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Part 1: Progress Note
Using the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following:
Note: Be sure to exclude any information that should not be found in a discoverable progress note.
Part 2: Privileged Note
Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.
In your progress note, address the following:
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Physical assessments are performed on both adults and children. There are some aspects of the assessments that resemble each other, but some aspects are different depending on if they are being performed on an adult or a child. The nurse will need to be aware that uncertainty and anxiety can be exhibited by both populations when having a physical assessment performed. Therefore, with both adults and children the nurse should express confidence, kindness, and compassion when performing the assessment to allow the patient to feel more at ease. In both scenarios the nurse will measure height and weight, assess vitals such as temperature, heart rate, respirations, and blood pressure. In adults the physical assessment is done in a head to toe order, and with a child the assessment order may not be as structured but will still be entirely completed. A good recommendation for a child assessment would also be to start with the least invasive portion of the assessment and ending with the most invasive such as the examination of the throat and ears. The interview and health history will be communicated with the adult by the nurse. Where with a child the information exchange will take place with the parent or caregiver. Children show differences from adults in the size of their bodies, and in their behaviors as they progress in their development. In a child assessment there is an added focus on their physical development and reaching age appropriate milestones as they are progressing in both areas rapidly. (Jarvis, 2015).
From infancy to adulthood multiple transitions take place in the psychosocial development of a human. Erik Erikson suggests that human development goes through a total of eight stages. When the nurse is performing a physical assessment and interview, they need to be aware of Erikson’s psychosocial developmental stages so that they will know how to best offer instruction and communication. How the nurse approaches an individual child will vary dependent of what stage of psychosocial development they are in. (Falkner, 2018).
An infant will be in the trust stage meaning that they look for their basic needs to be met establishing trust. The infant is completely reliant on their parent or caregiver. The nurse will direct most of the instruction and communication towards the parent during this stage but will be able to communicate with the infant by talking in a soft, calm tone, making eye contact, and smiling. If fussiness is exhibited the nurse can offer a brightly colored toy as a distraction method, or a pacifier for comfort. Toddlers are in the autonomy stage of development meaning they are becoming curious and more aware of their environment. They are seeking independence while still being dependent on their parent. In the toddler stage the nurse should acknowledge the parent as well as the toddler upon entering the room. The nurse can first interview the parent allowing the toddler to feel more at ease. The assessment should be performed with the parent in close view or if needed on the parent’s lap. Communication and instruction should be age appropriate, as well as clear, and direct. The nurse can allow the toddler to touch and feel the stethoscope prior to listening to their heart and lungs or demonstrate on the parent first to ease any associated fear. The preschooler will be in the initiative stage of development. During this stage, the preschooler begins to independently perform tasks, enjoy being involved and are helpful. Their verbal communication is present at this stage and will be helpful as the nurse performs the assessment. Directions as well as explanations should be short and simple. The nurse can communicate what they are doing as they move through the assessment. Including the preschooler in parts of the assessment such as allowing them to hold the stethoscope on their chest while you listen will allow them to feel helpful.
School-age children are in the industry stage. In this stage the child is developing both in school and socially and seeks approval from parents and teachers. At this stage language development has grown significantly, but their level of understanding still needs to be approached at an age appropriate level. (Jarvis, 2015). During this stage, the nurse can establish a relationship and open communication by offering a compliment such as “That’s a cool hat you have on.” (House, 2008). While performing the assessment the nurse can provide education on how the body works as this age group has interest and enjoys learning. In the adolescent stage self-identity is developing. In this stage the adolescent is trying to figure out who they are, and peer acceptance is extremely important. The nurse should not treat the adolescent like a child, but understand they are not yet an adult. The parent no longer needs to be present in the exam room during the assessment. This will allow for open communication and the ability to ask questions freely. While assessing the adolescent the nurse can take the opportunity to also offer education and information that can help promote health wellness. (Jarvis, 2015)
Strategies that can help encourage engagement during the assessment will vary upon the developmental stage. With most speaking calmly and in a non-threatening tone will help establish a positive rapport. Providing the infant or toddler with a comfort item such as a pacifier, special blanket or toy can help them feel more comfortable. Encouragement in the pres-chool and school-age child can be demonstrated by turning an assessment into a game, as well as allowing them to touch and feel equipment. For the adolescent engagement is more likely achieved by showing them a nonjudgmental attitude as well as treating them as an individual. (Jarvis, 2015).
