Uni friends and had been very excited
about the impending change in his life. He reports feeling like a failure,
stating that he feels “useless”.
· Loss of her sense of role / structure that he had had whilst at Uni.
Since then he had struggled to get some structure and routine in his
life leading to him staying up late and then sleeping half the day.
Past Psychiatric History: Bernard was diagnosed with 1st episode psychosis
three years ago and initially responded well to treatment. When he relapsed
11/12 ago he was diagnosed with Schizophreniform psychosis which was
revised and change to Schizophrenia during the current admission. The treating
team are also questioning the possibility of a mood component given Bernard’s
recent anxiety and depressive features.
Pre-morbid Personality: Bernard describes himself as being creative,
dramatic, funny and ambitious before becoming unwell. When asked further
about Uni he says he was motivated, hard-working and really enjoyed the
challenge of study though at times could be a little disorganised, putting this
down to “being young”. He also reports a being very loyal to family and
close friends, and has struggled with losing those friends who did not stay
with him when he became unwell.
Discipline of Nursing
Complex Mental Health & Recovery 4
Medical History: Bernard’s only physical issue was a # L wrist sustained in a
push-bike accident [when he was 17yo] that required surgery after it did not
set straight initially. He has no known allergies.
Family History: Bernard is the older of 2 children; the other being his
younger sister Estelle [23yo] with whom he is very close. His parents are
both alive and generally well; his father [Peter] suffers from high cholesterol
and his mother [Janet] has recently been diagnosed with Type 2 Diabetes.
Bernard reports that his father’s older brother [paternal uncle] had a
‘breakdown’ when his father was in his early 20’s and committed suicide;
this is never spoken of in the family so Bernard knows nothing more about
this.
Social and Developmental History: Bernard is the older of 2 children. His
mother’s labour was normal though he was delivered via caesarean section at
term after the labour failed to progress. His early developmental milestones
(talking, walking, etc.) were reached at normal age range. He denies any
maladaptive behaviours or experiencing unusual stresses as a child.
Academically, Bernard was a B grade student throughout his school years; he
states that he could have done better but didn’t apply himself as much as he
could have. He had many friends at school and as well as through various
community groups [such as drama and various sports]. He had his first
romantic relationship in Year 10 of secondary school and has had several
girlfriends since. His most recent was a girl he met in Uni however this ended
when he first became unwell. He states that he would like to meet someone in
the future but believes this is unlikely due to his illness. He has deferred his
studies at Uni and hopes to be able to return when well.
Bernard was raised in metropolitan Melbourne and has live in the family
home in Glen Waverly all of his life. He reports that the family has always
been very close and they all generally get alone quite well. He says his
parents and sister have been very supportive of him since becoming unwell
though he worries about the impact the ‘stress’ might have upon them all.
When first unwell he went through a period where he though they would be
better off without him but states that he no longer feels this well and is
regularly reassured of his family’s support. Long term goals had involved
completing his degree, establishing his career, travelling and eventually
settling down and starting a family of his own. Bernard is no longer certain
about how he sees his future.
Discipline of Nursing
Complex Mental Health & Recovery 5
Mental Status Examination
General Appearance: Bernard is a 25 year old male who appears of stated age.
He is of medium build, has short brown hair and is appropriately dressed. He is
mildly dishevelled in appearance [unshaven, malodourous] and he presents
with variable eye contact; in particular this drops when he is feeling anxious or
uncertain of himself.
Speech: Bernard speaks with a normal rate, tone and volume for the most
part. Occasionally his responses to questions are delayed however the
content of his conversation is logical, goal-directed, and appropriate to
situation and context. There is a noticeable increase in the rate [increased] and tone [more excitable] of his speech when discussing content related to
his paranoid ideation.
Thought Content: Bernard describes themes of loss, worthlessness,
helplessness and hopelessness. There are some residual paranoia ideas
evident regarding his former co-workers though these are fleeting in their
nature and are less intrusive when they do occur.
Affect and Mood: Bernard describes his mood as variable; he reports period
of sadness, anxiety and uncertainty for the future. His affect is mildly
restricted, with diminished range and a generally sad quality though he is
responsive to humour at times.
Motor Behaviour: Posture is generally closed, and leaning forward though
his level of psychomotor activity increases when anxious.
Perceptions: Bernard describes persistent paranoid delusions regarding his
former co-workers though these are gradually softening and appear less
frequent and intrusive that prior to his admission. He feels some emotional
response to them [primarily anger] though firmly denes any plans to act on
same. He had initially felt he could hear others talking about him at work
though he know denies any such phenomenon; there is no other evidence of
hallucinations.
Suicide Potential: Bernard describes fleeting episodes of suicidal ideation in
the form of a passive wish to be dead “because it would just be easier”
however he denies a history of suicide attempts or current suicidal plan,
stating he “could never do that to my mum and dad or sister”.
Orientation: Bernard is oriented to person, place, and time.
Discipline of Nursing
Complex Mental Health & Recovery 6
Concentration: Bernard describes a mild impairment in his concentration as
evidenced by an inability to do Serial 7’s accurately past a digit span of 5 [93,
86. 79. 72, 65 x, x, x,). He gives the example of struggling to concentrate on
TV or reading which frustrates him as he enjoys both of these activities.
Recent and Remote Memory: Bernard’s recent memory is intact, with three
of three objects recalled after 5 minutes. He is able to describe accurately
events from the past.
Insight and Judgement: Bernard has partial insight into his illness; he
accepts that he has a psychotic illness though he is unhappy with the
diagnosis of schizophrenia as he thinks it means he’ll never recover. He is
