Rebuttal Health Admin Week Db Post

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Rebuttal Health Admin Week Db Post

Rebuttal Health Admin Week Db Post

Rebuttal Health Admin Week Db Post

The author offers a captivating discussion of healthcare challenges the US healthcare system is facing, including prince transparency, underfunding of Medicare and physician shortages. Indeed regulatory bodies have failed to ensure price transparency since the passing of the Hospital Price Transparency Final rule that requires healthcare providers to present payer-specific negotiated prices, standard charges for every healthcare item and service, and discounted prices, which became effective on January 1, 2021.1 This rule also requires healthcare organizations to publish a customer-friendly list of this price-related information. Existing research shows a low compliance rate, at about 33%.2 By September 2021, over half of the hospitals registered with the CMS had not posted a machine-readable file or shoppable services. However, there have been measures to curb the low compliance rate, including the CMS introducing penalties for noncompliance, $300 per day for small hospitals and upwards of $5,500 per day for larger hospitals, effective January 1, 2022.2 Nonetheless, the compliance has remained low, between 29% and 56%, per different reports.

The hospitals have also been misreporting, intentionally stating lower figures than the median. For instance, the CMS established that among 70 shoppable services it specified, almost half of the hospitals disclosing cash and commercial prices quoted cash prices lower than the median commercial prices, about 17% of all hospitals.2 To address this issue, it is critical to answering these questions: did the price transparency rule low commercial prices for hospitals? Why are many hospitals still non-compliant with the rule? What are their concerns or negative implications of disclosing healthcare prices? What is the reason for the significant variations in prices between and within hospitals? Answering these questions would allow appropriate authorities to design strategies to enhance healthcare price transparency, lower healthcare costs, and facilitate comparison shopping for patients and payers.

References

Chen J, Miraldo M. The impact of hospital price and quality transparency tools on healthcare spending: a systematic review. Health Economics Review. 2022 Dec;12(1):1-2.

Jiang JX, Krishnan R, Bai G. Price Transparency in Hospitals—Current Research and Future Directions. JAMA Netw Open.2023;6(1):e2249588. doi:10.1001/jamanetworkopen.2022.49588 https://pubmed.ncbi.nlm.nih.gov/36602805/

 

 
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Health-Promoting Self-Care in Nursing 2

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Health-Promoting Self-Care in Nursing 2

NSG 301: Writing With Confidence, Clarity, and Style

Health-Promoting Self-Care in Nursing 2

Classical Argument: Health-Promoting Self-Care in Nursing

The healthcare environment is challenging and pressuring for nurses, impacting their health and well-being. Nurses have in-depth knowledge regarding health-promoting behaviors and practices, but they continue to report high overweight and obesity levels as well as mental health issues (Flaubert et al., 2021). Contributing factors include work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime, which leaves nurses with little time to practice self-care.

Lack of self-care is linked to unhealthy nurses, physically and psychologically, which negatively impacts nursing practice and patient outcomes (Flaubert et al., 2021). It is also related to health-risk behaviors like excessive alcohol consumption, smoking, and substance use (Flaubert et al., 2021). However, health-promoting self-care impacts nurses’ health and well-being, nursing practice, and overall institutional and patient outcomes. Therefore, adopting self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth would help minimize the adverse effects of poor health-promoting self-care.

Background

Self-care is related to any intentional effort to activity to cater to one’s mental, physical, and spiritual well-being. Nurses spend extended periods caring for others, and they can forget about themselves, which is detrimental to their and other people’s health (Ross et al., 2019). The American Nurses Association completed a survey that indicated the increased urgency to improve nurses’ health, especially in nutrition, safety, life quality, and physical activity. About 70% of the nurses surveyed admitted to prioritizing patients’ needs, safety, health, and wellness before theirs (Purdue University Global, 2021). Furthermore, 77% of the nurses reported being at a significant risk level for work-related stress (Purdue University Global, 2021). These numbers indicate the significance of the problem and how widespread it is in the healthcare environment. The evidence calls for prompt interventions to promote nurse health and well-being because poor nurse health and well-being can lead to compassion fatigue. Therefore, to care for others, nurses should first care for themselves. Conclusively, nurses’ health impacts patient care in all healthcare settings.

Compassion fatigue and burnout impact nurses’ capacity and ability to self-care, and if not treated, may cause long-term emotional trauma. Moreover, the nursing field can be traumatic for nurses because of increased exposure to suffering and pain, ending up traumatized without realizing it most of the time (Wolotira, 2022). However, the Code of Ethics recognizes self-care as a nurse’s responsibility because when nurses are not caring for themselves, they cannot care for their patients (Purdue University Global, 2021). In addition, the American Nurses Association Code of Ethics posits that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to other individuals (Purdue University Global, 2021). Based on these findings, it is imperative to assess trauma as a “cost of caring” when trying to understand nurses’ self-care behaviors. The assessment would help comprehend how continued exposure to pain, death, fear, abuse, and illnesses can cause trauma and how self-care behaviors and practices can help minimize trauma among nurses. Emphatically, trauma experienced in the healthcare environment can have long-term health impact on nurses.

(Health-Promoting Self-Care in Nursing 2)

Nurses are responsible for promoting their health and safety, preserving their wholeness of character and integrity, maintaining competence, and ensuring personal and professional growth through continuing education and training. These are self-care principles for nurses to promote holistic growth and manage the stress from working in the healthcare environment. Lack of self-care is linked to burnout, poor physical and mental health, depression, weight gain or extreme weight loss, unhealthy eating patterns, demoralization, back injury, and reduced job satisfaction (Williams et al., 2022). It is imperative to look into these factors because they impact a nurse’s capacity to function and lower productivity. For instance, a nurse experiencing burnout, is demoralized, and not satisfied with her job is more likely to cause mistakes like medication errors, which negatively impact health outcomes. The highlighted healthcare principles can be adopted to address the adverse effects of lack of self-care. Certainly, more attention is needed to enhance self-care in nurses because self-care helps minimize stress, replenish nurses’ compassion capacity, and ability to care for others, and improve the quality of care.

Self-Care Minimizes Stress

Self-care serves as a stress management tool, helping nurses reduce work-related stress. Adopting self-care practices like mindfulness, self-compassion, and emotional regulation can help nurses reduce stress and attend to their physical, mental, emotional, and spiritual needs (Hofmeyer et al., 2020). In this case, nurses should perceive self-care as integral to preventative care. Although individual factors can impact an individual’s ability to cope, control themselves, tolerate uncertainties, and resilience, self-care helps acquire and sustain these positive aspects of life. Per Hofmeyer et al. (2020), control is critical to an individual’s well-being. Still, work-related factors beyond a nurse’s control can disrupt the power to self-regulate and the need for control, adding to work-related stress.

(Health-Promoting Self-Care in Nursing 2)

Self-care begins with self-awareness, understanding how difficult events, uncertainties, and powerlessness impact oneself. For instance, it is normal to feel anxious, sad, and grief-stricken in difficult situations or crises, which begs individuals to accept their vulnerability and learn how to self-regulate to control emotions and feelings attached to such conditions. In this case, self-regulation, self-compassion, and mindfulness all allow nurses to focus on the positives rather than the negatives and uncertainties, accept situations, especially those that cannot be changed, like the death of a patient, and find meaningful ways to cope with the nursing environment, which helps reduce stress (Hofmeyer et al., 2020). Taking this approach builds resilience, allowing nurses to manage stress, maintain their health and well-being, and respond appropriately and effectively when facing crises and uncertainties. Conclusively, nurses can strengthen their psychological resilience through self-efficacy, mindfulness, and emotional regulation.

Self-Care Replenishes Nurses’ Compassion Capacity and Ability to Care for Others

The ANA Code of Ethics highlights that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to others. Poor health-promoting self-care is associated with burnout and compassion fatigue, leading to poor patient outcomes and the risk of medical errors (Flaubert et al., 2021). Nursing care relies on empathy and compassion; the more burned out or stressed a nurse is, the more their capacity to offer kindness and compassion suffers (Monroe et al., 2021). Nurses often show empathy and compassion to their patients daily without a chance of replenishing them. However, nurses should learn and be able to extend empathy and compassion to themselves because failure to invest in themselves puts their health, as well as patients’ health and well-being, at risk.

Moreover, nurses tend to be difficult on themselves when making mistakes, and they do not console or talk to themselves as they would talk to a patient or a friend. Nurses are overly critical and judgmental of themselves, which, according to Hofmeyer et al. (2020), stimulates the sympathetic nervous system, activating a stress response that harms an individual’s health and well-being. Engaging in self-care strategies, including having enough sleep, healthy eating patterns, regular physical activity, mindfulness, and social connections, can help replenish nurses’ compassion capacity and ability to care for others.

(Health-Promoting Self-Care in Nursing 2)

Therefore, nurses must practice self-compassion and understand their own needs before helping others. Nurses should also learn to talk kindly to themselves because kind self-talk is linked to increased compassion capacity and pro-social behaviors like kindness, empathy, and altruism, helping them communicate better with colleagues, patients, and their families (Hofmeyer et al., 2020). Undeniably, nurses experience in their practice environment is linked to patient experience and outcomes. Therefore, helping nurses expand their compassion capacity and enhance their pro-social behavior is fundamental to improving health outcomes and patient experience. Conclusively, practicing self-compassion like adopting kind self-talk enhance enable nurses to act with kindness and compassion, helping reduce patient suffering and distress.

Self-Care Improves the Quality and Safety of Care

Nurses caring for themselves and bringing the effects to the workplace helps promote safe and high-quality care. Nurses with self-compassion have better physical and psychological health, motivation, happiness, relationship-building, and perspective-taking, which are linked to better health outcomes (Hofmeyer et al., 2020). In addition, self-compassionate nurses report decreased anxiety, depressive symptoms, fear of failure, shame, and rumination, implying a greater capacity to work for others. On the contrary, stressed, burned out, overwhelmed, and unsatisfied nurses are more likely to be involved in medical errors, including medication administration errors that negatively impact the quality of care and patient safety (Hofmeyer et al., 2020). Therefore, self-care strategies like seeking a therapist’s support, taking breaks, engaging colleagues to stay connected, and maintaining physical activity can help reduce burnout, stress, and feeling confused, overwhelmed, frustrated, and angry, increasing nurses’ capacity to promote quality and safe care.

