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MSN 5550 Health Promotion: Prevention of Disease Case Study Module 4
Instructions: Read the following case study and answer the reflective questions. Please provide
rationales for your answers. Make sure to provide a citation for your answers. Must follow APA,
7th ed. format.
Each answer should be at least 200 worlds.
CASE STUDY: Family Member with Alzheimer’s Disease: Mark and Jacqueline
Mark and Jacqueline have been married for 30 years. They have grown children who live in
another
state. Jacqueline’s mother has moved in with the couple because she has Alzheimer’s disease.
Jacqueline is an only child and always promised her mother that she would care for her in her
old
age. Her mother is unaware of her surroundings and often calls out for her daughter Jackie
when
Jacqueline is in the room. Jacqueline reassures her mother that she is there to help, but to no
avail.
Jacqueline is unable to visit her children on holidays because she must attend to her mother’s
daily
needs. She is reluctant to visit friends or even go out to a movie because of her mother’s care
needs
or because she is too tired. Even though she has eliminated most leisure activities with Mark,
Jacqueline goes to bed at night with many of her caregiving tasks unfinished. She tries to visit
with
her mother during the day, but her mother rejects any contact with her daughter. Planning for
the
upcoming holidays seems impossible to Mark, because of his wife’s inability to focus on
anything
except her mother’s care.
Jacqueline has difficulty sleeping at night and is unable to discuss plans even a few days in
advance. She is unable to visit friends and is reluctant to have friends visit because of the
unpredictable behavior of her mother and her need to attend to the daily care.
Reflective Questions
1. How do you think this situation reflects Jacqueline’s sense of role performance?
2. How do you think that Jacqueline may be contributing to her own health?

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STU Health & Medical Enzyme Conversion Diagrams Question

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Module 2 Assignment i
Enzyme Conversion Diagram
After studying Module 2: Lecture Materials & Resources, submit the following:
•
Starting with the precursor substance tyrosine or tryptophan, draw three diagrams showing how the various
enzymes convert this substance to serotonin, dopamine and norepinephrine.
Submission Instructions:
•
•
•
•
•
Your diagrams must be hand-drawn. Scan your diagrams and submit them as an attachment of an image file or PDF.
Follow APA 7th Edition formatting guidelines for graphs and figuresLinks to an external site.
Complete and submit the assignment by 11:59 PM ET on Sunday.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and
other expectations are at the discretion of the instructor.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
Grading Rubric
Your assignment will be graded according to the grading rubric.
View Rubric
Neurotransmitter Diagram Rubric
Neurotransmitter Diagram Rubric
Criteria
Ratings
Pts
Illustration
view longer description
20 to >14 pts
Distinguished
The illustration is 100% accurate. Created 3 handwritten drawings illustrating each
chemical step required to create dopamine, norepinephrine, and serotonin.
14 to >8 pts
Excellent
The illustration is >75% accurate. Created 3 handwritten drawings illustrating each
chemical step required to create dopamine, norepinephrine, and serotonin. Some of the
steps were omitted or not illustrated accurately.
8 to >3 pts
Fair
The illustration is >50% accurate. Created at least 2 handwritten drawings illustrating
each chemical step required to create dopamine, norepinephrine, and serotonin. Some of
the steps were omitted or not illustrated accurately.
3 to >0 pts
Poor
The illustration is6 pts
Distinguished
The illustration and descriptions are neat, labeled 100% accurately, appropriately sized,
captioned, placed, and add to the reader’s understanding of the topic.
6 to >3 pts
Fair
Diagrams and illustrations are neat, labeled>75% accurately, appropriately sized,
captioned, and placed; for the most part, they add to the reader’s understanding of the
topic.
3 to >0 pts
Developing
Diagrams and illustrations are disorganized and labeled >50% inaccurately. The
descriptions are inappropriately sized, and captions are not omitted in some areas of the
illustration. The illustration appears unprofessional and sloppy.
0 pts
No Marks
No submission or missing criterion OR the illustration was illegible.
/ 10 pts

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Explanation & Answer:

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HAP 465 NVCC Supporting Arguments Peer Review Worksheet