able to acknowledge psychotic Sx in retrospect though at the time has poor
insight. He has begun to trust his family’s opinion on his symptoms and will
often seek reality based reassurance regarding things that he is experiencing.
Formulation of Impression
Bernard is a 25 year old male with a Hx. of 2 previous episodes of psychosis
recently diagnosed with schizophrenia. He presents with a 4-6 week history
of re-emerging psychotic symptoms in the context of [unintentional] poor
compliance with prescribed oral medications. He experienced increasing
levels of stress, disorganised thinking and behaviour as well as paranoid
delusions about his co-workers suspecting that they were planning to harm
him or his family. Subsequent to his admission he has also exhibited mildly
depressed mood; increased anxiety; feelings of worthlessness, hopelessness,
and helplessness, suicidal ideation; withdrawn behaviour and impaired
functioning; decreased concentration. His symptoms are consistent with that
of Schizophrenia though the emerging affective component will need to be
closely monitored for further evidence of a co-morbid depressive or anxiety
related disorder. Bernard’s preoccupation with worthlessness, rumination
about the losses he has experienced, passive suicidal ideation, and his
marked functional impairment, all occurring in the context of his illness are
suggestive of a co-existing grieving process though at this stage this appears
to be appropriate under the circumstances.
Traditional Nursing Diagnostic Focus
The following nursing diagnoses for Bernard are derived from the
assessment data gathered:
· Altered Thought Processes.
Discipline of Nursing
Complex Mental Health & Recovery 7
· Sensory-perceptual Alterations.
· Anxiety.
· Mood Disturbance
· Risk for Self-directed Violence
· Self-esteem Disturbance
· Self-care Deficit
· Social Isolation
· Sleep Pattern Disturbance [minor].
HONOs Scoring
Domain Results
1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 4
2. Non-accidental self-injury. 0 1 2 3 4
3. Substance use and misuse. 0 1 2 3 4
4. Cognitive problems. 0 1 2 3 4
5. Physical illness or disability problems. 0 1 2 3 4
6. Hallucinations or delusions. 0 1 2 3 4
7. Depressed mood. 0 1 2 3 4
8. Other mental health issues [Anxiety]. 0 1 2 3 4
9. Relationships. 0 1 2 3 4
10. Activities of daily living. 0 1 2 3 4
11. Problems with living conditions. 0 1 2 3 4
12. Problems with occupation and activities. 0 1 2 3 4
Results Key: see Assignment Information package.
Discipline of Nursing
Complex Mental Health & Recovery 8
DSM-5 Diagnosis for the Client with Schizophrenia
The DSM-5 diagnosis for Bernard is as follows:
· Schizophrenia (295.9).
Planning
The Nursing Care Plan for Bernard illustrates how nursing diagnoses
guide the development of goals and therapeutic interventions. Ideally, the
nurse collaborates with the client in planning care.
This can be difficult to do with the psychotic or depressed person who is
feeling hopeless, helpless, and unmotivated.
The nurse’s communication of the firm belief in the client’s capacity,
ability, resourcefulness and potential for recovery is critical in
empowering the client to begin the journey towards recovery.
Equally the nurse’s communication of the firm belief that the client will
feel better with time can often be enough to engage the client in at least
going along with the care plan.
Setting practical, reasonable, manageable, short-term goals that the client
can accomplish without much difficulty is important in fostering a sense of
hope and improved self-esteem.
The nurse should expect that with the amotivated psychotic client, early
interventions may need to be aimed at “doing for” the client [after accurate
identification of those abilities that remain intact vs. those that are
compromised].
The care plan will also need to include consideration regarding the
involvement/capacity of family, friends and other significant supports
care of her daughter], but the expectation should be that the client will
gradually assume more independent functioning as their mental state
improves.
Implementation
Nursing interventions are guided by the nursing care plan. For the
psychotic client, priority needs to be given to preventing self-harm
through ongoing assessment of suicide potential and maintenance of a
safe environment.
Discipline of Nursing
Complex Mental Health & Recovery 9
In addition, improving and maintaining physical health are important
foci of care for the depressed client, who is likely to have an altered
nutritional status and disturbed sleeping pattern.
Monitoring for side effects of pharmacological treatments for
depression is equally important to maintain biological integrity.
The psychotic client is often socially isolated and withdrawn.
Involving the client in individual and group interactions in the
hospital unit will decrease his or her isolation and foster a sense of
self-worth.
As the client’s symptoms of depression respond to the
psychotherapeutic and somatic interventions implemented, psychoeducation
becomes feasible.
Clients and their Families should be educated about the type of
mental illness they have, as well as its possible causes.
Specifically, the contribution of both neurobiological and psychosocial
factors to the onset of depressive illness should be discussed.
Informing the client of the signs and symptoms of depression is
important so that recurrence can be identified early.
Education regarding the maintenance of medication regimens should
be conducted.
Evaluation
Evaluation of the client’s responses to nursing interventions should be
ongoing. In developing a Recovery Focused Care Plan for Bernard the nurse
might ask the following questions to evaluate the effectiveness of the nursing
process to ensure progress remains ongoing:
· Does the client describe an improvement [reduction] in the frequency and
intensity of paranoid thoughts?
· Does the client describe an improvement in his level of organisation related
to both his thinking and his behaviour overall?
· Does the client describe an improvement in mood and energy level?
· Has there been any change in / worsening of his suicidal ideation?
· Has the client learned new, more effective ways of expressing feelings?
· Has the verbalisation of self-deprecatory [worthless/hopeless] ideas
diminished?
Discipline of Nursing
Complex Mental Health & Recovery 10
· Is the client initiating interactions with others?
· Is the client initiating planning for his future taking into account the
impact of his mental illness?
In asking these and other questions, the nurse reflects on his or her own
observations; on the observations of other team members and the client’s
family; and, of utmost importance, on the client’s description of his or her
own experience.

Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 1
Written Assessment Task
Recovery Focused Nursing Care Plan
DUE: Sunday 19th April 2015 by 23:59 [End of Week 6].
Title: Recovery Focused Nursing Care Plan
1500 Word Assignment
25 %
Assignment Number 1: 25%
Developing a Recovery Focused Nursing Care Plan [RFCP].
– A Recovery Focused Nursing Care Plan based on the care of a consumer described in one of
scenarios. Please see the assessment information package for more information on this
assignment.
Instructions:
1. Choose 1 of the scenarios to use as the basis for your assignment [you will base your entire
assignment on one of the case scenarios only] 2. Read the Case Study and identify 5 Goals drawn from both the case study information and
the HONOs scale for the consumer in the scenario. Consider and adopt a Recovery Model
perspective in doing this.
3. Having read the following case study, and familiarised yourself with the layout of the
nursing care plan, you are to complete the Recovery Focused Nursing Care Plan for this
client.
4. Each RFCP must include 5 full Goals/Issues with each section fully completed.
5. In keeping with the Recovery Model principles [as conveniently discussed in the Week One
lecture] remember to:
a. Rank the goal priority in the order in which the consumer would like to address
the issues listed [there are going to be different ways to do this depending on
what you see as being the highest priority]; this will require some critical
consideration on your behalf.
b. Make sure that language used on the RFCP is clear, encouraging and agreed by
consumer and clinician.
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 2
c. Keep in your mind at all times the importance of this being a ‘shared document’
that aims to maximise the consumer’s strengths, capacity, abilities and
resources.
6. You are allowed to ‘fill in’ details in the case study where you feel that it is important for
the completion of the RFCP. If you do this you must include all additional information in
an Appendix which should be cited in text wherever this information is relevant.
7. You must support your work with references. In particular this means that his means that
you will need to locate references that support nursing and consumer interventions as
wells as in identifying potential strengths [especially through the literature on the
Recovery Model] as well as when identifying supports and resources and determining
timeframes for review.
8. Please post all questions up on the Course Discussion Boards as this will allow all students
to benefit from the answers.
9. In keeping with RMIT policy all assignments are to be submitted through the Turnitin
Portal available via the course webpage.
The assignment is due by 23:59 on Sunday night: the portal will remain open until this
time however after the portal closes you will not be able to submit your assignment so
please make sure that it is submitted by 23:59.
The Turnitin portal will open 2 weeks prior to the assignment due date to allow you to
submit your assignment. You are allowed to submit it as many times as you would like up
until 23:59; the assignment I will receive to mark will be the LAST one you submitted.
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 3
Constructing the Recovery Focused Nursing Care Plan:
When constructing the RFCP you are required to submit he document using the following format:
Consumers
Priority
Identified
Goals/Issues
The consumer’s
strengths to
address these
issues.
Consumer and
Nursing
Interventions
Person/s
Responsible
Timeframe
– Include a
succinct
statement
describing
the issue.
– Rank
according
to the
consumers
priorities.
– Can be done
using HONOS or
based upon the
information
provided in the
case study
– This section is
critical to
ensuring the
plan has a
genuine
recovery focus.
– You need to
ask questions
such as:
– ‘What can they
do?’
– How
can they help
themselves?
– Include
agreed
actions and
expected
outcomes.
– Consider
what needs to
be done for
each Goal /
issue and
identify what
things the
consumer can
do and what
things the
nurse needs to
do.
– Who is
responsible
for this
intervention
occurring?
– Who will be
assisting in
this
intervention.
– What sort
of assistance
are they
going to give.
– This needs
to be realistic
and
developed
with the
consumer.
– It also
needs to
reflect the
time taken
for
interventions
to effect
change in the
consumer’s
symptoms.
So your final assignment will have the following structure
Consumers
Priority
Identified
Goals/Issues
The consumer’s
strengths to
address these
issues.
Consumer and
Nursing
Interventions
Person/s
Responsible
Timeframe
#1 Goal/Issue 1 Strengths 1 Interventions 1 Responsibility 1 Timeframe 1
#2 Goal/Issue 2 Strengths 2 Interventions 2 Responsibility 2 Timeframe 2
#3 Goal/Issue 3 Strengths 3 Interventions 3 Responsibility 3 Timeframe 3
#4 Goal/Issue 4 Strengths 4 Interventions 4 Responsibility 4 Timeframe 4
#5 Goal/Issue 5 Strengths 5 Interventions 5 Responsibility 5 Timeframe 5
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 4
The HONOs and the Recovery Focused Nursing Care Plan:
The HONOs scale is completed as part of the assessment data and can be used to identify the key Goals and Issues
and then rank them according to consumer preference. It is included as part of the case study information.
Domain Results
1. Overactive, aggressive, disruptive behaviour. 0 1 2 3 4
2. Non-accidental self-injury. 0 1 2 3 4
3. Substance use and misuse. 0 1 2 3 4
4. Cognitive problems. 0 1 2 3 4
5. Physical illness or disability problems. 0 1 2 3 4
6. Hallucinations or delusions. 0 1 2 3 4
7. Depressed mood. 0 1 2 3 4
8. Other mental health issues. 0 1 2 3 4
9. Relationships. 0 1 2 3 4
10. Activities of daily living. 0 1 2 3 4
11. Problems with living conditions. 0 1 2 3 4
12. Problems with occupation and activities. 0 1 2 3 4
Results Key
0 = No problem at all during the rating period [usually the last 72 hours].
1 = Minor problem / occasional issues causing occasional periods of distress or impairment during the rating
period [usually the last 72 hours].
2 = Moderate problem during the rating period [usually the last 72 hours] causing passing periods of distress or
impairment during the rating period [usually the last 72 hours].
3 = Significant problem causing persistent distress or impairment during the rating period [usually the last 72
hours].
4 = Severe problem causing constant distress or impairment during the rating period [usually the last 72 hours].
Discipline of Nursing
NURS2098: Complex Mental Health & Recovery 5
The Recovery Focused Nursing Care Plan Marking Guide.
Student Name: _________________________________________
Assessment Criteria Mark
Allocation
Consumer Priority:
· Prioritisation logical and appropriately organised.
· Reflects the information in the case study.
· Reflects consumer preference.
· Prioritisation reflects a commitment to the key concepts of the recovery model.
/3.
Identified Goals/Issues:
· Congruent with client needs.
· Reflects the information provided in the case study.
· Clear, succinct and relevant.
/3.
Consumer’s strengths to address these issues:
· Realistic, sensible and possible strengths identified.
· Relevant and connected to the Goal/Issue.
· Strong person focus.
/4.
Consumer and Nursing Interventions:
· Appropriate for outcomes.
· Feasible and realistic.
· Consumer interventions relevant & appropriate.
· Consumer interventions act to maximise consumer ability and capacity.
· Nursing interventions based on sound evidence/research.
· Nursing interventions Consumer oriented [not nurse / system oriented].
· Nursing interventions act to do only what the consumer cannot.
/4.
Persons Responsible
· Relevant, appropriate and realistic.
· Person and role clearly identified.
· Roles allocated to maximise consumer, carer and community involvement.
· Seeks to maximise consumer / carer involvement.
/3.
Timeframe
· Reflects the Goals / Issues as outlined.
· Feasible, Realistic & Measurable.
· Specific to the consumer and their strengths / resources / barriers and overall situation.
/3.
Style & Presentation:
• Including use of word limit, double-spacing, use of header & footer, section headings, page
numbers, and size-12 Times New Roman font.
· Spelling, grammar and paragraph structure meets academic standards.
/2.
Referencing:
• Utilises relevant and contemporary references to support the discussion in each response
• In text referencing used throughout.
• Referencing formatted in accordance with APA requirements.
• Includes at least 12+ current references (books and journal articles)
/3.
TOTAL: /25.