(Health-Promoting Self-Care in Nursing 2)

Opposition and Barriers to Implementing Self-Care

Implementing self-care requires commitment, planning, and joint efforts of nurses and hospital administrators. Multiple factors hinder nurses from implementing self-care to ensure a healthy workforce according to a survey, which reported that nurses complained about insufficient time and overwork as barriers to implementing self-care activities (Wolters Kluwer, 2020). Most nurses are overworked with poorer health and well-being and lack time to participate in healthy habits. Additionally, nurses reported a lack of facilities and resources and other commitments as reasons for not engaging in self-care. About 25% of nurses point to lack of access to a gym, exercise classes, changing facilities, showers, and lack of refrigerators or microwaves as barriers to implementing self-care (Wolters Kluwer, 2020). Exploring these factors is imperative because they are genuine concerns and typical of many practice environments. For instance, in the current work environment, working overtime and dealing with heavy workloads limits the time to go to the gym, cook healthy food, or socialize with people, and the little time available is used for sleep. Additionally, most nurses opt for fast foods because they lack adequate time to prepare their own meals. The survey also reported that over 50% of nurses stressed outside commitments like family responsibilities and school activities as interfering with the ability to live more healthily. Emphatically, per the current practice environment, there is limited time and resources to promote health-promoting self-care initiatives.

Refutation

Limited time, lack of resources like gyms and showers at the workplace, and other commitments like family responsibilities and school activities limit nurses’ ability and capacity to implement self-care. However, there are ways to encourage nurses to embrace healthy habits and self-care, like eating healthy and exercising regularly. Leadership and peer support can help guide and adopt healthier practices. Leaders can expand opportunities for nurses to have more breaks and provide facilities like gyms, showers, and refrigerators to store healthy snacks (Wolters Kluwer, 2020). Allowing breaks at the facility would help schedule time for self-care practices like establishing supportive connections with colleagues and exercising.

(Health-Promoting Self-Care in Nursing 2)

Conclusion

Health-promoting self-care can help improve nurses’ health and well-being, reduce stress, replenish nurses’ compassion capacity and ability to care for others, and improve the quality and safety of care. Conversely, poor health-promoting self-care is associated with increased nurses’ stress, burnout, lack of job satisfaction, compassion fatigue, chances of making medical errors, and decreased motivation. Nurses can adopt self-care strategies, including mindfulness, emotional regulation, self-compassion, regular physical activity, healthy eating patterns, personal and professional growth, and maintaining connectivity to promote health and well-being. Self-care is multifaceted, and improving self-care should address intrinsic and extrinsic motivators.

References

Flaubert, J. L., Le Menestrel, S., Williams, D. R., Wakefield, M. K., & National Academies of Sciences, Engineering, and Medicine. (2021). Supporting the Health and Professional Well-Being of Nurses. In The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Academies Press (US).

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the COVID-19 pandemic and beyond. Nurse education today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi.org/10.1016/j.apnu.2020.10.003

Purdue University Global. (2021, April 28). The importance of self-care for nurses and how to put a plan in place. Purdue University Global. https://www.purdueglobal.edu/nursing/self-care-for-nurses/

Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and health-promoting self-care: Do we practice what we preach? Journal of nursing management, 27(3), 599–608. https://doi.org/10.1111/jonm.12718

Williams, S. G., Fruh, S., Barinas, J. L., & Graves, R. J. (2022). Self-Care in Nurses. Journal of radiology nursing, 41(1), 22–27. https://doi.org/10.1016/j.jradnu.2021.11.001

Wolotira, E. A. (2022). Trauma, Compassion Fatigue, and Burnout in Nurses: The Nurse Leader’s Response. Nurse Leader.

Wolters Kluwer. (2020). Nurses and self-care: Factors influencing healthy behaviors during COVID-19. Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/nurses-and-selfcare-factors-influencing-healthy-behaviors-during-COVID-19/

 
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Repatriation of Indigenous Human Remains

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Repatriation of Indigenous Human Remains

Contemporary Social Justice Issue: Repatriation of Indigenous Human Remains

The repatriation of indigenous human remains has been a contentious issue for decades. Many indigenous communities have been forcibly removed from their ancestral lands and have had their cultural heritage stolen or destroyed. Archaeologists and museums have been accused of stealing and exploiting indigenous artifacts and human remains. In recent years, there has been a movement toward repatriating these items to their rightful owners. This research project will explore the issue of the repatriation of indigenous human remains through the lens of archaeology. The study will focus on the history of repatriation efforts, the ethical considerations of repatriation, and the role of archaeologists in repatriation efforts.

Repatriation of Indigenous Human Remains

Research Question

What is the role of archaeology in repatriating indigenous human remains, and how can it contribute to social justice?

History of Repatriation Efforts

Archeologists have obtained human remains from different parts of the world, but in the last several decades, it has been subject to new discussions. Human remains hold insights and records of past life useful to current and later generations (Licata et al., 2020). Despite their importance, there is a need to ensure human dignity, a reason that prompted discussions on the repatriation of human remains to their respective points of origin. Most communities treated their ancestral remains as sacred and secret valuables, increasing the need to repatriate remains to promote social justice and respect for cultures. In line with human remains repatriation, communities began to work with the national museums and archeologists on accessing, safe-keeping, and unconditional return of indigenous human remains.

In the 1960s, 1970s, and 1980s, the United States began listening to repatriation requests from indigenous societies and began returning human remains and sacred objects before establishing any laws to govern human remains repatriation. Passing the NMAIA (20 United States Code (U.S.C.) 80q et seq.) and the NAGPRA (25 U.S.C. 3001 et seq.) were significant and revolutionary to human remains repatriation efforts (Buikstra, 2017). This initiative transformed the repatriation nature and process and had consequential effects internationally. Repatriation under these laws began in the 1980s after an establishment that modern ethics differ from those of the past, and museums had to consider changing accordingly. However, repatriation did not follow any request because there were conditions, for instance, repatriating human remains to only living descendants (Goldstein, 2015). If a group forwarded a request for repatriation, the group had to present convincing evidence of religious and cultural values that outweighed scientific interests. Repatriation was done on a case-by-case basis. With time, the repatriation of indigenous human remains has become a human rights issue based on the argument that human bodies should be treated with dignity and respect, which is not the case when excavated and placed in a museum.

Ethical Consideration of Repatriation

Native tribes, organizations, and some archeologists believe that repatriation is a moral and ethical duty for the archeological profession, even if it means losing access to the remains and artifacts. There was never a consistent national policy dictating repatriation and consultation with indigenous groups until the 1990s despite the increasing requests by native people, who posit repatriation as a human right. For the longest time, indigenous groups have perceived archeologists as looters because they saw no difference. For instance, the incident in Iowa angered many, including some archeologists, after a road construction project led to a cemetery being excavated (Goldstein, 2015). These remains were sent to the museum, and the government insisted they belonged in the museum, implying there was something wrong with archeology and museums. The case in Iowa made more archeologists uncomfortable regarding the concept of study and curation, indicating an ethical issue in archeology involving human remains.

The Western belief system and science have imposed themselves on indigenous people’s belief system regarding their past and how they treat or consider their ancestors and their remains. There was insignificant resistance from indigenous groups against archeologists for a long period, making them assume that the people concurred with their initiatives or did not object. However, archeologists were wrong, shown in the past 30 to 40 years, where polls have indicated the general public supports repatriation calls and the position of the Native Americans (Goldstein, 2015). Moreover, archeology did not consider the centrality of a human and the protection of dignity, raising multiple ethical concerns. The ethical issues surrounding archeology and with respect to repatriation are popular in the international community today. In this regard, reconciliation policies were developed at the international level to guide the return of human remains to the requesting indigenous groups.

According to the ICOME Code of Ethics for Museums, human remains are culturally sensitive materials. Per the code, the collection of human remains is justifiable by compelling evidence that they will be placed in a safe space and treated with respect and dignity (Licata et al., 2020). Furthermore, research involving human remains must follow professional standards and adhere to the beliefs and interests of community members and ethnic and religious groups from where the materials were collected. Additionally, displaying sensitive materials, comprising human remains and related sacred objects, must comply with professional standards. Archeologists must expose human remains with high-level respect and comply with the moral principles of the community (Licata et al., 2020). The code also guides the withdrawal of public display of human remains with non-certified origin. Conclusively, codes, policies, and regulations surrounding the collection, preservation, and repatriation of human remains have placed the interest of indigenous communities and ethnic and religious groups before scientific interests, which is ethically and morally right.

Role of Archeologists in Repatriation

Archeologists are integral to repatriation efforts because they bare a preexisting working relationship with the local people and tribal governments. Most indigenous people would rather have archeological sites like cemeteries left undisturbed or studied and restored instead of transferring materials to museums (Fforde, 2020). Human remains and sacred materials attached to them should belong to the communities and regions they came from, or it would be considered looting and stealing, which has been the case for centuries. Archeology has been accused of stripping communities of their cultures as antiquities are taken from and displayed publicly. Conventionally, developed countries like the US and UK have claimed that human remains and materials are safer in developed countries because of stable and better equipment and environment of preservation, and archeologists are accountable for such suggestions. This attitude patronizes individuals trying to maintain their culture and heritage in their respective places.

Collection of human remains begins with archeologists, and so can repatriation. Most communities are not against conducting a study but the transfer of human remains from their indigenous settings. Archeologists can act as advocates of repatriation to balance the scientific interests and cultural interests of indigenous people (Bauer et al., 2016). Archeologists should lead repatriation efforts of human remains and materials with historical and cultural roots to honor those roots and the people attached to them. It is an issue of cultural sensitivities that should be a competency of every archeologist. As such, archeologists can enhance community research and build respectful relationships by engaging in community-led studies and repatriation projects (Bauer et al., 2016). Archeologists can be at the center of consultations and agreements with indigenous communities regarding the study of human remains and restoration of sites they were obtained from after completing a study, promoting social justice. Emphatically, archeologists can help repatriation efforts through advocacy and promote social justice.

Conclusion

Archeology has been accused of cultural insensitivities and taking from people their cultures and heritage. Archeologists have been compared to looters, and most indigenous communities continue to fight for the return of human remains and other sacred objects. Repatriation should be considered an ethical and moral responsibility of archeology. Archeologists can bolster repatriation efforts through advocacy, building respectful relationships with communities, promoting community-led studies and repatriation projects, and being at the center of negotiations and consultations with communities to protect the interests of indigenous people before their own.