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Peer Review of Assignment 6: Supporting Arguments
Reviewer name:
Author name:
Item
Write a brief narrative (23 sentences) that outlines
your first impression of
this section of the paper.
Indicate what you LIKE
about the writing
(positive/encouraging
feedback).
Does reading this section
of the paper make you
more curious to read
about the opposing
arguments? Why or why
not?
What do you think is the
author’s thesis or main
point? Is there a clear
connection regarding how
these arguments support
that thesis?
Are there parts of the
arguments that are
confusing? Where would
you like more details or
examples to help you see
what the author means?
What parts could use
more explanation or
definitions?
How clear is the writing?
If there are places that
seem wordy or unclear,
how might the author
revise to address those
problems?
Are in-text citations
formatted correctly and
used often enough? Is
each Argument Labeled
correctly, using Level 1
and Level 2 headings?
Overall Comments:
Reviewer Response
Page 1 of 1
Supporting Arguments:
However, proponents of EI counter by highlighting its role in nuanced decision-making. While
data-driven analytics provide a foundation, EI equips leaders to better interpret, contextualize,
and act on such data, especially in situations where human emotions and reactions play a
significant role (Brown & Clarkson, 2022). Furthermore, emotionally intelligent leaders are often
more adept at handling crisis situations, as they can empathize with, calm, and guide their teams
effectively (Roberts, 2021).
Nevertheless, contemporary research provides a robust defense for the significance of EI in
healthcare leadership. Leaders with heightened emotional intelligence consistently demonstrate
an aptitude for fostering positive interpersonal relationships, leading not only to improved team
cohesion but also to reductions in staff turnover and burnout – a prevalent issue in the healthcare
sector (Johnson & Greenberg, 2021). Moreover, from a patient-centric perspective, leaders with
strong EI tend to establish deeper connections with patients. Such relationships amplify patient
trust, resulting in higher satisfaction scores and a notable increase in adherence to medical
regimes (Morrison & Smith, 2020).
There’s also a pertinent economic perspective. Organizations with emotionally intelligent
leadership often see better financial outcomes due to enhanced team productivity, reduced
turnover costs, and a more favorable public image, contributing to a stronger brand presence in
the competitive healthcare market (Fernandez & Rogers, 2023).
Furthermore, there’s an emerging trend focused on nurturing EI in healthcare settings. Recent
endeavors in training programs emphasize the enhancement of emotional intelligence
competencies among healthcare professionals. These initiatives debunk the earlier notion that EI
is an innate trait, immutable to change. Instead, evidence suggests that with appropriate training,
professionals can indeed cultivate and refine their emotional competencies, leading to tangible
benefits in patient care and team dynamics (Reyes & Kim, 2021).

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NSU Rural Medical Staff Shortage Discussions

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DISCUSSION 1

There are several reasons why it is so difficult for rural towns to find and keep medical personnel. The scarcity of resources is one of the main causes. Medical facilities in rural areas are few, understaffed, and struggling financially. These are key deterrents for recruiting staff because they will anticipate many challenges and heavy workloads. Medical facilities are limited, which causes an influx of patients seeking care at a single facility. Unfortunately, a shortage of recruits results in understaffed hospitals with an excessive number of patients. resulting in a sense of underpayment, overwork, and overwhelm among medical professionals. In this setting, medical professionals typically feel underappreciated, burn out more quickly, and leave with a negative experience that they might share with other colleagues. The financial resources available to medical facilities in rural areas are not equivalent to those in metropolitan areas. This is brought on by a lack of funds and a large number of uninsured patients. Wage compensation is restricted in the absence of sufficient cash flow, which significantly hinders recruiting. Many individuals cannot afford to live on the lower-income salaries that many rural medical institutions may offer.

Nursing directors must, in turn, employ creative staffing strategies. Establishing collaborations with nearby medical and nursing schools is one approach. This partnership will help pipeline students look forward to working within their community and offer scholarships and loan forgiveness programs. The pipeline program is excellent for exposing students to the benefits of working in a rural community. Giving students the chance to be mentored will also help them receive guidance and support both in the classroom and in the workplace. By providing scholarships, a great number of students would be able to pursue higher education without having to shoulder a heavy financial burden. Additionally, by working in these specific areas, students who attended these colleges but still incurred debt may be eligible for loan forgiveness under the loan forgiveness program. Both solutions will boost recruiting in the future of health care since they allow students to concentrate on their education rather than the financial strain.