Agency Health Education and Health Promotion Personnel.Research potential funding opportunities by visiting – Partners in Information Access for the Public Health Workforce –

Agency Health Education and Health Promotion Personnel.Research potential funding opportunities by visiting – Partners in Information Access for the Public Health Workforce –

As you are aware, World AIDS Day is quickly approaching.

I would like your staff to send me a listing of ideas and methods our department could use to promote this international event. With each method please provide the funding needed to successfully complete the project.

Research potential funding opportunities by visiting – Partners in Information Access for the Public Health Workforce – http://phpartners.org/grants.html
Thank you for your attention to this matter.

Advantages and Disadvantages of Medication for Children Diagnosed with ADHD

ADHD, also known as Attention Deficit/Hyperactivity Disorder;  is a neurodevelopmental disorder that causes and imbalance, deficiency, or inefficiency in brain chemicals, effecting certain regions of individuals brains (Edmunds, 2018. P.152.). The three principle characteristics that make up ADHD are; impulsivity, hyperactivity, and inattention (Wender, 2002). Hyperactivity characteristics can be seen in fidgeting, restlessness, non-stop talking ect. Impulsivity is characterized by speaking without thinking, displaying reactions without restraint, acting out without thinking about consequences and so forth. Inattentiveness is comprised of forgetfulness, having a hard time staying on task, easily distracted, and having a hard time fallowing instructions (Wender, 2002). Students diagnosed with ADHD can have on stream or a combination of streams in their diagnosis. Individuals can only be diagnosed with ADHD from a psychiatrist; this process is comprise of a history of the individual from parents, teachers, coaches, an interview with the child themselves, as well as input on the child’s current behaviours based on rating scales (Edmunds, 2018 P.152). According to facts Canada, “ADHD conservatively occurs in 4% of adults and 5% of children worldwide” (CADDAC, 2018).

ADHD is a disorder that effects all areas in life, including the classroom, however, there are multiple ways to help these individuals control their outbursts, and maintain a high level of functioning through forms of therapy and medication. This paper will be discussing the benefits and limitations to medicating individuals with ADHD, and my stance on the matter.

Among the multiple avenues to helping children who have ADHD, medication is a very prevalent option. ADHD medication acts as a stimulant by increasing levels of two brain transmitters: norepinephrine and dopamine. “These Neurotransmitters wake up the front and pre-frontal lobe braking functions, allowing them to exert better executive function in areas such as distractibility and self-control. They provide self-control by waking up (stimulating) the brain’s own brakes” (Kutscher, 2008. P. 102). Contrary to a sedative, ADHD medication allows individuals to stimulate the parts of the brain that help them stop (brake) getting distracted, fidgeting, ect. And focus on the task at hand, improving their performance.