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There are similarities and differences in doing a physical assessment between an adult and child. Doing a head-to-toe between an adult and a child is similar in many ways except that the nurse should take into account changes related to puberty and developmental issues related with adolescence (Falkner, A., 2020). The nurse should explain to the patient the normalcy of those physical development. During this time there will also be an influx of hormonal changes, making the patient develop curiosity towards sex as a whole (Curtis, 2015). It will be the duty for the nurse to provide education for this too. The more information they get the more likely they will make an informed decision about their bodies (Falkner, A., 2020). In any assessment wether adult or child, the nurse should always practice standard precautions to protect both the nurse and the patient. The rationale for this is to prevent exchange of blood and bodily fluids and the use of hand hygiene, personal protective equipments and disinfecting potentially contaminated equipment and surface (Nelson, L., 2020). Before any physical assessment the nurse should prepare the things she will be using. Although the list of equipment for both adult and child are basically similar, there will be some differences. For example, the pediatric client may need a neonatal, infant, or pediatric blood pressure cuff. The techniques used to assess the vital signs also vary among the age group (Registered Nursing, 2020). During assessment, the nurse should also be aware of developmental milestones for children. The nurse should reassure parents or caregivers that there are variances, although any extended delay in achieving the milestones should be reported to the pediatrician (Falkner, A., 2020).
Children are dependent upon adults for their welfare, Teaching and communication should involve the parents and caregivers for a family-centered care. Often direct communication and recommendation to other community sources provides the best advice (Falkner, A., 2020). Knowledge of Erikson’s psychosocial stage of development is essential for the nurse to be able to make a working plan on how to assess and communicate with the child depending on the child’s stage of development (Falkner, A., 2020). The initial encounger with the nurse is the best opportunity to build trust with the nurse. Use of open-ended questions will provide information and build upon that trust (Falkner, A., 2020). The nurse should include the children in the communication. Using of understandable vocabulary and avoiding medical jargons, active listening, being aware of verbal and non-verbal cues and be culturally aware of the child and family’s needs (Burks, J., 2016). Providing anticipatory guidance and a walkthrough on what you will be doing will usually gain cooperation. If the procedure will cause discomfort be honest. Tell them how long the assessment will last (Burks, J., 2016). Use of age-appropriate toys and questions will foster cooperation and communication. Showing interest to the child and what the child has to say should be encouraged. Mke the child feel important. This will help the child feel comfortable and establish rapport (Belleza, M., 2017). When dealing with teenagers, the nurse should be aware that they need to be treated with respect. The nurse should communicate with them with privacy, away from their parents or siblings. This will allow the teenager to provide answers pertaining to sexuality, drugs and alcohol use, and other topics they might not feel comfortable discussing when others are around (Falkner, A., 2020).
Resources:
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Select a client whom you observed or counseled that suffers from a disorder related to trauma. Then, address the following in your Practicum Journal:
This paper is done, I only want the third question answered. My take is Cognitive behavioral therapy for PTSD.
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Less than 10 % similarity
References APA
This is another student post to which i have to react adding some extra information related this post.
short answers.
– Registered nurses (RNs) play an integral role in the healthcare system by providing care to patients. Based on their experiences in care provision, RNs should be vital stakeholders in formulating healthcare policies. Some factors, such as technological advancement and political factors, are responsible for the rapid changes being experienced in the healthcare system. Therefore, new policies are essential to improve health care delivery to the public. However, RNs do not have an understanding of the policy process or are uninterested in engaging in political issues (Burke, 2016). Registered nurses should be aware of the emerging policy issues that affect them and become more active in the policy process to improve the provision of care to the public.
Several issues are affecting nurses in the modern environment, which requires the intervention of all stakeholders by formulating the necessary policies. Some of these issues are workplace safety, training and educational requirements, violence, and quality of health care (Huston, 2020). According to the American Nurses Association (ANA, 2017), staffing shortage is one of the main concerns that is currently being discussed in the policy arena. The shortage in RNs is attributed to the aging population, the cost-cutting decisions, the increase in patients’ needs as well as the complexity of health issues, and the rise in the aging workforce (ANA, 2017). The challenge of having a few nursing profession is that it leads to burnout affecting the performance and the health of nurses. Therefore, healthcare policy-makers should develop and implement policies that address the shortage to improve healthcare services.
2.- Nursing practitioners have numerous opportunities to participate in the policy-making process. According to Burke (2016), nurses must acknowledge that they are professionals in their field who are responsible for promoting the current and future care delivery system. The author asserts that nurses should ensure that policies that define and ingrain practice standards, that improve care provision and harness conditions necessary to provide quality care. Therefore, individual registered nurses should make recommendations that would improve the working conditions of nurses to policymakers and other stakeholders. Besides, registered nurses should advocate for more resource allocation to boost healthcare service delivery. Nurses can also join professional associations that represent them and serve as a means of making their voices and will heard. They should stay informed about who their elected officials are and actively participate in social media to support their policies and political campaigns (Huston, 2020). Therefore, registered nurses in the contemporary world should be more involved in the policy-making process to ensure their concerns are addressed. As a result, the healthcare delivery system would become more efficient, resulting in more positive public health outcomes.