DISCUSSION 2

In my view and according to the information provided in the article, the major reason there are few medical staff in rural areas is due to the work settings in the rural hospitals. Medical staff get overworked while working in rural areas and do not receive salary increments and bonuses like their urban counterparts. I believe any government effort to increasemedical staff in rural areas should go beyond salary increases to the elevation of living and working conditions in the rural areas. It is general knowledge that all human beings deserve a better quality of life thus, improving the work setting in rural areas will increase the number of medical staff interested in working in those areas.

As a Nursing Director of a rural hospital facing a significant nursing staff shortage, I would first focus on improving the existing workforce’s living standards to reduce the workload and maintain favorable working conditions. The next move would be campaigning for a balance in the government efforts because much of the government assistance is sent to larger hospitals with more patients, thus forgetting hospitals in rural areas (Wright, 2021). To avoid early retirements, I would provide attractive salaries and bonuses to keep the existing workforce at work instead of relying on continuous recruitment.

To alleviate the current and future medical staff shortage, I would recommend the creation of awareness in the nursing field to increase the number of students enrolled in medical schools every year. Increasing the number of students in the field would help counter the problem of early retirement as more energetic medical staff would be readily available. My solution is viable because it is permanent, though it might take time before the students finish their studies and get employed. Investment in education would increase enrollment in medical college, hence a long-term solution to a shortage of nurses.

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NSU Quality Care Measurement for Health Services Discussion Replies

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Write Discussion Replies:

Discussion 1

Importance of Quality-of-Care MeasurementQuality assurance through measurement helps healthcare organizations to gauge their performance and discover avenues of improvement. It enables the tracking of the patients’ results, ensuring the safety of the patients, minimizing the costs of healthcare, the development of evidence-based practice and the boosting of patients’ satisfaction (Carey et al. 2022). Healthcare managers use measurement to determine ways to make sound decisions, distribute resources appropriately, and perform interventions that improve general care delivery.Quality Measures and IndicatorsQuality measures refer to specific measures designed to evaluate various care quality components. They may be structural, process-oriented, and outcome-oriented (Nordenfelt, 2021). These include readmission ratios, infections, patient satisfaction scores, adherence to recommended therapies and healthcare-associated severe events.Methods of Quality MeasurementQuality of care is measured through, among others, administration data analysis, reviews of medical records, surveys of patients, and clinical audits. These indicators can be evaluated in terms of the single patients, the healthcare providers, or the organization itself (Salem, 2020). Quality is often quantified and compared for different healthcare settings using quantitative data like percentages, rates, and ratios.Tools and Frameworks for Quality ImprovementThere exist various tools and frameworks that can be used in ensuring quality improvements. Some of these include the PDSA cycle, Lean Six Sigma, and the IHI Model for Improvement (Salem, 2020). Healthcare managers are guided by these approaches to help them set up goals for improvements in care quality systematically and make changes based on evidence.

Application and Relevance to Health Services Management

In terms of health services management, quality of care measurement is an essential tool for measuring performance, strategic planning, resource allocation and making decisions. This helps managers identify any missing links in care delivery, distribute resources appropriately, and support continuous quality improvement (Nordenfelt, 2021). It is also important in ensuring organizational compliance with regulatory requirements as well as accreditation standards, which contribute to institutional credibility and accountability.

Therefore, quality of care measurement is critical for the administration of healthcare services. It assists healthcare service providers in evaluating their care delivery systems, including how effective they are, the extent of safety, and efficiency aspects of care.

Discussion 2Quality of care measurement and their application:

Quality at the most fundamental level is derived from clinicians making judgements about balancing benefit and harm to achieve desirable patient objectives (Donabedian 1980). A more comprehensive definition of quality would include such dimensions as access to care and patient satisfaction (Fleming 2021 pg.123). Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care (What are Quality Measures? 2023).

Safe: Avoiding harm to patients from the care that is intended to help them.

Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).

Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care.

Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy.

Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. (Six Domains Six Domains of Healthcare Quality 2022) 

Relevance to health services management:

Quality of care measurement relates to health services management by Donabedian stated that the possibility of quality of healthcare improvement depended on both the technical and interpersonal quality of healthcare services. Technical care is about the medical treatment aspects of patient care, while interpersonal care is about communicating with the patient about his or her treatment. It is generally agreed that the quality of healthcare services should be measured using the viewpoints of main stakeholders such as users, healthcare providers, payers for the services, politicians and managers of health and against explicit criteria reflecting the values of a given society (Endeshaw 2020). 