To give a bit of context of the type of medication students with ADHD use, I will introduce two types. The first being Ritalin; this is a stimulant medication containing methylphenidate, and is taken via pill, multiple times a day. Ritalin essentially stimulates specific neurons throughout the brain that are not working as they should. The neurons that they target are ones that tell us “when to pay attention to specific activities, and when to ignore other ones” (Edmunds, 2018, P.156.). Secondly, there is Concerta; this is a one-pill a day medication that also contains methylphenidate, and is a stimulant medication.

Among my research done, there is always one prominent question; what are the advantages and disadvantages of medication? As with any medication, there are side effects that come with taking it. According to Edmunds, research shows several downsides to ADHD medication, including but not limited too; insomnia, which is a sleep disorder, usually characterized as getting little sleep or having difficulty falling asleep, Loss of appetite is seen in a lot of cases, more so towards the beginning of introducing the medication to the body (Edmunds, 2018. P.156). Loss of appetite can also result in some weight loss early on in the stages of starting medication, this side effect has resulted in concerns of growth stunts (Edmunds, 2018. P.156) Mild changes in personality has also been seen as a side effect, bringing forward behaviours such as irritability, and overall negative behaviours. Additionally, Anxiety and OCD symptoms are sometimes seen as worsening as an effect of the stimulants (Edmunds, 2018, P.156). Some more minimal side effects associated with the medications are headaches and stomach aches.

Although some of the side effects are scary and seem daunting, “The risks of using these medications are very low,” says William W. Dodson, M.D., a Denver-based psychiatrist who specializes in ADHD. “The risks involved in not treating ADHD are very high. These include academic failure, social problems, car accidents, and drug abuse.”

“Eighty percent of children who take stimulants experience some appetite suppression, but this side effect usually goes away on its own within six months,” says Dr. Copps (Van De Loo-Neus, 2011.P.2).

On the other hand, we have the benefits of these medications. The benefits brought by these medications are seen in all aspects of life; in the classroom, at home, in the workplace, and more. As Edmunds explained, medications have a significant improvement in the area of attention span, and they are proven to reduce hyperactivity and impulsivity (Edmunds, 2018, P.157.). In the classroom, Edmunds noticed that teachers had mentioned a resolution of prior problems with “incomplete class work, distractibility, and disruptive behaviour” (Edmunds, 2018, P.157.). Additionally, on the home front, parents will notice that their children are having an easier time getting homework done, tasks are completed with less distractions, as well as less outbursts (Edmunds, 2018. P 156.). Overall, the medication is designed to help the brain stimulate is neurons that regulate self-control, in turn, helping individuals regulate themselves on a day to day basis with less distraction, restlessness, and uneasiness. It is clear how this is helpful in a classroom setting, not only helping class run smoothly, but an overall improvement in learning, and the development of the individual.

Along with the side effects of the medication, there are side effects of NOT taking medication if you have been diagnosed with ADHD. Specifically; a 30% chance risk of substance abuse, high risk of dropping out of high school or college, poor self-esteem, and a higher risk of a car accident (Edmunds, 2018. P.157).

Considering both the benefits and advantages of ADHD medication on individuals, it is not a very straightforward answer of if we should or should not medicate our children. I believe that the medication can help greatly, however, I do not believe it is the first solution. When we discover that our children may have ADHD I think there are multiple resources to reach to first, such as behavioural therapy, implementing and IEP, EA and so forth. A diagnosis can only be made by a psychiatrist who compiles of complete history of the child, once this diagnosis has been made, medication can then come up as a source of help. I understand the concerns surrounding medicating children and the threats it poses, however, from research done, a lot of the side effects I have researched are only temporary. Specifically side effects such as loss of appetite, headaches, and stomach aches which appear to be present at the onset of taking medication, are also reported to decrease as time goes on and the body gets used to the medication (Van De Loo-Neus, 2011. P. 1).

Considering all the information I have learned, I think that medications should be used for children who are diagnosed with ADHD when therapy and other interventions fail to work. Kutscher condenses my thoughts well when he says, “once you have given a child a reasonable attention span with medication, then we can ask him to behave in class. We are not saying to use medication instead of teaching coping skills; we are saying that sometimes medication is needed to make utilizing those techniques actually possible” (Kutscher, 2008. P.109). This is a disorder that students cannot cope with sometimes, and the need for medication is there, I believe the benefits of improving school work, learning, and self-efficacy, outweigh the cons of being at risk to have some side effects. I have a friend with ADHD and I asked him if I could ask him about his experience taking Concerta. Friend X uses Concerta 18 mg once a day in the morning, he experienced some loss of appetite which went away as time went on. When I asked what improved, his responded that his ability to focus increased severely, as well as an increase in his grades, and overall achievement at school. When I asked if he would recommend other students that have been diagnosed with ADHD to take medication, he replied with a yes.

To conclude, I believe as a teacher it is our job to help our children succeed and feel impowered in their studies. We are to mold and shape the classroom to help fit to the unique needs of students, including the needs of students with ADHD. While I do not think medication is the first choice, I do believe it is a suitable choice when the need is clearly there. The benefits it provide cannot be ignored, and with a support team of school, family and doctor, side effects can be monitored and dosages modified when needed as the child grows up. I think every child deserves to feel successful and smart, and if medication is allowing these students to focus and achieve then I believe that they should be prescribed medication with a doctors approval.


