1-  In the infant, sutures separate the bones of the skull from one another. The areas where the major sutures intersect in the anterior and posterior portions of the skull are fontanelles. Discuss various problems associated with fontanelles. 

2-3 paragraphs of 3 sentences each

3- APA style

4- 2 references not older than 2015

• Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
• Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.

Supportive Psychotherapy versus Interpersonal Psychotherapy

With the rising cases of mental disorders, there has been an increasing urge for healthcare providers to assess the efficacy of the approaches used in psychotherapy. This is intended to help in the identification of the strategy that will be effective in assisting patients who are suffering from psychiatric disorders. Two of the common approaches that are used in helping the patients is supportive psychotherapy and interpersonal psychotherapy. Herein, this paper will seek to discuss the similarities of the approaches, the differences, and the effective strategy that could be selected for helping patients. 

How supportive and interpersonal psychotherapies are similar

Both supportive psychotherapy and interpersonal psychotherapy are important and seek to bring therapeutic impact to the patients who have psychiatric disorders. Whiting et al. (2019) argue that the use of supportive psychotherapy by a healthcare provider is intended to help in the enhancement of the adaptive and health patterns of the patients with the objective of reducing the cases of intrapsychic conflict. The interpersonal approach as well seeks to resolve the interpersonal problems that a patient may have. These intend to help the patient in attaining a healthy state if thinking. 

Three differences between these therapies and how these differences might impact practice as a mental health counselor

One of the differences is that the use of supportive approach involves the adherence to a time-limited approach that is structured and takes three to four months but the supportive approach is not structured and makes use of a combination of cognitive behavior and conceptual approach. The focus of the supportive approach is to ensure that the patient is able to have an improved standard of health while interpersonal approach aims at identifying and bringing a resolution to a problem that has prevailed. This infers that there will be a need for the therapists to have an evaluation of the relational aspects of psychiatric disorder patients (Bombardier et al., 2019). 

The therapeutic approach that might be used with clients and why

The therapeutic approach that will be useful in this case will be the interpersonal approach. I prefer to make use of this approach as a nurse therapist in addressing the challenges that are presented by patients with psychiatric disorders. This is attributed to the fact that the approach puts stress on the importance of interpersonal relationships. Psychiatric disorders as per Marrie et al. (2015) are mainly developed by lack of an effective interpersonal relationship. Along these lines, tackling the issue will help in resolving the issue of the patients. The selection is as well attributed to the fact that in considering interpersonal relationships one is able to consider the issues of mood changes and the behavioral changes of a patient which are the main aspects that contribute to psychiatric disorders. 

Working in healthcare can be extremely stressful when it comes to patient care, poor outcomes, and traumatic events. On top of this, stress can be exacerbated by incivility, bullying, and workplace violence (Marshall & Broome, 2017). According to Clark et al. (2011), “Incivility in healthcare can lead to unsafe working conditions, poor patient care, and increased medical costs.” Completing the Clark Healthy Workplace Inventory gave me some more insight into the civility of my workplace (2015).

Based on The Clark Healthy Workplace Inventory, my organization scored a 73. Clark explains that a 73 is associated with a moderately healthy workplace. I would agree my workplace deserves this score, and the description is fitting. My lower scores reflected my “neutral” score in statements that described how management views employees. Marshall and Broome note, incivility can take on many forms, from condescending remarks to refusal to acknowledge a coworker’s need for assistance and can occur between nurses or those in leadership positions (2017, p. 108). For me, the incivility in the work environment often stems from opposition between management and staff. It seems that management does not always value staff nurses. For this reason, the statement, “Employees are viewed as assets and valued partners within the organization,” stuck out to me. It can sometimes seem that nurses are not in control of decisions being made that affect nurses.

Most recently, an event occurred at my workplace that rubbed many staff nurses the wrong way. I work in the emergency department, where we have recently had a massive influx of COVID-19 patients. We have separated our department into a respiratory and medical side. As you can imagine, we screen every patient that enters the department. If they have any respiratory symptoms, they go to the department’s respiratory side and are considered a rule out COVID until otherwise stated by the physician. If they are diagnosed with COVID and need to be admitted, they are admitted to the hospital’s COVID floor. Recently, an email was leaked that stated the nurses on the COVID floor were receiving extra compensation. In contrast, our nurses who were taking care of the same patients who were being admitted were not receiving the additional payment.

From our standpoint, it was extremely frustrating that this information was kept from us, and it made us feel extremely undervalued. It was discouraging to feel our organization was not being transparent, and we were not treated fairly. To address this situation, one of our staff nurses voiced her concerns to our leadership in the emergency department, the emergency department’s administrative director. He was also kept from this knowledge, so he scheduled a meeting with his direct report. From here, the administrators compromised on allowing emergency department nurses to float up to the COVID floor for extra shifts to receive the additional compensation.