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Harvard University Nursing Staffing Worksheet

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State of California-Health and Human Service Agency
California Department of Public Health
NURSING STAFFING ASSIGNMENT AND SIGN-IN SHEET
(DHPPD SALARIED/DUAL ROLE/NURSE ASSISTANT)
1. FACILITY NAME
2. DATE OF PATIENT DAY (MM/DD/YY)
3. DIRECTOR OF NURSING/DESIGNEE
4. SHIFT
1
2
3
5. SHIFT START TIME (HH:MM AM/PM)
6. STATION/WING/UNIT/FLOOR
7.
NURSING SERVICES
ASSIGNMENT
EMPLOYEE NAME
ACTUAL
ACTUAL
SHIFT
MEAL BREAK
DISCIPLINE START/ END START/END EMPLOYEE SIGNATURE
x
x
x
x
x
x
x
8. I have reviewed and verified all staffing assignments are true and accurate. Employees not captured in payroll
records, nurse assistants or employees who are primarily engaged in duties other than nursing services that
provided nursing services during the patient day are recorded and their direct care service hours to be included in
Direct Care Service Hours Per Patient Day are accounted for with an original signature.
X
DIRECTOR OF NURSING/DESIGNEE SIGNATURE
CDPH 530 (06/19)
1
State of California-Health and Human Service Agency
California Department of Public Health
DHPPD SALARIED/DUAL ROLE/NURSE ASSISTANT
NURSING STAFFING ASSIGNMENT AND SIGN-IN SHEET
INSTRUCTIONS
Direct caregivers not captured in payroll records must capture their direct care service
hours on this form. This includes nursing management, supervisors, registry, contract,
nurse assistants, and corporate staff.
For example, this may apply but not be limited to, the direct care service hours provided
by such employees as a Director of Nursing in a facility with 60 or more beds and a
Director of Staff Development when providing nursing services beyond the hours
required to carry out the duties of these positions.
SNFs with a subacute unit, shall not count direct care service hours provided in the
subacute unit for purposes of determining compliance with the 3.5 and 2.4 minimum
standards. CCR, Title 22, section 51215.5(h) prohibits nursing staff assigned to the
subacute care unit from being assigned other duties outside of the subacute care unit
during any given shift. Direct care service hours of nursing services provided by crosstrained staff who are otherwise regularly assigned to departments such as medical
records, housekeeping, dietary or laundry, must be captured on this form. Documentation
must delineate the time spent on nursing services. Failure to provide this information will
result in the exclusion of all direct care service hours for such employees.
The Nursing Staffing Assignment and Sign-In Sheet must be legible. All employee
names must be include both first and last name.
Corrections and modifications must be completed on the Nursing Staffing Assignment
and Sign-In Sheet to document employee absences, substitutions, and/or schedule
changes. Legible pen/ink changes are acceptable.
Each direct caregiver included on the Nursing Staffing Assignment and Sign-In Sheet
must provide an original, written signature next to their printed name. This signature
verifies the employee was present in the facility, provided nursing services, and actually
worked the hours stated. Initials are not acceptable.
Only the employee that worked the nursing assignment may sign for him/herself.
The form must be signed by the Director of Nursing or his/her designee verifying the
information on the Nursing Staffing Assignment and Sign-In Sheet is complete, true and
accurate.
CDPH 530 (06/19)
2
State of California-Health and Human Service Agency
California Department of Public Health
1. Enter the facility name.
2. Enter the date of the patient day in MM/DD/YY format.
3. Enter the name of the person who has Director of Nursing responsibility for the day.
4. Circle the appropriate shift: one, two or three.
5. Enter the shift start time in HH:MM AM/PM format.
6. If applicable, enter the name of the specific location in the facility for the patient
assignments.
7. Record only direct caregivers not otherwise captured in payroll records. Enter
the specific patient assignment and the employee’s name responsible for the
patient assignment. Enter the employee’s discipline (RN, LVN, CNA, NA, Psych
Tech). Enter the employee’s actual shift start and end time. Enter the start and end
time of the employee’s meal breaks. The employee must sign the form.
8. At the conclusion of each patient day, the Director of Nursing or his/her
designee shall sign the form verifying the nursing assignments are true and
accurate and that all assignments are accounted for with an employee signature,
or state a reason why the assignment was vacant. The DON or designee should
not sign the 530 form to verify his or her own time. The facility administrator or
other designated staff should sign to verify the hours.
CDPH 530 (06/19)
3

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Health & Medical Question

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Requirements:

Complete a review of the literature and select a minimum of 3 articles that are appropriate research articles related to your question. A research article may be quantitative, qualitative, or integrative. A research article may to related to a Quality Improvement study, an Evidence-Based Practice study, or a Research article that reports new knowledge.