References:

  • CADDAC. (N.D). Retrieved November 28, 2018, from https://caddac.ca/adhd/understanding-adhd/in-general/facts-stats-myths/
  • Kutscher, M. L. (2008).

    ADHD – Living Without Brakes

    . London: Jessica Kingsley Publishers. Retrieved from

    https://ezproxy.student.twu.ca/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=236294&site=eds-live
  • Mccarthy, L.M. (N.D). Top 10 Questions about ADHD medications answered. https://www.additudemag.com/top-10-questions-about-meds-answered/
  • van de Loo-Neus, G. H. H., Rommelse, N., & Buitelaar, J. K. (2011). Review: To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended?

    European Neuropsychopharmacology

    ,

    21

    , 584–599. https://doi.org/10.1016/j.euroneuro.2011.03.008
  • Paul H. Wender, MD. 2002. ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults , by Paul H. Wender, MD. Oxford University Press.

Why is computer fraud often more difficult to detect than other types of fraud?Why is computer fraud often more difficult to detect than other types of fraud? (Points : 2) Rarely is cash stolen in computer fraud.

Why is computer fraud often more difficult to detect than other types of fraud?Why is computer fraud often more difficult to detect than other types of fraud? (Points : 2)
Rarely is cash stolen in computer fraud.

Redundancy can be a major problem in the design and operation of relational databases. If a database uses only one relation to store data, several problems may subsequently occur. The problem of changes (or updates) to data values being incorrectly recorded is known as (Points : 2)
an update anomaly.
an insert anomaly.
a delete anomaly.
a memory anomaly

Why is computer fraud often more difficult to detect than other types of fraud? (Points : 2)
Rarely is cash stolen in computer fraud.
The fraud may leave little or no evidence it ever happened.
Computers provide more opportunities for fraud.
Computer fraud perpetrators are just cleverer than other types of criminals.

3. (TCO 7) Chelsana Washington is a medical equipment sales representative. Her company has provided her with a laptop computer that uses wireless connectivity to access the accounting information system from virtually anywhere in the country. She, and the other sales reps, have read access to customer and product information. They have write access that allows them to enter and cancel customer orders. These permissions define a(an) ______ in the company’s database management system. (Points : 2)
schema
subschema
data dictionary
physical view

4. (TCO 2) This control framework’s intent includes helping the organization to provide reasonable assurance that objectives are achieved and problems are minimized, and to avoid adverse publicity and damage to the organization’s reputation. (Points : 2)
ISACF’s control objectives for information and related technology
COSO’s internal control framework
COSO’s enterprise risk management framework
None of the above

5. (TCO 7) Which statement below is false regarding the basic requirements of the relational data model? (Points : 2)
“Every column in a row must be single-valued.”
“All non-key attributes in a table should describe a characteristic about the object identified by the primary key.”
“Foreign keys, if not null, must have values that correspond to the value of a primary key in another table.”
“Primary keys can be null.”

Infectious Disease MRSA and the Role of the Nurse Practitioner

Infectious Disease MRSA

Methicillin-resistant Staphylococcus aureus (MRSA), is a common bacteria. About 20-40% of people carry it their noses and may carry it on their skin (Aboualizadeh et al., 2017). Studies show that about 33% people carry staph in their nose, usually without any symptoms or illness (Aboualizadeh et al., 2017). People who have MRSA on their skin can contaminate the items that they touch as well as shedding MRSA into the air, which can persist in the environment for prolonged periods of time unless removed through cleaning (Aboualizadeh et al., 2017).

MRSA commonly colonized in warm, moist parts of the body, such as the axilla, groin, perineum, and nose. People with MRSA infection sometimes think that they have a spider bite. However, unless a spider is actually seen, then likely it is not a spider bite (Nazarko, 2014). Most MRSA skin infections appear as a bump or infected area on the skin that might be red, swollen painful, warm to the touch, full of pus or other drainage, and accompanied by a fever (Nazarko, 2014).

If left untreated, MRSA infections can become severe and cause sepsis, a life-threatening reaction to severe infection in the body. Other strains of MRSA can produce a toxin that is responsible for toxic shock syndrome and gastro-enteritis if ingested (Nazarko, 2014). MRSA is responsible for approximately one-third of all wound infection in hospitals. MRSA infection increases length of hospital stay, increases treatment costs, and increases risk of death.

Treatments for MRSA is to remove MRSA from the skin and nostrils by using a topical antimicrobial ointment and oral antibiotics (Nazarko, 2014). The antibiotic recommended will depend on the strain and resistance of the MRSA. While undergoing treatment, it is essential that the patient also ensures that the environment is clean to prevent re-colonization and/or re-infecting the area (Nazarko, 2014). Also, many MRSA skin infections may be treated by draining the abscess or boil and may not require antibiotics.

Prevalence rate of MRSA are based on population and geographical location. One study found a 59% overall prevalence with a range from 15% to 74% of MRSA are presented in the emergency departments in 11 major United States (U.S) cities (U.S. Department of Health & Human Services, 2019). Increases in MRSA infection rates occurs in young adults, children, Native Americans, Alaskan natives, and Pacific Islanders. The highest rates of mortality are black males over the age of 65 years old. According to Centers for Disease Control and Prevention (CDC) an estimates of 19,000 Americans died from invasive MRSA infections in 2005 (U.S. Department of Health & Human Services, 2019). Today, the increased incidence of MRSA has become a national health priority because patients seek healthcare approximately 14 million times a year for suspected MRSA infection (U.S. Department of Health & Human Services, 2019).