References

Bauer, A. A., Lindsay, S., & Urice, S. (2016). When theory, practice and policy collide, or why do archaeologists support cultural property claims?. In Archaeology and Capitalism (pp. 45-58). Routledge.

Buikstra, J. E. (2017). Repatriation and bioarchaeology: Challenges and opportunities. Bioarchaeology, 411-438.

Fforde, C. (2020). Vermillion accord on human remains (1989)(indigenous archaeology). In Encyclopedia of global archaeology (pp. 11016-11019). Cham: Springer International Publishing.

Goldstein, L. (2015). Archaeology, Politics of. International Encyclopedia of the Social & Behavioral Sciences (Second Edition). https://doi.org/10.1016/B978-0-08-097086-8.13024-7

Licata, M., Bonsignore, A., Boano, R., Monza, F., Fulcheri, E., & Ciliberti, R. (2020). Study, conservation and exhibition of human remains: the need of a bioethical perspective. Acta bio-medica : Atenei Parmensis, 91(4), e2020110. https://doi.org/10.23750/abm.v91i4.9674

 

 
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Health-Promoting Self-Care in Nursing

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Health-Promoting Self-Care in Nursing

NSG 301: Writing With Confidence, Clarity, and Style

Health-Promoting Self-Care in Nursing

Classical Argument: Health-Promoting Self-Care in Nursing

The healthcare environment is challenging and pressuring for nurses, impacting their health and well-being. Nurses have in-depth knowledge regarding health-promoting behaviors and practices, but they continue to report high overweight and obesity levels and mental health issues (Flaubert et al., 2021). Contributing factors include work-related stress, heavy workloads, shift work, poor engagement and communication, increasing patient health demands, and working overtime, which leaves nurses with little time to practice self-care. Exploring these factors is the first step to promoting nurse health and well-being.

Health-promoting self-care practices are fundamental to a nurse’s health and well-being. Lack of self-care is linked to unhealthy nurses, physically and psychologically, which negatively impacts nursing practice and patient outcomes (Flaubert et al., 2021). It is also related to health-risk behaviors like excessive alcohol consumption, smoking, and substance use (Flaubert et al., 2021). Consequentially, it impacts nursing practice and overall institutional and patient outcomes. Nurses can enhance their health and well-being by adopting self-care strategies such as emotional regulation, self-compassion, mindfulness, healthy eating patterns, regular physical activity, staying connected, and continued individual and professional growth would help minimize the adverse effects of poor health-promoting self-care. Conclusively, self-care is integral to a nurse’s health and well-being, which is related to a nurses’ capacity to offer care to patients.

Background

Self-care is related to any intentional effort to activity to cater to one’s mental, physical, and spiritual well-being. Nurses spend extended periods caring for others, and they can forget about themselves, which is detrimental to their and other people’s health (Ross et al., 2019). The American Nurses Association completed a survey that indicated the increased urgency to improve nurses’ health, especially in nutrition, safety, life quality, and physical activity. About 70% of the nurses surveyed admitted to prioritizing patients’ needs, safety, health, and wellness before theirs, while 77% of the nurses reported being at a significant risk level for work-related stress (Purdue University Global, 2021). These numbers indicate the significance of the problem and how widespread it is in the healthcare environment. The evidence calls for prompt interventions to promote nurse health and well-being because poor nurse health and well-being can lead to compassion fatigue. Therefore, to care for others, nurses should first care for themselves. Conclusively, nurses’ health impacts patient care in all healthcare settings.

(Health-Promoting Self-Care in Nursing)

Compassion fatigue and burnout impact nurses’ capacity and ability to self-care, and if not treated, may cause long-term emotional trauma. Moreover, the nursing field can be traumatic for nurses because of increased exposure to suffering and pain, ending up traumatized without realizing it most of the time (Wolotira, 2022). However, the Code of Ethics recognizes self-care as a nurse’s responsibility because when nurses are not caring for themselves, they cannot care for their patients (Purdue University Global, 2021). In addition, the American Nurses Association Code of Ethics posits that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to other individuals (Purdue University Global, 2021). Based on these findings, assessing trauma as a “cost of caring” is imperative when understanding nurses’ self-care behaviors. The assessment would help comprehend how continued exposure to pain, death, fear, abuse, and illnesses can cause trauma and how self-care behaviors and practices can help minimize trauma among nurses. Emphatically, trauma experienced in the healthcare environment can impact nurses’ long-term health.

Nurses are responsible for promoting their health and safety, preserving their wholeness of character and integrity, maintaining competence, and ensuring personal and professional growth through continuing education and training. These are self-care principles for nurses to promote the holistic growth and manage the stress from working in the healthcare environment. Lack of self-care is linked to burnout, poor physical and mental health, depression, weight gain or extreme weight loss, unhealthy eating patterns, demoralization, back injury, and reduced job satisfaction (Williams et al., 2022). It is imperative to look into these factors because they impact a nurse’s capacity to function and lower productivity. For instance, a nurse experiencing burnout is demoralized, and dissatisfaction with her job is more likely to cause mistakes like medication errors, negatively impacting health outcomes. The highlighted healthcare principles can be adopted to address the adverse effects of a lack of self-care. Certainly, more attention is needed to enhance self-care in nurses because self-care helps minimize stress, replenish nurses’ compassion capacity and ability to care for others and improve the quality of care.

(Health-Promoting Self-Care in Nursing)

Self-Care Minimizes Stress

Self-care serves as a stress management tool, helping nurses reduce work-related stress. Adopting self-care practices like mindfulness, self-compassion, and emotional regulation can help nurses reduce stress and attend to their physical, mental, emotional, and spiritual needs (Hofmeyer et al., 2020). In this case, nurses should perceive self-care as integral to preventative care. Although individual factors can impact an individual’s ability to cope, control themselves, tolerate uncertainties, and resilience, self-care helps acquire and sustain these positive aspects of life. Per Hofmeyer et al. (2020), control is critical to an individual’s well-being. Still, work-related factors beyond a nurse’s control can disrupt the power to self-regulate and the need for control, adding to work-related stress. Determinately, nurses can manage their stress levels through self-care strategies.

Self-care begins with self-awareness, understanding how difficult events, uncertainties, and powerlessness impact oneself. For instance, it is normal to feel anxious, sad, and grief-stricken in difficult situations or crises, which begs individuals to accept their vulnerability and learn how to self-regulate to control emotions and feelings attached to such conditions. In this case, self-regulation, self-compassion, and mindfulness all allow nurses to focus on the positives rather than the negatives and uncertainties, accept situations, especially those that cannot be changed, like the death of a patient, and find meaningful ways to cope with the nursing environment, which helps reduce stress (Hofmeyer et al., 2020). Taking this approach builds resilience, allowing nurses to manage stress, maintain their health and well-being, and respond appropriately and effectively when facing crises and uncertainties. Conclusively, nurses can strengthen their psychological resilience through self-efficacy, mindfulness, and emotional regulation.

Self-Care Replenishes Nurses’ Compassion Capacity and Ability to Care for Others

The ANA Code of Ethics highlights that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to others. Poor health-promoting self-care is associated with burnout and compassion fatigue, leading to poor patient outcomes and the risk of medical errors (Flaubert et al., 2021). Nursing care relies on empathy and compassion; the more burned out or stressed a nurse is, the more their capacity to offer kindness and compassion suffers (Monroe et al., 2021). Nurses often show empathy and compassion to their patients daily without a chance of replenishing them. Therefore, it is imperative that nurses learn and be able to extend empathy and compassion to themselves because failure to invest in themselves puts their health and patients’ health and well-being at risk.

Moreover, nurses tend to be difficult on themselves when making mistakes, and they do not console or talk to themselves as they would talk to a patient or a friend. Nurses are overly critical and judgmental of themselves, which, according to Hofmeyer et al. (2020), stimulates the sympathetic nervous system, activating a stress response that harms an individual’s health and well-being. Engaging in self-care strategies, including having enough sleep, healthy eating patterns, regular physical activity, mindfulness, and social connections, can help replenish nurses’ compassion capacity and ability to care for others. In conclusion, nurse should treat themselves as they would treat others and their patients.

Nurses must practice self-compassion and understand their needs before helping others. Nurses should learn to talk kindly to themselves because kind self-talk is linked to increased compassion capacity and pro-social behaviors like kindness, empathy, and altruism, helping them communicate better with colleagues, patients, and their families (Hofmeyer et al., 2020). Undeniably, nurses’ experience in their practice environment is linked to patient experience and outcomes. Therefore, helping nurses expand their compassion capacity and enhance their pro-social behavior is fundamental to improving health outcomes and patient experience. Summing up, practicing self-compassion, like adopting kind self-talk, enables nurses to act with kindness and compassion, helping reduce patient suffering and distress.

(Health-Promoting Self-Care in Nursing)

Self-Care Improves the Quality and Safety of Care

Nurses caring for themselves and bringing the effects to the workplace helps promote safe and high-quality care. Nurses with self-compassion have better physical and psychological health, motivation, happiness, relationship-building, and perspective-taking, which are linked to better health outcomes (Hofmeyer et al., 2020). In addition, self-compassionate nurses report decreased anxiety, depressive symptoms, fear of failure, shame, and rumination, implying a greater capacity to work for others. On the contrary, stressed, burned out, overwhelmed, and unsatisfied nurses are more likely to be involved in medical errors, including medication administration errors that negatively impact the quality of care and patient safety (Hofmeyer et al., 2020). Therefore, self-care strategies like seeking a therapist’s support, taking breaks, engaging colleagues to stay connected, and maintaining physical activity can help reduce burnout, stress, and feeling confused, overwhelmed, frustrated, and angry, increasing nurses’ capacity to promote quality and safe care.