Critique each of the articles using the appropriate Appraisal Form below, either C, E, or F.

If a question included in the form you selected is not applicable to your particular study, select option 3, Not Clear.

An Integrative Review, Appraisal form C, can be used for a meta-analysis or systematic review. 

Please Note: 

  • – For this assignment I need the proper appraisals and the 3 articles pdfs uploaded.
  • – I have uploaded the 3 templates that you may need to complete this assignment.
  • Select 3 articles of your choice. However you must use my PICOT TOPIC:
  • My Picot Question is: 

In patients over 65 who are at risk of falling, does the use of measures to avoid falls and tactics to make sure people take their medicines (I) compared to methods for preventing falls that don’t include techniques for sticking to medications or standard care (C) lead to fewer falls and better adherence to medications (O) over a 6-month period (T)?

P: Patients over 65 who are at risk of falling

I: Interventions to avoid falls and methods to make sure people take their medications

C: Interventions to avoid falls that don’t include methods for keeping up with medications or normal care

O: Fewer falls and better drug compliance

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APPENDIX C
Appraisal Guide:
Findings of a Integrative Review
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
How many persons were involved in conducting the review?
What topic or question did the integrative research review address?
How were potential research reports identified?
What determined if a study was included in the analysis?
How many studies were included in the review?
What research designs were used in the studies?
What were the consistent and important across-studies conclusions?
Clinical Significance
Across studies, is the size of the treatment or the strength of the association found or the
meaningfulness of qualitative findings strong enough to make a difference in patient outcomes
or experiences of care?
Yes
No
Not clear
Are the conclusions relevant to the care the nurse gives?
Yes
No
Not clear
The conclusions clinically significant?
Yes
No
Not clear
Applicability
Does the IRR address a problem, situation, or decision we are addressing in our setting?
Yes
No
Not clear
Are the patients in the studies similar to those we see, either overall or in a subgroup of patients?
Yes
No
Not clear
What changes, additions, training, or purchases would be needed to implement and sustain a
clinical
protocol based on these conclusions?
Yes
No
Not clear
Specify
Is what we will have to do to implement the new protocol realistically achievable by us (resources,
capability, commitment)?
Yes
No
Not clear
How will we know if our patients are benefiting from our new protocol?
Yes
No
Not clear
Specify
Should we proceed to design a protocol incorporating these conclusions?
Yes
No
Not clear
Comments
___________________________________________________________________________
___________________________________________________________________________
APPENDIX E
Appraisal Guide:
Findings of a Qualitative Study
Citation:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Synopsis
What experience, situation, or subculture does the researcher seek to understand?
Does the researcher want to produce a description of an experience, a social process, or an event,
or is the goal to generate a theory?
How was data collected?
How did the researcher control his or her biases and preconceptions?
Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes,
theories) included in the report?
What are the main findings of the study?
Credibility
Is the study published in a source
that required peer review?
Yes
No
Not clear
Were the methods used appropriate
to the study purpose?
Yes
No
Not clear
Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?
Yes
No
Not clear
*Were data collection methods
effective in obtaining in-depth data?
Yes
No
Not clear
Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?
Yes
No
Not clear
Were data collection and analysis
intermingled in a dynamic way?
Yes
No
Not clear
Brown
APP E-1
*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?
Yes
No
Not clear
*Does the data provided justify
generalized statements, themes,
or theory?
Yes
No
Not clear
ARE THE FINDINGS CREDIBLE?
Yes All
Yes Some
No
Clinical Significance
*Are the findings rich and informative?
Yes
No
Not clear
*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?
Yes
Some
No
ARE THE FINDINGS
CLINICALLY SIGNIFICANT?
Yes All
Yes Some
Not clear
No
* = Important criteria
Comments
___________________________________________________________________________
___________________________________________________________________________
APP E-2
Brown
APPENDIX F
Appraisal Guide:
Findings of a Quantitative Review
Citation:
Synopsis
What was the purpose of the study (research questions, purposes, and hypotheses)?
How was the sample obtained?
What inclusion or exclusion criteria were used?
Who from the sample actually participated or contributed data (demographic or
clinical profile and dropout rate)?
What methods were used to collect data (e.g., sequence, timing, types of data, and
measures)?
Was an intervention tested?
Yes
No
1. How was the sample size determined?
2. Were patients randomly assigned to treatment groups? What are the main findings?
Is the study published in a source that required peer review?
Yes
No
Not clear
Was the design used appropriate to the research question?
Yes
No
Not clear
*Did the data obtained and the analysis conducted answer the research question?
Yes
No
Not clear
Were the measuring instruments reliable and valid?
Yes
No
Not clear
*Were important extraneous variables and bias controlled?
Yes
No
Not clear
*Was the study free of extraneous variables introduced by how, when, and where the study was done?
Yes
No
Not clear
*If an intervention was tested, answer the following five questions:
1. Were participants randomly assigned to groups and were the two groups similar at the start
(before the intervention)?
Yes
No
Not clear
2. Were the interventions well defined and consistently delivered?
Yes
No
Not clear
3. Were the groups treated equally other than the difference in the interventions?
Yes
No
Not clear
4. If no difference was found, was the sample size large enough to detect a difference if one
existed?
Yes
No
Not clear
5. If a difference was found, are you confident it was due to the intervention?
Yes
No
Not clear
Are the findings consistent with findings of other studies?
Yes
No
Not clear
Are the findings credible?
Yes
No
Not clear
Clinical Significance
Is the target population clearly described?
Yes
No
Not clear
Is the frequency, association, or treatment effect impressive enough for you to be confident that the finding
would make a clinical difference if used as a basis for care?
Yes
No
Not clear
Are the findings clinically significant?
Yes
No
Comments
Not clear