While it was not the answer we wanted, it was nice that our administrative director of the emergency department tried to make something happen. It did give me a poor impression of our administrators who are in charge of making these decisions, who neglected to include any representatives from the ER. I do not feel these individuals view me or any other emergency department staff nurses as assets or valued partners with the organization. I think this type of leadership creates more incivility in the workplace. 

References

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering Civility in Nursing

Education and Practice Nurse Leader Perspectives. Journal of Nursing Administration, 41(7–8), 324–330. https://doi-org.ezp.waldenulibrary.org/10.1097/NNA.0b013e31822509c4

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American

Nurse Today, 10(11), 18-23. Retrieved from https://www.myamericannurse.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert

clinician to influential leader (2nd ed.). New York, NY: Springer

This case study documents an ongoing interaction between a wife and her husband who live in a spacious home in a gated community.

When Dan (now 80) and Jane (now 65) began dating more than 15 years ago, both were emotionally charged to begin their lives anew. Well-educated and financially secure, they had a lot in common. Dan was a protestant minister, and Jane’s deceased husband had been a protestant minister. Both had lost their spouses. Jane’s first husband had suffered a catastrophic cerebral aneurysm 2 years earlier. Dan had conducted the funeral service for Jane’s husband. Dan’s wife had died of terminal cancer a little over a year earlier. Dan’s first wife had been a school counselor; Jane was a school teacher. Both had children in college. They shared a love for travel. Dan was retired but continued part-time employment, and Jane planned to continue teaching to qualify for retirement. Both were in great health and had more than adequate health benefits. Within the year they were married. Summer vacations were spent snorkeling in Hawaii, mountain climbing in national parks, and boating with family. After 7 years, Dan experienced major health problems: a quadruple cardiac bypass surgery, followed by surgery for pancreatic cancer. Jane’s plans to continue working were dropped so she could assist Dan to recover and then continue to travel with him and enjoy their remaining time together. Dan did recover—only to begin to exhibit the early signs and symptoms of Alzheimer’s disease. One of the early signs appeared the previous Christmas as they were hanging outdoor lights. To Jane’s dismay, she noted that Dan could not follow the sequential directions she gave him. As time passed, other signs appeared, such as some memory loss and confusion, frequent repeating of favorite phrases, sudden outbursts of anger, and decreased social involvement. Assessments resulted in the diagnosis of early Alzheimer’s disease. Dan was prescribed Aricept, and Jane began to prepare herself to face this new stage of their married life. She read literature about Alzheimer’s disease avidly and organized their home for physical and psychological safety. A kitchen blackboard displayed phone numbers and the daily schedule. Car keys were appropriately stowed. It was noted that she began to savor her time with Dan. Just sitting together with him on the sofa brought gentle expressions to her face. They continued to attend church services and functions but stopped their regular swims at their exercise facility when Dan left the dressing room naked one day. Within the year, Jane’s retired sister and brother-in-law relocated to a home a short walk from Jane’s. Their intent was to be on call to assist Jane in caring for Dan. Dan and Jane’s children did not live nearby so could only assist occasionally. As Dan’s symptoms intensified, a neighbor friend, Helen, began to relieve Jane for a few hours each week. At this time, Jane is still the primary dependent-care agent. She prides herself in mastering a dual shower; she showers Dan in his shower chair first, and then, while she showers, he sits on the nearby toilet seat drying himself. Her girlfriends suggested that this was material for an entertaining home video! Although Jane is cautious in her care for Dan, she often drives a short distance to her neighborhood tennis court for brief games with friends or spends time tending the lovely gardens she and Dan planted. During these times, she locks the house doors and leaves Dan seated in front of the television with a glass of juice. She watches the time and returns home midway through the hour to check on Dan. On one occasion when she forgot to lock the door while she was gardening, Dan made his way to the street, lost his balance, reclined face-first in the flower bed, and was discovered by a neighbor. Jane has given up evenings out and increased her favorite pastime of reading. Her days are filled with assisting Dan in all of his activities of daily living. And, often, her sleep is interrupted by Dan’s wandering throughout their home. At times, when the phone rings, Dan answers and tells callers Jane is not there. Jane, only in the next room, informs him “Dan, I am Jane.” Friends are saddened by Dan’s decline and concerned with the burdens and limitations Jane has assumed as a result of Dan’s dependency.

Critical thinking activities

1. Examine this case study through the dependency cycle model (Fig. 14.3). The outer arrows show a progression through varying stages of dependency. The inner circle represents who can be involved in the dependency cycle. Where are Jane and Dan in this cycle?

2. Using the basic dependent-care system model (Fig. 14.4), assess Dan and Jane. Identify the basic conditioning factors (BCFs) for each. What is the effect of Dan’s BCFs on his self-care agency? Is he able to meet his therapeutic self-care demands? Continue on to diagnose Dan’s self-care deficit and resulting dependent-care deficit. Now assess Jane’s self-care system.

3. Design a nursing system that addresses Jane’s self-care system as she increases her role as dependent-care agent for Dan.