Opposition and Barriers to Implementing Self-Care

Implementing self-care requires commitment, planning, and joint efforts of nurses and hospital administrators. According to a survey, multiple factors hinder nurses from implementing self-care to ensure a healthy workforce, which reported that nurses complained about insufficient time and overwork as barriers to implementing self-care activities (Wolters Kluwer, 2020). Most nurses are overworked with poorer health and well-being and lack time to participate in healthy habits. Additionally, nurses reported a lack of facilities and resources and other commitments as reasons for not engaging in self-care. About 25% of nurses point to lack of access to a gym, exercise classes, changing facilities, showers, and lack of refrigerators or microwaves as barriers to implementing self-care (Wolters Kluwer, 2020). Exploring these factors is imperative because they are genuine concerns and typical of many practice environments. For instance, in the current work environment, working overtime and dealing with heavy workloads limit the time to go to the gym, cook healthy food, or socialize with people, and the little time available is used for sleep. Additionally, most nurses opt for fast foods because they lack adequate time to prepare their own meals. The survey also reported that over 50% of nurses stressed outside commitments like family responsibilities and school activities as interfering with the ability to live more healthily. Emphatically, per the current practice environment, there is limited time and resources to promote health-promoting self-care initiatives.

Refutation

Limited time, lack of resources like gyms and showers at the workplace, and other commitments like family responsibilities and school activities limit nurses’ ability and capacity to implement self-care. However, there are ways to encourage nurses to embrace healthy habits and self-care, like eating healthy and exercising regularly. Leadership and peer support can help guide and adopt healthier practices. Leaders can expand opportunities for nurses to have more breaks and provide facilities like gyms, showers, and refrigerators to store healthy snacks (Wolters Kluwer, 2020). In conclusion, allowing breaks at the facility would help schedule time for self-care practices like establishing supportive connections with colleagues and exercising.

Conclusion

Health-promoting self-care can help improve nurses’ health and well-being, reduce stress, replenish nurses’ compassion capacity and ability to care for others, and improve the quality and safety of care. Conversely, poor health-promoting self-care is associated with increased nurses’ stress, burnout, lack of job satisfaction, compassion fatigue, chances of making medical errors, and decreased motivation. Nurses can adopt self-care strategies, including mindfulness, emotional regulation, self-compassion, regular physical activity, healthy eating patterns, personal and professional growth, and maintaining connectivity to promote health and well-being. Self-care is multifaceted, and improving self-care should address intrinsic and extrinsic motivators.

References

Flaubert, J. L., Le Menestrel, S., Williams, D. R., Wakefield, M. K., & National Academies of Sciences, Engineering, and Medicine. (2021). Supporting the Health and Professional Well-Being of Nurses. In The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. National Academies Press (US).

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the COVID-19 pandemic and beyond. Nurse education today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi.org/10.1016/j.apnu.2020.10.003

Purdue University Global. (2021, April 28). The importance of self-care for nurses and how to put a plan in place. Purdue University Global. https://www.purdueglobal.edu/nursing/self-care-for-nurses/

Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2019). Nurses and health-promoting self-care: Do we practice what we preach? Journal of nursing management, 27(3), 599–608. https://doi.org/10.1111/jonm.12718

Williams, S. G., Fruh, S., Barinas, J. L., & Graves, R. J. (2022). Self-Care in Nurses. Journal of radiology nursing, 41(1), 22–27. https://doi.org/10.1016/j.jradnu.2021.11.001

Wolotira, E. A. (2022). Trauma, Compassion Fatigue, and Burnout in Nurses: The Nurse Leader’s Response. Nurse Leader.

Wolters Kluwer. (2020). Nurses and self-care: Factors influencing healthy behaviors during COVID-19. Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/nurses-and-selfcare-factors-influencing-healthy-behaviors-during-COVID-19/

 

 
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Identification and Contextual Assessment Planning for the Group

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Identification and Contextual Assessment Planning for the Group

Identification and Contextual Assessment Planning for the Group

  1. Identify and briefly describe a population you are working with in the field that could benefit from a group-based intervention. What are some challenges potential members face? How did this population come to your attention?

The group has six individuals, African American youth and adolescents, including two Caribbean girls aged 15 and 17, two African Americans; a boy aged 14 and a girl aged 16, one African girl aged 17, and one Jamaican boy aged 17. I worked with these individuals at the clinic I went to for my clinical. All have been diagnosed with generalized anxiety and depression from different circumstances. Both Caribbean girls are Christians, but the others do not identify with a religion, although they grew up religious. They all live in Nassau County, Long Island, NY, and receive therapy from the same agency. Their pain points are verbal abuse, neglect, and ongoing trauma.

These individuals are up against cultural practices they do not wish to be part of, including religious beliefs, high dependency by family members due to close nit families, and stereotypes associated with African Americans like crime and poverty, as they feel powerless and unheard of because they are minors. I encountered and worked closely with these individuals during my internship. These clients share common circumstances and have been diagnosed with anxiety and depression. They perceive their families as toxic, which is beyond their ability to change because they are minors. They all face isolation and loneliness and feel misunderstood for wanting to dissociate from the cultural practices and beliefs associated with their family background. These individuals will undergo group therapy to help them relate to one another by sharing experiences and establishing common goals for behavioral changes and coping strategies to help them through their everyday ordeals.

  1. Using the required readings and course syllabus to guide the literature, what are the three key values or benefits of using a group approach with this population?

The group therapy approach is preferred to individual or one-on-one therapy for this group of individuals because of related experiences, challenges, and struggles. Members have been diagnosed with anxiety and depression, are in a toxic environment, and face isolation, loneliness, and feeling misunderstood. Despite having related experiences, the clients have individual differences, and members can benefit from the broadly varying clusters of therapeutic factors typical in group settings (Yolom & Leszcz, 2005). According to Wayne and Cohen (2001), high-quality group work education facilitates effective group work practice. Therefore, the practitioner should help members develop interactional skills for group work practice and foster a healthy and relatable environment where members can benefit from the group work approach.

By engaging in group work, members can benefit from interpersonal learning. Individuals in the group have related experiences and can help members acknowledge their struggles and issues and feel less alone, offering support and encouragement (Yolom & Leszcz, 2005). The group members interact with each other and receive feedback from other group members or the therapist, which helps them better understand themselves and how they can improve their behaviors and attitudes. Group members are also each other’s role models, helping one another successfully cope with the problems they experience, feeling encouraged and inspired about their recovery process, and establishing a culture of support and motivation.

Group members will also benefit from mutual support to promote social skills, enhance self-reflection and awareness, and receive support and encouragement from various individuals (Brandler & Roman, 2016). Members will interact to build communication skills and engage others’ feedback to learn more about themselves to enhance self-awareness. The group approach will offer a safe environment where members can share their personal life and information, display natural behaviors, and express themselves without feeling discriminated against or unheard (Brandler & Roman, 2016). Members can observe each other’s behaviors through social interactions or situations and help the practitioner respond better than if it was individually expressed in a one-to-one session.

(Identification and Contextual Assessment Planning for the Group)

Group members can also gain from the installation of hope. Individuals selected join a group of individuals struggling with similar issues. In this case, they have a remarkable chance to experience or witness changes in others while also experiencing small wins as they are acknowledged and celebrated by peers (Yolom & Leszcz, 2005). Group members react differently to treatment, and the group might include members at various recovery levels at some point. Members can see other individuals cope and recover from their illnesses, which gives them hope to begin or continue the process.

  1. Using course literature on models and theories of group practice, what type of group approach do (or did) you propose?

Successful group practice requires the leader or the leading practitioners to adopt group practice best practices and values that inform and guide interpersonal interactions between group members and between group members and the practitioner (Wayne & Cohen, 2001). The group has six members, and new memberships will be limited as it might disrupt the progress if new members are allowed to join at any time. In this case, by the time a new member joins, the group will have undergone several staging of group practice, which will be seen as disruptive. The sessions will be two times a week, two hours long, for six months to ensure members completely recover from their anxiety and depression and feelings of loneliness, isolation, and misunderstanding. The leader will be less active, facilitating interpersonal interactions, balancing support and confrontation, managing the working process and tasks, and encouraging member-to-member empathy. The group sessions will be in a circle, and icebreakers will be the primary approach in helping members integrate and connect.

The primary aim of the practitioner is to establish working and constructive relationships between group members using group activities. The remedial model is ideal for this group as it addresses individual dysfunction, utilizing the group as context and means to alter deviant behavior (Alissi, 1980). Individuals involved in group work have behavior disapproved by society, including the desire to dissociate from cultural practices attached to their ethnic backgrounds. The remedial model can help remove the adverse conditions from group members whose behavior is unacceptable. This approach is also suited for isolated and alternated persons, which is the case with group members selected for this group work. The model will guide attempts to bring change in these individuals, especially adjusting personal and social relations.

  1. Using the required readings and course syllabus to guide the literature, identify at least two key opportunities, challenges, or obstacles in group interventions in the contexts below. How would you address each of these challenges?

Discuss at least two challenges or obstacles for each of the following: Use, cite, and reference at least one source in each subsection (A, B & C) – sources may be used in more than one)

  1. In the agency context?
  2. How will the agency\’s organizational mission, structure, and activities influence the group?

The agency’s primary purpose and mission is to help individuals recover and promote group cohesiveness. However, the agency has a leadership structure, policies, requirements for membership, and activities such as relationships with local governments, funding sources, and other partners that influence the agency’s operations. The government is critical to the agency’s continuity through yearly funding. Apart from government funding, the agency depends on payment for services to continue operating, which in this case, parents are paying because group members are teenagers. Therefore, group sessions can only be sustained with membership fees. The agency policies would see a group member discontinued if they fail to pay the required fee, affecting group dynamics and the established cohesion (Brandler & Roman, 2016).

(Identification and Contextual Assessment Planning for the Group)

Also, the agency continued operation depends on funding from the local government, implying political interference in the leadership and running of the agency (Brandler & Roman, 2016). Local government involvement in the agency’s running means that government policies impact the agency’s operations. Sometimes the budget is cut, or the funding is late, affecting the agency’s and group sessions’ operations. To address this problem, a potential solution would be the agency seeking other reliable or timely funding sources, including charitable funding, community-based funding, or partnership with non-profit organizations addressing mental health in the community and alternatives to curb the inconveniences caused by lateness or budget cuts from local government funding.

  1. How will they affect the way you develop and work with the group?

Therapists have a signed contract and work agreement with the agency to promote the agency’s mission, vision, values, and policies. Therapists enforce these policies in the group, which affects working with the group because strict adherence is needed. For instance, I have to enforce the level of discipline required in the agency, including regulations for lateness, absenteeism, membership payment, and discrimination policies. In such cases, agency interest might come before the group’s interests, negatively affecting how I develop and work with the group. When forming the group, the therapist must explain and clarify agency policies and rules and help members understand and apply them for continuity.