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WCU Health & Medical Diagnosis and Management for Depression Essay

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Rewatch the same Patient Interview. This time, you will focus on writing the diagnosis and differential discussion. The discussion should include the following sections:  

  • A summary of findings
  • Psychodynamic formulation
  • Primary diagnosis with ICD code
  • Prognosis
  • Plan including medications, labs, therapy, patient education, follow up, non-pharmacological treatments 

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So what’s been happening over the past week or two that prompted you to make this appointment? I’ve been feeling really down and I’m crying over everything, OK? And when did you first begin to have these kind of problems? I’ve been feeling pretty depressed for the past four months. It’s just been the worst year ever. I was laid off and then I wound up losing my job. My mom died and I had to identify her body, which was very traumatic. And I also have a special needs son who is in the hospital for a week, I’m sorry to hear about your mom, that must have been hard. How is your son doing now? Oh, he’s better now. Thanks for asking. He’s autistic and has epilepsy. I feel like I’m always waiting for the next crisis or hospitalization. It just makes me anxious sometimes. Oh, I understand. Being a mother of a special needs child must be challenging at times. I’m glad to hear he’s doing well now. You also mentioned you lost your job. What do you do for a living? I have a bachelor’s in art history and I worked at the museum. I’ve always had a job up till now. So it’s been a big change for me. Yeah, that must be a big change in the dynamic for you and your husband. How long have you been married? We’ve been married ten years. OK, well, I’m glad he’s been a good support for you. I’m just checking. This is your only marriage. Yes. OK, and how would you describe your marriage? You know, we’re a great team. My husband’s a teacher and he’s he’s very supportive. Good. And do you have a lot of friends or other supportive relationships or groups? Uh, not really. I’m not very religious and I don’t belong to any groups or anything. I mean, I have a few friends, but having a special needs child keeps me pretty busy. Yeah, tell me, have you ever had symptoms like this before? Yes, I had postpartum depression after my son was born. Otherwise, I’ve always been able to manage. But lately, everything has been building up and I’m just not coping very well. I feel like I cry over every little thing. Well, when you’ve had depression before, did you see a therapist or take any medication need to be hospitalized for mental health? Yes, I took Paxil and I saw a therapist for about a year, but I never needed to be in the hospital. OK. Was that helpful for you? Yes. I think things gradually got better as I learned how to handle the stress of being a mother of a special needs child. Good. What about your mental health in general? Do you take any other medications? Yes, I have high blood pressure and I take lisinopril. OK. Do you have any allergies to foods or medications and have you had any surgeries, no allergies? I had a C-section with my son, but that’s the only surgery. OK, well, it sounds like you’ve been pretty healthy, except for the blood pressure. I’d like to ask you more about how you’re feeling now. You’ve been feeling depressed for four months. How has this affected your energy? Yes, I feel like I sleep all the time, but I’m still tired. OK, so you’re sleeping more than normal. But what about motivation? Do you feel less motivated to do things you normally do? Yes, I thought it was because I’ve been so tired, but I just can’t seem to even start doing anything, dishes are piling up in the laundry needs to be done. And I’m not working right now. So there’s no reason to be behind on any of these things. But I just look at the mess and I can’t get up the energy to start doing it. And then I feel guilty for just sitting around doing nothing. I see. That sounds like you have no motivation and you’re feeling overwhelmed and guilty. It must be very frustrating for you. It sounds like it might be making you feel worse. Let me ask you, how’s your appetite? Most days I don’t even feel like eating. I think I’ve lost some weight, but I haven’t checked, OK? Have you had any thoughts about hurting yourself or anyone else? That day, the day my son was in the hospital, I thought it might have given him the wrong dose of his seizure medication and I I felt like it could have been my fault that he was in the hospital. And I I thought about taking pills. I was in a really bad place that day.