Determinants of Health

MRSA first emerged in pediatric population in the 1990s and the incidence of pediatric ambulatory has nearly tripled (Aboualizadeh et al., 2017). Close contact with people who have been infected with MRSA increases the population risk for MRSA infection. Therefore, implementing personal protective equipment (PPE) is important to prevent the spread of MRSA. Several published reports have documented MRSA outbreaks among military, religious, and sport communities (Robinson, Edgley, & Morrell, 2014).

Carpeted floors were identified as the surface with the highest incidence of MRSA infection in an athletic facility, and crowding and poor hygiene in community settings contribute to the spread of MRSA infection (Aboualizadeh et al., 2017). Removing carpet floor and applying hard floor will makes it easier to disinfect work environment. Overcrowded environment are more likely to transmit MRSA, it is estimated that 85% occupancy is best, as this allows staff sufficient time and space to ensure the environment is clean and procedures are adhered (Aboualizadeh et al., 2017). MRSA poses a much greater risk in hospitals, where there are large numbers of invasive devices and where operations are being carried out (Aboualizadeh et al., 2017). Furthermore, each time a member of staff attends to a patient, they should wash their hands with liquid soap and water.


Host Factors

MRSA is a non-spore forming and gram-positive cocci agent that appear as golden tinged clusters when seen under a microscope (Nazarko, 2014). Older people are at greater host of developing MRSA than younger people because they have impaired immune systems. People who are colonized with MRSA are at risk of developing an MRSA infection because the individual has MRSA bacteria on his or her skin (Nazarko, 2014). Hospital treatments, including intravenous infusions, urinary catheterization and surgery, all provide a ‘portal of entry’ and enable bacteria that have been sitting harmlessly on the person’s skin to enter the body and cause a potentially life-threatening infection (Nazarko, 2014).

MRSA is rarely spread by airborne transmission. There is little evidence to suggest that nasal carriers of MRSA transmit disease. MRSA is normally spread from patient to patient on the hands of nursing and medical staff. MRSA can remains on the hands from minutes to hours. Overcrowded and understaffed healthcare environments are more likely to lead to infection control breaches and transmission of MRSA (Nazarko, 2014). To break the chain of infection and prevent the spread of MRSA is hand washing.


Role of FNP

According to American Association of Nurse Practitioner (AANP), the role of the primary care nurse practitioner is to provide healthcare to patients of all ages and walks of life (American Association of Nurse Practitioners (AANP), 2019). Nurse practitioners (NPs) assess patients, order and interpret diagnostic tests, make diagnoses and initiate, and manage treatment plans including prescribing medications (AANP, 2019). NPs role in management of infectious disease is to understand the different stages allows for a better understanding of the approach to the prevention and control of disease (Robinson, Edgley, & Morrell, 2014). NPs use the population-based models as it related to evidence-based practice to focuses on populations as risk, analysis of aggregate data, evaluation of demographic factors, and public health through the use of population health sciences of clinical practice (Robinson et al., 2014). Finally, NPs play an increasingly important role in evaluating the quality and effectiveness of healthcare delivery such as reduce the cost of care and improve the patient’s experience of their healthcare.

References

  • Aboualizadeh, E., Bumah, V. V., Masson-Meyers, D. S., Eells, J. T., Hirschmugl, C. J., & Enwemeka, C. S. (2017). Understanding the antimicrobial activity of selected disinfectants against methicillin-resistant Staphylococcus aureus (MRSA).

    Plos One, 12

    (10), e0186375. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186375.
  • American Association of Nurse Practitioners. (2019). All about nurse practitioners. Retrieved from https://www.aanp.org/about/all-about-nps.
  • Nazarko, L. (2014). Methicillin-resistant Staphylococcus aureus (MRSA): A guide to prevention and treatment.

    British Journal of Healthcare Assistants, 8

    (8), 377–383. Retrieved from https://www.magonlinelibrary.com/doi/abs/10.12968/bjha.2014.8.8.377.
  • Robinson, J., Edgley, A., & Morrell, J. (2014). MRSA care in the community: Why patient education matters.

    British Journal of Community Nursing, 19

    (9), 436–441. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25184897.
  • U.S. Department of Health & Human Services. (2019). Center of disease control and prevention: Methicillin-resistant Staphylococcus aureus. Retrieved from https://www.cdc.gov/mrsa/community/index.html.

Patient Care And The Effects Culture Can Have

This essay is going to focus on my experience of caring for a patient who was admitted on a forensic ward in relation to culture diversity and the impact this had on my ability to communicate and engage effectively with them. Due to confidentiality NMC (2008) am going to refer to this patient as Mr Kay. Mr Kay is a 50 year old Caucasian man who was admitted on a forensic after being transferred from prison and was detained under section 37/41 of the Mental Health Act 1983 under the legal category of mental illness with a diagnoses of schizophrenia. According to his family background Mr Kay’s parents were alcoholics and separated when his was eleven and he moved to Glasgow with his mother in 1972and was placed in a group home. He is the eldest of four siblings’ two sisters and a brother and has been diagnosed with schizophrenia. At age fifteen he was considered beyond control by his family and was given into the care of local authority. Records indicate that he had been in various flats and hostels around London. He has a history of heavy drinking and polydrug use (including cocaine,LSD and cannabis).He has had 33 convictions between ages 14 and 25yearsoffences including theft, deception, ABH,indecent assault burglary and various assaults on police. He has delusional belief that the police officer he bites in the neck died from bleeding and this lead to him being demitted in hospital. He has been instutionalised for almost 25 years.