  1. In the community context?
  2. What communities influence the development of this group?

The selected group members are from the African American community, although from different regions, including the US, Africa, Caribbean Island, and Jamaica, meaning they share common characteristics. Working with this group is a social work practice that needs the involvement of the community where these individuals come from. The African American community influences this group’s development through its beliefs, values, and cultural practices. For instance, African Americans emphasize family closeness, community bonding, and solidarity; any altered values are considered deviant from community values and cultural beliefs. Group members will have to show adjustment to acceptable behavior if they want to be part of the community, including dissociating from not wanting to be involved in cultural practices and values of the African American community.

(Identification and Contextual Assessment Planning for the Group)

For successful integration back into the community, the community has to facilitate an accepting environment for the individuals who have adjusted their behavior. As a therapist, I will consider the African American community’s values, culture, beliefs, and social perception when developing the group to ensure I attend to these backgrounds and promote cultural sensitivity with the group. The group dynamics will not be complicated because all members are African Americas. Notably, the members’ countries of origin differ because I have some from Africa, America, Jamaica, and Caribbean Islands. The specific cultures and values of these different sub-communities will influence group development. The difference in values and backgrounds will be key in establishing and sustaining cohesiveness in the group.

  1. How may/will communities influence and/or support the ongoing development of this group?

These group members are part of the community, and community values and interests will influence its development. Members have shared experiences and feelings of isolation, loneliness, and misunderstanding. Members also claim to be in a toxic environment where they must conform to specific values and practices they disagree with but have no choice because they are minors. According to Berman-Rossi and Miller (1994), individuals act on the environment, but its influence on individuals is greater, influencing choices, actions, and ideas. Therefore, their communities have influenced and played a critical role in developing mental health issues like anxiety and depression and how they feel.

At the end of group therapy, the members must integrate into the community and develop healthy interpersonal relationships. Members are also minors are will require consent and direction from seniors, particularly family members, to be part of the group. Therefore, community members, including their families, social workers, and community leaders, who better understand the community’s cultural practices, values, and acceptable behavior, will be involved to inform and support the group’s ongoing development. There will be interactive sessions with these community members at different stages of the group process to help access individual development and behavior adjustment per the community values and acceptable behavior.

  1. In the potential members\’ and worker context?
  2. How are your identities similar or different from the client or system potentially represented in the group?

The group members experience isolation and loneliness, feel misunderstood, and have recently been diagnosed with anxiety and depression. These individuals have a commonality that I do not identify with or share experience with, but only at the professional level. I have proficient knowledge and expertise in addressing such cases and recognize how individuals feel. However, I lack personal experience or firsthand experience at a personal level on anxiety and depression symptoms or feeling disconnected from the community and family members. I need high-level empathy to understand what the clients are going through and help them throughout the recovery process.

(Identification and Contextual Assessment Planning for the Group)

  1. What assumptions or biases may you need to be aware of?

After the norming or middle stages, it is assumed that members will have no conflict, interact openly and freely, and acknowledge individual differences, working towards a common goal. I need to be aware that this is not always the reality and expect conflict or individual differences to sustain throughout therapy. I should also be keen on hidden personalities that only appear in particular circumstances, for instance, members’ reactions when one of them is overwhelmed by feelings. I should also be aware of in-group biases where some individuals feel smarter, in a better position, or more important than others. It can happen when individual members rival for attention or superiority in the group and tend to belittle or embarrass others (Brandler & Roman, 2016). Conclusively, I should expect individual versus individual and individual versus group confrontations at any point in the process.

  1. How might culture and identity impact the power dynamics in your relationship with group members and/or client system?

Culture affects group dynamics and the relationship between group members and between the therapist and group members. The cultural characteristics of group members influence how group members interact and might lead to the formation of sub-groups within the group. Although all group members are African Americans, their origin countries differ, meaning cultural practices, values, and beliefs are somewhat different for the different sub-groups. For instance, African Americans from the U.S. might develop a superiority complex over African Americans from other countries, which might impact group dynamics. Culture influence habits, preferences, and values, and the differences in the cultures of the sub-groups might be a source of conflict between group members or between group members and the therapist, affecting group cohesiveness. For instance, American pop culture is integral to the culture of African Americans from the U.S., which might impact a close relationship with African Americans from other countries and continents like Africa, Jamaica, Caribbean Islands with unique cultural practices. To address this problem, I should understand every team member’s cultural characteristics and identity and develop initiatives to ensure cultural sensitivity, eliminating any potential superiority complex that might impact the group’s cohesiveness and work process.

(Identification and Contextual Assessment Planning for the Group)

  1. Using the Worksheet: Planning Guide for Social Work Groups format; discuss your

actual or proposed group in relation to each of the 8 headings.

  1. Agency/Environmental Context: The agency has had groups of adolescents and youths before. However, this particular group comprising exhaustively of African American adolescents and youth is new in the agency. It fits with the agency’s goal of helping vulnerable groups. The agency serves the immediate community, and the group composition includes adolescents and youth from the community, which fits the value of responsiveness. Mental health issues associated with adolescents and youth in the community are on the rise, coupled with family disjoints that act as a barrier to promoting family support for patients. Fees: A small fee is required from the clients, and parents were contacted regarding the payment to ensure sustainability.
  2. Client Need(s): The group, comprising African American adolescents and youth, experience psychological and mental health issues linked to family issues and non-conformance to societal beliefs, standards, and expectations. The clients experience isolation and emotional problems from issues with their families and the community at large. There are no systems to re-establish and negotiate a connection with the family and the community, who perceive the client as non-conformant.
  3. Purpose: The group work aims to help clients re-establish connection with their families and community, recover from mental health issues, feel part of society, and change behaviors to ensure conformance with family and community expectations.
  4. Composition: The group comprises African American adolescents and youth faced with increased pressure of dissociating from their families and communities because they do not agree with the cultural practices and religious beliefs of their families and communities. Clients are from the community, can speak English, travel to the meeting point, and can be relied on for information.
  5. Structures: The group work will be held at a Community Service Center on the ground floor, next to the conference room. Members will pay a small initial fee disclosed in the contract agreement. There is a membership policy dictating group engagement rules. The group is closed, and new members are not accepted mid-course to avoid disrupting group dynamics. The group will meet for two hours thrice a week. It will break for the summer and resume in mid-August. Members will be involved in the decision-making. Meeting notifications were sent through texts.
  6. Content: The content varies, including check-in by members before the session to catch up from the previous meeting and introduce materials and resources designated for the current meeting. The content also includes social activities like games, role-plays, warm-ups, and exercises. There will be a trip at the end of group work.
  7. Formation Strategy: The group members are recruited from the patient list presenting at the community health center. After the initial assessment, group members are invited to their first session to develop an approach and discuss initiatives that would best fit each individual and the group.
  8. Evaluation Strategy: There will be time set aside before every session to review content and knowledge gained from the previous meeting. The session will be Q&A. There are weekly reviews of individuals’ goals and expectations and a collection of perceptions of their own progress and feelings about the group work. Group-generated scales for anxiety, depression, and stress will be used to monitor progress.
  9. Identify and briefly discuss three readings from the course syllabus that were

particularly useful in developing your plan and beginning strategy.

I have interacted with multiple course readings that are relevant to this endeavor. Developing successful groups is demanding, but three particular prices of literature have been resourceful in efforts in planning group work and conducting the first session successfully. One reading is Alissi (1980), who presents social group work models and offers perspectives on social group work practice. This reading is rich in perspectives and ideas regarding basic group behavior, group development, group process, group therapy, and group work practice. I specifically learned from this reading my role as the group coordinator, which is helping and enabling function and helping group members develop greater independence and capacity for self-help. The reading also offers insights into creating group interaction and program activities that enhance individual growth and help achieve desirable goals. It also guided the enabling of individualization to ensure individuals are not lost in the whole.

(Identification and Contextual Assessment Planning for the Group)

The second reading is Brandler and Roman (2016), who discuss group work skills and strategies for effective interventions. Brandler and Roman (2016) emphasize group diversity and offer insights into group work and competencies needed for success. The material addresses dilemmas and complications in group work and specific techniques to help with various issues like confrontations. It contains discussions and excerpts valuable to this particular group. This reading enhanced my understanding of value dilemmas in a group practice, the group process (In the beginning, the middle, and the ending), and group planning.

The third reading is Wayne and Cohen (2001), who present educative information on group work. Wayne and Cohen (2001) posit that effective group social work practice relies on high-quality group work education. The reading offers an overview of group work and its benefits and presents group work practice models that enhance understanding of the essentials to developing a successful team. It also offers strategies to supervise group work and members, which are vital in developing evaluation strategies for this group.

(Identification and Contextual Assessment Planning for the Group)

  1. Discuss your plans for an initial group session or describe how you conducted the first

session. What are/were your goals for these initial sessions? Incorporate process

recording excerpts, and/or anticipated statements and anticipated reactions.

I conducted the first session, which focused on introducing myself to the group members and having them introduce themselves. I also provided details regarding the purpose of the group, the expectations, and engagement rules and ensured members felt comfortable to participate in the following sessions. In the initial session, I intended to develop a proper rapport to break the unfamiliarity with the group members and ensure members develop a positive attitude towards the group work and its intended purpose. Secondly, I wanted to ensure that all group members understood engagement rules, which were actualized through a contract. I invited perspectives from group members and suggestions to make the group more effective, including their expectations, goals, and needs. I recorded them to ensure I integrate them into revised group engagement rules and appropriate behavior. I would use their perspectives to develop group work, plan group work activities, and ensure individualization. After the first session, we established the following rules:

  1. Respect others and their opinions
  2. Avoid any form of shaming, discriminatory behavior, or harassment.
  3. Treat each other with dignity.
  4. Respect turn taking.
  5. Complete a session and walking out mid-session is discouraged.
  6. Avoid walking around or engaging in any activity that would disrupt the session.
  7. Based on the Skill Inventory in the Standards for Social Work Practice with Groups,

discuss three critical skills you used, or expect to use in the beginning stage of the group.