My husband made me feel better. He made me realize that I’ve been giving in this medication every day for years. And I probably was just worrying about our son and and feeling guilty. And that’s not even why my son was admitted anyway. He had an allergic reaction. So I know I didn’t do anything wrong. Yeah. Look, feelings of guilt are part of the symptoms of depression. So it makes sense that you are feeling guilt even though, you know, an allergic reaction couldn’t have been your fault. Your husband sounds like he’s a supportive spouse, so I’m glad you have them. Have you had any other thoughts of suicide or hurting yourself? No, I, I know that I, I couldn’t do that to my family, but that made me realize how bad the depression was getting in that I really need to get help.
I’m OK, I’m OK, I’m just I’m just feeling really overwhelmed, yeah, it’s OK. I’m certainly glad you were able to recognize that you need help and you’re here today. We’re definitely going to be able to recommend some therapy and treatment to help you start feeling better. I understand that you’re feeling overwhelmed, but this is what we do here and you’ve come to the right place. Do you feel like you’re ready for a few more questions? Yes, I’m I’m good. OK, has anyone in your family ever had psychiatric diagnosis? My mother also had depression. I think she took medication for it, but otherwise, no. OK, I’m looking at your intake form and it looks like you checked no to all of these. But I’m going to double check and ask you if you’re having any problems with various parts of your body moving from your head to your toes. Have you had any fatigue or weight loss? No. Do you have any problems with headaches, seizures, vision or hearing, smelling or taste throat problems or any thyroid problems? No. Any problems with your heart or lungs, like shortness of breath or coughing? Uh, problems with your stomach, bowels or urination? No. Any problems trying to move your arms or legs? I don’t think so. Joint problems or problems walking and. No. Any rashes? No. Any problems with seizures, numbness or tingling? Uh, have you noticed any bruising or bleeding? Uh, overall, I’m feeling OK today. Good. I’m glad to hear that. Now we’re going to talk a little bit about your background. Can you tell me a bit about where and how you grew up? I was born and raised here with both my parents. And I have a brother who’s two years younger than me. And how would you describe your parents and childhood? Um, my parents were loving. I had a pretty good childhood. I guess lots of friends did pretty well in school. How would your parents react when you got into trouble? I really got into trouble, but they would just ground me. So no spanking or abuse of any kind? No, no, nothing like that. OK, what about school? Were there any problems with bullying or did you have any struggles with low self-esteem? Not really. I was a star student, pretty active in sports. I had a lot of friends. Good. And you never had any legal problems either? No. So just a few last questions about tobacco, alcohol and drugs. Do you use any now or have you ever taken any in the past? I drink wine and I use marijuana edibles occasionally, but I’ve never smoked cigarettes or used any other drugs. OK, well, I think we’ve covered everything unless there’s anything else you want to add. No, I think I’ve told you everything about me. OK, good. Next, we’ll talk about a treatment plan for you.
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MDC Benefits Explanation Technical and Lay Terms Questions

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Review figure 11.5, Explanation of benefits, in the textbook. Answer the following three questions.

a. Why are the charge and allowable charge different amounts? Explain your answer in technical terms and then explain your answer in layman’s terms.

b. Differentiate between the contractual adjustment and the charge. Explain your answer in technical terms and then again in layman’s terms.

c. If the procedure on line 4 was denied by the payer for incorrect coding, how would the benefit payment change? What are the revised benefit payment and coinsurance amounts?