Mr Kay had very little interaction with staff and other service users and would only approach staff when definitely a need and this was due to the fact that he did not approve of him being cared for by a black person. During his ward round he expressed that he was not happy that his sisters had black children and this had made him bitter towards any black person hence the negative attitudes towards staff.

It is important to recognise and acknowledge cultural differences and needs because awareness is imperative in health care delivery and practice (Joe, 2006). Awareness of cultural diversity affects diagnoses, assessment, and intervention strategies for patients. Communication is a vital part of cultural interaction that takes place between health care providers and client. Patters of communication are influenced by culture and not only include language differences but verbal and non-verbal behaviours as well (Warren, 1997). According to (Prunell& Counts, 1998) nurses must culturally assess each patient individually while keeping in mind that differences can occur not only between cultures but also within cultures and that culture affects how mental illness may be exhibited. Cultural competence encourages the nurse to proficiently develop cultural awareness, knowledge, skill for use in areas of nursing education, practice and research in order to promote effective and quality health care delivery patients (Campinnha-Bacote, 1997). This also encourages nurse to acknowledge, value and accept a patient’s cultural belief. Cultural incompetence creates patient non-compliance and inadequate interventions because it negates the importance of culture (Spector, 1998).

The patient cultural needs were met I communicated with the other staff on the ward and it was decided that at first the patient had a one to one session with the primary nurse. During the meeting Mr Kay seemed guarded and did not say much of his views on the matter but only managed to say that he was not comfortable working with staff of black origin hence he was reluctant to participate in any therapeutic interventions if they was a black person involved in the activity. According to (Peplau, 1952) nurse and patients begin as strangers and work collaboratively in providing care. Providing a structure decreases the withdrawal and isolation of quiet and non-participating patients to decrease or stop dysfunctional behaviours. The primary nurse and me agreed with the patient that we were going to raise the issue in the ward round to others members of the multidisciplinary team, he was missing out on the activities that would help them in their rehabilitation process and this would prolong their stay in hospital. I recorded the meeting that had taken place in the patients notes in order that information would be passed over to other staff and that if they would see the patient behaving in certain way would having an understanding of what was happening. |As stated by Springhouse (1995) documentation is an effective communication of clients status between health care providers and helps in providing quality care and minimises errors. During the ward round I presented to other members of the multidisciplinary team what the patient felt and it was discussed that it would be helpful may to try and gain trust from the patient and may encourage and remind them when they have sessions to attend and try to point out how this would be helpful in their rehabilitation process Mr Kay was also called to express how he felt and the team told him that that they respected how he felt but it would be helpful if he would try and work with the staff as they were there to help him in his recovery and non participation would only slow he rehabilitation process and prolonged stay in hospital or being sent back to prison for him to complete his sentence. According to (Joe, 2003) responding effectively means being sensitive to individual cultures in its broadest dynamic sense not only a patient ethnicity but also their socio-economic background education, prior health experiences, religion and also the importance of structural influences on health care experience, such as racism and social inequality. He expressed that he felt he would try and work with the staff and that it would take time for him to engage fully with the staff.

Due to Mr Kay’s beliefs he missed most of his session, which were supposed, to help him towards he rehabilitation process and this lead to him being perceived as someone who did not want participate. The patient’s negative attitude towards me made it very difficult to engage with him as sometimes he would never respond to anything I was saying and was difficult to know whether he understood what I was saying. This made it quite difficult for other staff and sometimes other staff would avoid any contact with him, which was not good for the patient. I felt that although Mr Kay was encouraged to express his cultural views he only agreed to engage with the staff because they were very few options for him, but he had very strong views of working with black people. The way the team handled the situation showed that discrimination is not acceptable and that it is important to encourage to patients to express their view and if they lose control it is important to provide a structure taking temporary control (Forchuck, 1992).

I have learned that what we consider as in ethnic minorities or people from other backgrounds is different from the number on patients in psychiatric hospitals. As mostly the patient are from an Afro-Caribbean background and patients from white backgrounds are minority. Mostly these patients feel that their needs are not being met as they feel that too much emphasis is put on trying to meet the ethnic minorities needs and feel that they are being neglected. As stated by (Worthing 1992) that patients are more complaint with their health care programmes and outcomes are more successful if patients’ cultural needs are incorporated into assessments, screening, interventions and protocols. Culture is a critical component of a person’s and affects one’s health care attitudes and actions in relationship to one’s ability to understand and utilize the interventions. According to (Stewart, 1998) culture affects how mental illness may be exhibited and behaviours may be misinterpreted as pathological if a nurse is not aware of the patient’s cultural beliefs and norms as they relate to health care actions. The psychiatric patient maybe labelled, as being noncompliant may have not frequently received appropriate or culturally competent nursing care. The new mental health culture has seen the role of the patients changed and their rights have been clearly defined and patients have greater knowledge about their illness. They are active participants in the development and implementation of their treatment process and know more about themselves, the health care system and management of their illness .It is important to note that therapeutic communication focuses on the patient but is planned and directed by the professional and that the professional is obligated to share information within the treatment team. The nurse is a patient’s advocate and not a patient’s friend (Kemper 1999).

The broader issues that arise from this situation are that although there is a clear policy on that patients have to be active participants in mental health service development and delivery, however research shows that negative attitudes of health professionals to patients has been a significant barrier to the realisation of this policy goal (Roper&Hapel,2007).It is also important to note patient’s history is vital as this helps to relate to some of the issues that may arise as they may be issues that may have happened in the past and begin to surface because of a current or similar situation.