The Standards are available at: http://www.aaswg.org/node/377

The beginning of the group is the most crucial stage and could determine a group’s success or failure. I adopted skills, including creating the initial contract that specifies tasks and goals to complete and achieve and the work process, identifying confidentiality and limits, ensuring respect for social and cultural, autonomy and self-determination, and empowering individuals (AASWG, 2010). Using these skills, I provided a clear statement of group purpose and roles and requested feedback on their perception of needs, interests, and problems. I encouraged members to share their strengths and weaknesses and any concerns they might have. I promoted the connection between group members and encouraged them to identify and express commonalities among themselves. Additionally, I evaluated the impact of existing cultural differences between members and between them and me. I worked with group members to establish rules and norms that bolstered change and growth and helped members develop personal and group goals. Most importantly, I established an environment and expectations for sociocultural safety.

(Identification and Contextual Assessment Planning for the Group)

  1. If you are referring to a group that has taken place, what is your critique of your work

and how might you have proceeded similarly and differently? If you are referring to a

proposed group that has not met, what challenges do you anticipate and what are your

strategies to address them?

I worked with this group as an intern at the community health center. I worked with them for the period I was there, and managed to adopt course concepts and insights into ensuring effective group work practice. The group has taken place, the beginning was successful, and I acknowledge the input from group members and their right attitudes towards the group and its purpose. I would continue similarly because I saw members who are invested in bettering themselves and ready to contribute meaningfully to their individual and group success. A concern regarding group work is the lack of adequate experience with this patient population and the ethical dilemmas surrounding working with adolescents or young adults. All members required consent from parents because they are yet to be adults, raising concerns regarding their autonomy. Working with teens has unique challenges, such as inconsistent decision-making, the likeliness of conflict between members, increased need for privacy and autonomy, peer relationships, and self-centeredness. Reflecting on this experience, I would engage group members in understanding challenges or issues associated with their developmental stage and how they might be contributing to their current state. I would be more involved and demand parental engagement to help establish family support of patient care.

References

Alissi, A.S. (1980). Social Group Work Models: Possession and Heritage. Perspectives on Social Group Work Practice: A Book of Readings. NY: The Free Press. Chapter 9

Association for the Advancement of Social Work with Groups, INC (AASWG, Inc). (2010). Standards for Social Work Practice with Groups Second Edition.

Berman-Rossi, T., & Miller, I. (1994). African-Americans and the settlements during the late nineteenth and early twentieth centuries. Social Work with Groups, 17(3), 77-95. https://www.tandfonline.com/doi/abs/10.1300/J009v17n03_06

Brandler, S. & Roman, C.P. (2016). Group Work: Skills and Strategies for Effective Interventions. Third Edition. NY & London: Routledge.

Wayne, J. L., & Cohen, C. S. (2001). Group work education in the field (Vol. 2). Council on Social Work Education.

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. Basic books. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/theory-and-practice-of-group-psychotherapy/96ADB4A6E578EED3C9245D58986300B9

 
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Focus SOAP Note

/in /by

 

 

 

 

 

 

Student Name

Course

Institution Affiliation

Instructor

April 4th, 2023

 

 

Focus SOAP Note

Patient Verification

Name: K.T.

DOB: November 29th, 2013

Minor: Yes

Accompanied by: Mother

Demographic: 9-year-old African American

Gender Identifier Note: Female

SUBJECTIVE:

CC: “I’m depressed.”

HPI:

A 9-year-old African American female presented at the clinic accompanied by her mother. The patient states she feels depressed. The mother also states that the patient has been complaining of feeling depressed. The mother reports that the patient was diagnosed with ADHD in 2020 at the age of 7 years. The mother is away most of the time because of her job. Her sister is also away while at home with her brothers, whom she claims are mean to her most of the time. The patient states she felt lonely because she has no one to play with or talk to. She has five friends in school who are foreigners from different countries. The patient states she does not want to go to school and does not feel like getting up in the morning to go to school. The mother reports the patient is always crying, and she does not want it to get worse, hence the reason they came for evaluation. The patient struggles in school, especially in math, with low grades. However, she is respectful in class, and she loves art and writing, drawing, painting, and sketching but finds it very hard to learn new subjects. She has problems with concentration. Painting and sketches make her less sad. The patient reports that she does not express her feelings in school but in her head. The mother reports patient has problems sleeping and decreased appetite. The client denies suicidal and homicidal thoughts and intent to hurt others. However, she has sometimes made her lips bleed twice and slapped herself on the wrist.

Social Hx: Mother, 38 years, has a history of bipolar 1 disorder with borderline traits and PTSD. Patient has 3 siblings, two brothers, and one sister. Sister has a history of anxiety and is not around most of the time. Mother is also not around, mostly due to her job. Parents are divorced, and the dad, 41, has no visitation right or custody.

Legal Hx: Denied.

Medical Hx: Denied.

Surgical Hx: Denied

Psychiatric Hx: Patient has a history of ADHD. The mother has a history of bipolar 1 disorder with borderline traits and PTSD. Sister has a history of anxiety

Psychiatric medication use: Denied.

Substance Abuse History: Denied.

ROS:

General: Denies weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

Skin: No rash or itching.

Cardiovascular: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

Respiratory: Denies wheezes, shortness of breath, consistent coughs, and breathing difficulties while resting.

Gastrointestinal: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. Reports decreased appetite.

Genitourinary: Denies burning on urination, urgency, hesitancy, odor, odd color

Neurological: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. Reports difficulties were concentrating and paying attention.

Musculoskeletal: Denies muscle, back pain, joint pain, or stiffness.

Hematologic: Denies anemia, bleeding, or bruising.

Lymphatics: Denies enlarged nodes. No history of splenectomy.

Endocrinologic: Denies sweating, No reports of cold or heat intolerance. No polyuria or polydipsia.

OBJECTIVE

Vital Signs

Temp: 98.3 F

B.P.: 117/59

HR:71

R: 18; non-labored

O2: 96% room air

Pain: Negative

Ht:4ft, 7 inches

Wt.: 71.2 lbs.

BMI:17.9

BMI Range: Healthy Weight

Physical Exam: General appearance: The patient appears healthy and well-fed. She routinely discusses with the medical personnel; however, she easily gets distracted and abruptly leaves the subject under discussion. The mother steps in to assist with replying.

HEENT: Normocephalic and atraumatic. Sclera anicteric, No conjunctival erythema, PERRLA, oropharynx red, moist mucous membranes.

Neck: Supple. No JVD. Trachea midline. No pain, swelling, or palpable nodules.

Heart/Peripheral Vascular: Regular rate and rhythm noted. No murmurs. No palpitation. No peripheral edema to palpation bilaterally.

Cardiovascular: Although the patient’s heartbeat and rhythm are regular, murmurs and other sounds are coming from her chest. The patient’s heart rate is constant, and capillaries refill in two seconds.

Musculoskeletal: Normal range of motion. Regular muscle mass for age. No signs of swelling or joint deformities.

Respiratory: No wheezes, and respirations are easy and regular.

Neurological: Balance is stable, gait is normal, posture is erect, the tone is good, and speech is clear.

Psychiatric: The patient’s fast switching from one discussion or topic to another indicates inattentiveness. Patient is easily distracted yet occasionally appears to pay attention to the mother and the practitioner.

Neuropsychological testing: Patient has difficulties executing functions where he is required to prioritize, plan, inhibit behavior, and attend to processing speed, especially schoolwork.

ASSESSMENT

MSE: K.T. underwent a mental health assessment. The patient has dressed appropriately for the setting and the season. Despite being highly talkative, she remained seated during the interview, was compliant, and displayed no discomfort. The patient denied having hallucinations, suicidal or homicidal thoughts, paranoia, insomnia, appetite loss, or auditory or visual hallucinations.

DSM5 Diagnosis

  1. F90.9. Attention-Deficit hyperactivity disorder (Confirmed):

Attention-deficit/hyperactivity disorder (ADHD), a chronic mental health condition that frequently worsens as people age, affects millions of children. ADHD’s enduring symptoms include hyperactivity, impulsive behavior, and difficulties paying focus. For those with ADHD, especially children, common issues include low self-esteem, troubled relationships, and lack of involvement (Magnus et al., 2017). Impulsivity, disorganization, poor time management, difficulty setting priorities, difficulty focusing, difficulties multitasking, excessive activity and restlessness, poor planning, and a low threshold for irritability are some symptoms of ADHD.

The patient reported experiencing depressive, lonesome, and melancholy feelings, typical of many ADHD patients. The DSM-5 diagnostic criteria for people with ADHD include five or more inattention symptoms, several of which must have appeared before the age of 12, several of which must have appeared in two settings, evidence that the symptoms impair or negatively affect social or academic functioning, and symptoms that do not only coexist with another psychotic disorder (Magnus et al., 2017). The patient demonstrates continuous loss of focus and attention and has previously been diagnosed with ADHD. The patient claims to be depressed and exhibits many symptoms of depression. However, ADHD patients also report decreased appetite, symptoms resembling sleep deprivation, and are more likely to engage in non-suicidal and suicidal self-harm, which may account for the patient’s bleeding lips and slapping of oneself. The primary diagnosis, according to the examination, is ADHD.

  1. F32.9 Major Depressive Disorder

A prolonged sense of sadness and passivity are two features of depression. All depressive disorders have the symptoms of sadness, emptiness, or irritability, as well as other physical and mental changes that significantly restrict the patient’s capacity to function (Chand et al., 2021). Patients who are depressed have noticeably lower interest in or excitement for nearly all endeavors for the majority of the day, essentially every day. According to the DMS-5 criteria, a diagnosis requires five of the following symptoms: trouble sleeping, loss of intrigue or pleasure, feelings of inadequacy or helplessness, fatigue or erratic energy, problems concentrating or listening attentively, fluctuations in appetite or weight, psychomotor issues, suicidality, and depressed mood (Agostino et al., 2021). The patient claims to feel down, melancholy, and lonely. Moreover, the patient has trouble falling asleep and has less desire to eat. The patient disputes any suicidal thoughts. Many depressive symptoms are present in the patient; however, the diagnosis was ruled out because the patient did not exhibit a protracted state of sadness.

  1. F41.9. Generalized Anxiety Disorder

Excessive, exaggerated anxiety and worry about everyday events without an apparent reason are characteristics of a generalized anxiety disorder (GAD) (Munir et al., 2021). 3.1% of the population, or more than 6.8 million people, are affected. Although it can begin at any age and progress gradually, the risk is most between the ages of five and middle age. Biological variables, family history, life events, and other stressors contribute to GAD, despite the exact cause being unknown (Toussaint et al., 2020). Looking for symptoms like excessive, persistent worry and tension, unrealistic views of problems, restlessness or a feeling of being “edgy,” difficulty focusing, quickly becoming exhausted, increased crankiness or irritability, trouble sleeping, and muscle tension can help diagnose a general anxiety disorder. Individuals with GAD frequently see doom coming and worry excessively about everyday occurrences like going to work. GAD is diagnosed when a person has uncontrollable worrying, which K.T. does not have.