3.- Since the demand for care continues to rise, the next policy issue that would largely be discussed affecting nurses is their development and growth. According to Annemarie (2016), the Institute of Medicine (IOM) recommended an increase in the number of BSN-prepared nurses to approximately 80 percent by 2020. Individual nurses should focus on their professional development and growth to become BSN-prepared to meet the demand. By developing appropriate policies, nurses would become motivated to advance their qualifications to fill in the positions. Therefore, the next policy discussion affecting nursing is redefining nursing education to align with emerging healthcare needs.
Registered nurses have numerous opportunities to participate and contribute to the formulation of healthcare policies. Therefore, they should be central to the policy process. Their input would ensure that appropriate policies are developed and implemented, promoting the delivery system of care. The changing dynamics in the healthcare system have necessitated the involvement of nurses in the policy process. Conventionally, nurses’ involvement in the policy process has been limited to implementation.
References
American Nursing Association. (2017). Nursing staffing. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/.
Annemarie, P. (2016). The future of nursing: Leading change, advancing health…how are we doing? Nursing Critical Care, 11(3), 4. doi: 10.1097/01.CCN.0000482518.50906.58
Burke, S.A. (2016). Influence through policy: Nurses have a unique role. Reflection on Nursing Leadership. Retrieved from https://nursingcentered.sigmanursing.org/commentary/more-commentary/Vol42_2_nurses-have-a-unique-role.
Huston, C. (2020). Professional issues in nursing: Challenges and opportunities (5th ed.). Philadelphia, PA: Wolters Kluwer.
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Please respond to these questions appropriately citing your references if necessary.
#1) Identify 2020 National Health Goals related to home care during pregnancy or childhood that nurses can help the nation achieve.
#2) Describe what family centered care is.
#3) Identify common areas or concerns of cultural diversity and apply these to nursing practice.
#4) Formulate 2 nursing diagnoses related to family health and what would be some interventions. How would you evaluate your interventions?
KINDLY NOTE THAT I NEED 2 PAPERS ON SAME TOPIC
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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
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This week’s PowerPoint lecture is about motivation. As you can see, there are many perspectives on what constitutes motivation and how to engage it.
Most likely you can imagine many examples of motivating. If you watched any of the multiple big sports championships over these past weeks, you saw the coaches preparing their teams. High stakes in the sports world and for host city, team, and fan (i.e. those who pay the salaries) pride. Yet, in some ways this is easier than the task you face as a healthcare administrator. Sports teams have a shared goal (no pun intended), a common language and lexicon, and finite circumstances.
In healthcare, the team is comprised of multiple constituencies, some of which are organizationally separate (e.g., typically the hospital and medical staffs are two independent entities). As has been discussed this past week, patients come from many backgrounds, with diverse beliefs and myriad expectations. Navigating that environment take a different set of skills.
Review the concept of Emotional Intelligence at this link: http://psychology.about.com/od/personalitydevelopment/a/emotionalintell.htm
Then, briefly review insights to Servant Leadership, available at: http://ctb.ku.edu/en/table-of-contents/leadership/leadership-ideas/servant-leadership/main and https://www.butler.edu/volunteer/resources/ten-principles-servant-leadership
When you have reviewed these resources, please respond to this week’s Discussion topic.
Here is a TEDx presentation that presents a very interesting perspective on the future:
After you watch it (it’s about 17 minutes long), then discuss the following questions:
1. What do think of the video’s basic premise?
2. What do you imagine the future of healthcare to be like?
Here are some additional YouTubes to help spark your thinking:
https://www.youtube.com/watch?v=qkm_7XUDqIY
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Please answer the following questions in 75-100 words using the APA-6th-Edition-Template-without-Abstract.dot
template.
DQ Rubric
CriteriaRatingsPts
All questions are answered and conveyed clearly and concisely.
There is evidence the assigned course material is covered. 40.0 ptsFull Marks
APA template is used to answer the Discussion Question 10.0 ptsFull Marks
Mechanics/GrammasThe post is well written and easy to understand.
Free from grammar issues.
*Ran through Grammarly.com* 25.0 to >15.0 ptsFull Marks
Original Thought/ IdeasThe DQ is not plagiarized.
If a citation is required, the student cited correctly.
Blatant plagiarism will receive a zero for the entire assignment 15.0 ptsFull Marks
If submitted timely 10.0 pts
Total points 100.0
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