PLAN

Pharmacologic interventions:

  • Start Venlafaxine 18.75-75 mg/day; may increase to 150 mg/day after 4 weeks

Psychotherapy

Behavioral psychotherapy: With behavioral therapy and the appropriate medication, it can improve ADHD symptoms while enhancing executive function, lowering anxiety, and reducing hyperactivity (Magnus et al., 2017).

Psychosocial interventions: Psychosocial therapies, including applied relaxation interpersonal psychotherapy, short-term psychodynamic psychotherapy, and social skills instruction, can assist in lessening the symptoms of ADHD and anxiety (Magnus et al., 2017).

Cognitive therapy: Cognitive-behavioral therapy helps reduce anxiety and restlessness sensations that arise when performing tasks, improve focus and time management, and improve mood (Lopez et al., 2018).

 

 

Patient Education

  • Talk to the patient and parent about the risks and benefits of medication, including non-treatment and probable side effects.
  • Discuss with the patient and parent when to stop the medication, how to recognize it, and when to report adverse events.
  • Talk to the patient and parent about the dangers of combining prescription pharmaceuticals with OTC, illicit, or natural substances.
  • Educate patient and parent to develop structured daily routines and schedules and minimize changes.
  • Engage the patient in skills training.
  • Encourage patient and parent to make time for exercise every day.
  • Educate the patient to accept herself and her limitations and interact with people who accept her.
  • Teach patients to create a system for prioritizing the day and create deadlines for activities.
  • Advise parents to create more time to spend with the patient.

Follow-up: Patient should follow up after one week for psychotherapy.

Reflection

Access to treatment in mental health, and in particular ADHD, has not been actualized fully because, by 2017, only 75.2% of children had received treatment per the Healthy People 2030, implying a significant part of the population, about 25%, have not received treatment. Based on the most recent data (2020-2021), only 72.5% had received treatment. Healthy People 2030 targets this proportion to reach 79.4% (Healthy People 2030). The goal is to increase the number of children and adolescents with ADHD who access developmentally appropriate treatment like behavioral therapy and/or medication. This initiative would help more patients enhance their health outcomes and integrate and function normally in society. Regarding health promotion, ADHD patients are at an increased risk of being overweight and developing obesity. Recommending and guiding healthy habits like healthy diets, including vegetables, fruits and whole grains, frequent physical activity, and reducing screen time would be appropriate in preventing weight-related health issues.

If I was to conduct the session over; I would contact the teacher and the family physician to gather more information and perspectives that the child or the parent might have missed out or not disclosed. Teachers spend more time with the child and hence have more understanding and knowledge regarding the challenges the child faces in class and socializing with others. The family physician is highly knowledgeable of the deficiencies in functioning or issues the child experiences. I followed up with the patient, and the interventions had achieved the expected objectives, but it is still a work in progress. Addressing ADHD can take time because it is a learning process involving comprehensive training and coaching of the child and the patient to ensure optimal results.

References

Chand, S. P., Arif, H., & Kutlenios, R. M. (2021). Depression (Nursing). In: StatPearls [Internet]. StatPearls Publishing.

Healthy People 2030. (n.d.). Increase the proportion of children and adolescents with ADHD who get appropriate treatment — EMC‑04. https://health.gov/healthypeople/objectives-and-data/browse-objectives/children/increase-proportion-children-and-adolescents-adhd-who-get-appropriate-treatment-emc-04

Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018). Cognitive-behavioral interventions for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane Database of systematic reviews, 3(3), CD010840. https://doi.org/10.1002/14651858.CD010840.pub2

Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2017). Attention deficit hyperactivity disorder (ADHD).

Munir, S., Takov, V., & Coletti, V. A. (2021). Generalized Anxiety Disorder (Nursing). StatPearls [Internet].

Toussaint, A., Hüsing, P., Gumz, A., Wingenfeld, K., Härter, M., Schramm, E., & Löwe, B. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of affective disorders, 265, 395-401

 
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Child Onset Fluency Disorder (Stuttering)

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Child Onset Fluency Disorder (Stuttering)

(Child Onset Fluency Disorder (Stuttering))

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The most prevalent type of stuttering, childhood-onset fluency disorder, is a neurologic impairment caused by an underlying brain defect resulting in dysfluent speech. Subsequent effects of stuttering include a negative perception of oneself and judgmental comments by others, anxiety, and, in rare cases, depression (Maguire et al., 2020). Patients diagnosed with stuttering tend to develop verbal or situational avoidance and involuntary movements over time. Stuttering that is pervasive into adulthood can significantly restrict or impact an individual’s quality of life, including social engagement and professional growth and development (Maguire et al., 2020). Identifying stuttering early can help with early intervention intending to initiate compensatory changes in the brain, which are possible in the early stages of development, to minimize consequences such as social anxiety, limited social skills, negative attitudes towards communication, and maladaptive compensatory behaviors.

Child Onset Fluency Disorder (Stuttering)

Signs and Symptoms

Patients with childhood-onset fluency disorder are marked by normal fluency and time patterning of speech disturbance that is unrelative to an individual’s age or development stage. Patients often repeat or prolong sounds or syllables (Maguire et al., 2020). Additionally, patients demonstrate speech deficits, including broken-up single words like pauses within a word, audible or silent blocks like speech with filled or unfilled pauses, circumlocutions like substituting words to avoid problematic ones, producing words with excess physical tension, and use of monosyllabic whole-word repetitions like “she-she-she-she is there.”

(Child Onset Fluency Disorder (Stuttering))

DMS-5 Criteria

DMS-5 Criteria for Stuttering
Criteria A Criteria B Criteria C Criteria D
Repetition of sounds and syllables The disturbance leads to anxiety regarding speaking or ineffective communication, social engagement, or academic or occupation performance, individually or combined. Symptoms begin in early childhood development period. The disturbance is not linked to any speech-motor or sensory deficit., disfluency related to neurological insult like stroke or trauma, or any medical condition and is not better demonstrated by another mental disorder.
Prolonging consonants and vowels      
Broken words      
Audible or silent blocking      
Producing words with excessive physical tension      
Repeating monosyllabic whole-words like he, she, and I      

Etiology

The origin of stuttering is attributed to genetic and epigenetics and neural and motor correlates. Studies have indicated that stuttering is typical in some families because of the presence of a gene linked to stuttering transmission, which can be established using a family tree with a high density of people who stutter (Smith & Weber, 2019). The gene can vary from family to family; hence stuttering is not attributed to a single genetic basis. Studies have also used epigenetics to understand stuttering. Epigenesis is based on environmental influences, linking the bridge between genetic and environmental factors. More recent studies have focused on neural and motor correlates to understand the etiology of stuttering. These studies have investigated the difference in brain sections between stuttering and fluent individuals (Smith & Weber, 2019). The commonality in the investigations indicates atypical connectivity and functioning in the left inferior frontal areas typically specialized for speech production and other sections related to auditory and linguistic processing.

Epidemiology

Stuttering is a common disorder across all age groups. In 80-90% of people who stutter, it begins by age 6. Most people averagely develop stuttering between 2 and 7 years. Stuttering affects 5% to 10% of kindergarten children (Sjøstrand et al., 2019). About 5.2% of children aged 3 to 5 years and 8.4% of those aged 2 to 7 years stutter (Sjøstrand et al., 2019). Stuttering is common among persons with intellectual disabilities, affecting 0.8% to 20.3% per different reports. Persistent stuttering affects about 1% of the population (Sommer et al., 2021). Males develop stuttering 4 times more than females.

Prognosis

Individuals can recover from stuttering, although it can be life-long. About 65%-85% of stuttering children recover (Sommer et al., 2021).

Pharmacological Treatment

There is no FDA-approved medication to treat stuttering. However, patients can be prescribed medications with a dopamine-blocking activity that have proved effective and efficient (Maguire et al., 2020). However, it is fundamental to limit medication after reviewing side-effects profiles. A dopamine-blocking antipsychotic, haloperidol, can be prescribed as it has proven its efficiency in improving brain activity in speech areas.

(Child Onset Fluency Disorder (Stuttering))

Non-Pharmacological Treatment

Non-pharmacological treatments are the first line treatment for stuttering. Common non-pharmacological treatments include speech therapy, cognitive behavioral therapy, and electronic delayed auditory feedback tools (Maguire et al., 2020).

  1. Speech therapy promotes slow and effective speaking
  2. Cognitive behavioral therapy can be adopted together with speech therapy to identify undesired thought patterns that worsen stuttering and help the patient develop coping strategies to manage stress associated with stuttering.
  3. Electronic delayed auditory feedback tools are adopted to help persons to slow down their speech to enhance effectiveness.

Diagnostic and Labs

Family physicians are the first contact during patient assessment and diagnosis because of their broad knowledge of individual disfluencies. After collecting subjective data, various tests can be done to ascertain the diagnosis. The practitioner can test phonological skills and syntactic and morphosyntactic proficiency using SPELT-3 (Smith & Weber, 2019). The test of Childhood Stuttering (TOCS) can help determine speech fluency. It adopts standardized speech measures like rapid picture naming, modeled sentences, narration, and structured conversation. The Behavior Assessment Battery for School Age Children (BAB) can help identify disfluencies. A norm references stuttering assessment like Stuttering Severity Instrument (SSI-4) is also useful in ascertaining the diagnosis.

Differential Diagnosis

  1. Sensory deficits
  2. Normal Speech dysfluencies
  3. Medication side effects
  4. Adult-Onset Dysfluencies

Patient Education

  • Educate the patient to speak slowly and calmy with frequent pauses.
  • Advise the parent to spend some quiet, uninterrupted time with the child every day.
  • Ask the parent to be polite when the child speaks,
  • Educate the parent on using positive affirmations and reinforcement.

References

Maguire, G. A., Nguyen, D. L., Simonson, K. C., & Kurz, T. L. (2020). The Pharmacologic Treatment of Stuttering and Its Neuropharmacologic Basis. Frontiers in neuroscience, 14, 158. https://doi.org/10.3389/fnins.2020.00158

Sjøstrand, Å., Kefalianos, E., Hofslundsengen, H., Guttormsen, L. S., Kirmess, M., Lervåg, A., Hulme, C., & Næss, K. A. B. (2019). Non‐pharmacological interventions for stuttering in children aged between birth and six years. The Cochrane Database of Systematic Reviews, 2019(11), CD013489. https://doi.org/10.1002/14651858.CD013489

Smith, A., & Weber, C. (2019). Childhood Stuttering: Where Are We and Where Are We Going?. Seminars in speech and language, 37(4), 291–297. https://doi.org/10.1055/s-0036-1587703

Sommer, M., Waltersbacher, A., Schlotmann, A., Schröder, H., & Strzelczyk, A. (2021). Prevalence and Therapy Rates for Stuttering, Cluttering, and Developmental Disorders of Speech and Language: Evaluation of German Health Insurance Data. Frontiers in human neuroscience, 15, 645292. https://doi.org/10.3389/fnhum.2021.645292

 
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American Consumption of Health Services

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American Consumption of Health Services

(American Consumption of Health Services)

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American Consumption of Health Services

The United States spends more on healthcare than other developed countries. Comparing the US and German healthcare systems, for instance, there are significant disparities in the consumption of health. America has higher spending than Germany despite the German healthcare system being better. Healthcare spending in the US is rising and, if not addressed, will drive the country to an unsustainable national debt, making it harder to address public health issues. This paper discusses the American consumption of health as a healthcare system challenge and proposes interventions to minimize healthcare spending.

US Healthcare Spending

The US healthcare spending is among the highest in the world, spending over $4.3 trillion in 2021, which averages to about $12,900 per individual, double what individuals in other wealthy nations spend. Also, America spends a significant part of its GDP on healthcare, about 16.3% to 17.0%, compared to Germany, which spends roughly 11% of its GDP.1 In 2021, the US spent 18% of the GDP, which is a significant increase from 5% in 1960.2 The Covid-19 pandemic significantly increased healthcare spending in the United States, and it has since been increasing despite the size of the economy stagnating as US citizens grapple with significant inflation.

Multiple factors, including aging population, the increasing cost of healthcare services, and increasing drug addiction, such as the opioid pandemic, are increasing prices and utilization, hence the growing healthcare spending.1 The aging population, comprising of older adults aged 65 years and above, has increased considerably over the past decade, from 13% in 2010 to 16% in 2021.4 This proportion is anticipated to continue increasing to about 20% by 2030.4 Older adults experience more health issues than the other generation; hence spending more than any other group. Therefore, the increasing population means that healthcare spending will continue to rise into the future if appropriate interventions are not adopted. Additionally, older people above 65 years will be eligible for Medicare, and the number of enrollees will rise significantly, increasing Medicare costs over time, projected to double by 2050 relative to the economic size, increasing from 2.9% in 2022 to 5.9% of GDP by 2052.4

Additionally, price increases and inflation are raising healthcare spending due to the increased cost of healthcare products and services. The cost of healthcare services is rising more than the cost of other goods and services. For instance, in the past two decades, the consumer price index (CPI) has experienced constant growth averaging 2.4% annually for other goods and 3.4% for medical care.5 The innovative healthcare technologies improve the quality of care, but also the cost of procedures and products; hence high healthcare spending. Per this evidence, it is fundamental to explore the high cost of healthcare because, despite the cost of healthcare increasing, the quality of health and health outcomes have not.

(American Consumption of Health Services)

There are several remedies to reduce healthcare spending, including promoting competition, focusing on preventative care, reducing service and product prices through regulation, establishing incentives to minimize the utilization of low-value care, developing spending targets, and fostering payment reforms.3 Preventative care should be emphasized to avoid disease development in the first place; hence no need to seek healthcare services. Physician assistants can work closely with other providers to adopt preventative care measures, such as patient education and coaching of healthy habits and lifestyles, to reduce disease incidence and burden. Health policy commissions and policymakers should support these strategies through initiatives in current state and federal agencies and direct implementation of new policies. There are limits to federal action, and states should take more meaningful policy action to drive the reforms and control the spending in their respective states, which would hence reduce the nationwide spending growth. It can be possible through state health policy commissions.

Conclusion

American consumption of healthcare services is significantly higher than other wealthier and more developed countries. Individual spending is double that of other developed nations. The increasing spending is a concern because health outcomes have not improved. Reducing healthcare spending is possible through health policy reforms implemented at the state and federal levels and should not be left to the federal government only.

References

Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863-884. doi:10.1001/jama.2020.0734

McCullough JM, Speer M, Magnan S, Fielding JE, Kindig D, Teutsch SM. Reduction in US Health Care Spending Required to Meet the Institute of Medicine’s 2030 Target. Am J Public Health. 2020;110(12):1735-1740. doi:10.2105/AJPH.2020.305793

National Academies of Sciences, Engineering, and Medicine. Factors that affect health-care utilization. InHealth-Care Utilization as a Proxy in Disability Determination 2019 Mar 1. National Academies Press (US).

Peter G. Peterson Foundation. Why are Americans paying more for healthcare? 2023. https://www.pgpf.org/2023/01/why-are-americans-paying-more-for-healthcare/

The Commonwealth Fund. Reducing Health Care Spending: What Tools Can States Leverage? 2021. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/reducing-health-care-spending-what-tools-can-states-leverage

 
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NR705-WEEK7-Project Implementation Plan

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NR705-WEEK7-Project Implementation Plan

(NR705-WEEK7-Project Implementation Plan)

Practice Question

The following practice question will serve as the basis of the DNP project: For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication non-adherence (O) in 8-10 weeks (T)?

NR705-WEEK7-Project Implementation Plan

Project implementation Plan Summary

Across weeks 2-3, the project implementation activities included project identification, determining whether the problem was a priority to the organization, developing the team, gathering and analyzing evidence, critiquing and synthesizing the research articles, and assessing evidence for adequacy. Across weeks 4-9, the project team began implementing the intervention, which is motivational interviewing. The first step was assessing the fidelity of practice among the selected practitioners to ensure the intervention is delivered. The next step was gathering input from practitioners regarding the implementation plan and any viewpoints they would like to share before beginning MI. Practitioner training and education followed to ensure necessary learning and integration of MI. The project team assessed the leadership readiness to prioritize MI implantation and ensure consistent focus. After completing training, the project team prioritized practitioners showing the capacity to support integration. The team selected the right coaches, coding instruments, and competent internal coaches to evaluate the MI and offer feedback.

In the initial implementation, the project team ensured the data system was in place to ensure the routine gathering of data from identified measures. The selected practitioners and coaches engaged the patients in assessing their perceptions of risks and problems with their current behavior, weighing up the advantages and disadvantages of change, including exploring ambivalence and alternatives, identifying reasons for change, and enhancing the patient’s confidence in the capacity to change. The practitioners also engaged patients to develop realistic plans make changes towards the next steps, and identify and use strategies of MI to avoid relapse. Currently, we are implementing relapse strategies to help patients contemplate and take action without being demoralized or getting stuck.

In weeks 2 and 3, the project team evaluated project development activities and successes using problem tree analysis, priority matrix, and stakeholder analysis. Across weeks 4-9, the project evaluated project implementation activities using a literature review, solution tree analysis, focus groups and discussions, semi-structured interviews, ORID, and project diary. The project team also evaluated implementation activities through schedule tracking, budget tracking, dartboard, questionnaire, huddles, and questionnaire and fidelity and review feedback of MI implementation. The only changes made to the implementation plan were introducing internal coaches to regularly review MI practice and offer feedback on the implementation progress and success. This action was undertaken to ensure MI practice is delivered as intended through the implementation phase.

 
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Reflection Paper 3

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Reflection Paper 3

(Reflection Paper 3)

Student Name

Reflection Letter

NSG 301

Professor

Reflection Paper

RE: Writing Reflection

Writing is an exciting endeavor because it allows the presentation of thoughts or knowledge in a written format available for others to read. In the academic field, writing is the primary method of presenting and sharing knowledge. Writing in the academic field is formal in most instances to ensure a standard way of sharing knowledge and promote consistency. In higher education, skills in academic writing are imperative to academic success. Proficiency is awarded and reflected in final grades, hence the need for students to practice writing skills to become better writers. I have engaged in various assignments in this course and had an opportunity to showcase my writing skills, which I acknowledge have improved over time. Although I have not achieved the level I aspire to, I can testify to significant improvement.

When writing, it is imperative that information is presented concisely to enhance understandability and ensure the information is interpreted correctly and achieves the desired objective. However, it is impossible to control how readers perceive and interpret the information presented due to individual differences or biases on the topic. You can only wish the information reaches the intended audience and is interpreted as anticipated to achieve its desired objective. My greatest fear in writing is presenting a piece of work and readers interpreting the information differently, causing controversy or misinformation. Writing aspects of grammar, including punctuation, proper spelling, and tone, influence how readers interpret information. My goal in this course is to ensure that I utilize the writing aspects of grammar, specifically punctuation, to make reading more sensible and clearer and ensure the correct interpretation of presented information.

Although my writing has significantly improved, I still think I have several weaknesses I should work on to strengthen my writing ability. I need to practice more often to achieve perfection, aiming to become a scholar or write a scientific paper one day. I am goal-oriented, a strength I can utilize to improve my writing skills. I can focus on reading more about academic and scholarly writing, borrowing from course resources, instructor feedback, and online resources, which provide valuable insights into proper writing. When comparing it with writing in high school, I can attest that writing follows the same process. You have to initiate an idea, gather information about it, plan your points, and present them in a written format. However, as you advance at the academic level, writing standards are requirements also advance. At this level, writing is more demanding, and instructors are keener with writing requirements per the provided standards like APA. To perform at the highest level, I have had to do more and invest more in my papers and essays. I proofread my essays and review grammar, adopting tools like Grammarly to limit errors before presenting my assignments.

(Reflection Paper 3)

Writing is essential in academic and professional life. Proficient writing gives confidence and enhances clarity in communication, which is fundamental in professional and general life. Writing will bolster my intelligence and competency because I engage more with information, learn to understand materials, ideas, and concepts, and do research for expounded understanding when writing an essay. I also engage in more critical thinking when writing, which can improve my intelligence. I also learn to express my thoughts, feelings, and ideas through writing. Writing also enhances memory, and I can attest that I remember better when I write things down.

 
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