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Discussion Question 3: Person-Centered Therapy

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Class:

Foundations of Clinical Psychology

Class book for the reference:

Title: Theories of Psychotherapy & Counseling: Concepts and Cases

Author: Richard Sharf

Publisher: Cengage Learning

Edition: 6th

ISBN Code: 9781305087323

ISBN Code 2: 9781305087323

Originality ReportSafeAssign enabled

Discussion Question 3: Person-Centered Therapy

In person-centered therapy, core conditions such as unconditional positive regard, empathy, and congruence are essential to successful therapy. Discuss why these conditions are so crucial in establishing the relationship between therapist and client and how might the therapeutic process be affected if these conditions are lacking?

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Theories of Psychotherapy and
Counseling: Concepts
and Cases
6th Edition
Richard S. Sharf
Chapter 6
Person-Centered Therapy
© 2016 Cengage Learning. All rights reserved.
© 2016 Cengage Learning.
All rights reserved.
Carl Rogers’s Four Phases
of Person-Centered Therapy
Developmental
–
forming his approach
Nondirective
–
focus on understanding the client and
communicating understanding
Client-centered
–
theoretical development of therapeutic
change
Person-centered
–
application to family, groups, and
political activism as well as the
individual
Slide 1 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Influences on Carl Rogers’s
Development of Person-Centered
Therapy
Early theological training
Otto Rank
–
creativity of individuals
Alfred Adler
–
value of the individual and good
relationships
Abraham Maslow
–
self-actualization
Martin Buber
–
“I-Thou”
Rollo May
–
existentialism
Slide 2 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Person-Centered View of
Psychological Development
Infancy
–
monitoring of pleasantness
of environment
Children
–
develop trust in their
reactions to the environment
Older children
–
develop a need for positive
regard from others
Older children and adults
–
develop a sense of self-worth
or self regard
Slide 3 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Person-Centered Theory
of Personality
Conditions of worth
–
lead to incongruence
Conditional regard
–
a sense of alienation
Psychological disturbance is related to the amount of incongruence
between individual experience and self-concept
Congruent relationships
–
Fully functioning person
–
Psychological maturity
–
Slide 4 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
a sense of being heard and
understood
provide positive regard to
others and receive it from
others – a goal
openness, creativity, and
responsibility
Goals of Person-Centered
Therapy
Client determines goal
More deeply understand various aspects of oneself
Accept oneself and others
More self-direction which leads to better problem solving
ability and less defensiveness
Slide 5 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Necessary and Sufficient
Conditions
for Person-Centered Change
1. Psychological contact between two people
2. Client is incongruent
Therapist provides
3. Congruence and genuineness
4. Unconditional positive regard or acceptance
5. Empathy
The client perceives
6. Empathy and acceptance
Slide 6 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
What the Client Experiences
in Person-Centered Therapy
Responsibility for self
The therapist’s empathy and unconditional positive regard
which stimulates
The process of exploring oneself
which allows the client to
Experience oneself
Experience therapeutic change
Slide 7 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Psychological Disorders:
Examples of the Person-Centered
Approach
Disorder
Therapist
Patient
Depression
Rogers, C.
Female graduate student
Grief and loss
Rogers, D.
7 year old boy
Anxiety/ phobia
Van Fleet, Sywulak,
& Sniscak
5 year old boy
Slide 8 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Current Trends in
Person-Centered Therapy
Application of person-centered principles to international
concerns regarding conflict and peace
Incorporating other theoretical models into person-centered
therapy
Constructionist trends – empathy with the individual in a cultural
context
Training trends – person-centered ideals applied to graduate
training
Slide 9 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Gender Issues in
Person-Centered Therapy
Can therapists truly understand clients of the other
gender?
Focus on intimacy in relationships
Therapists values and lesbian, gay, bisexual, or
transgendered clients
Slide 10 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Multicultural Issues and
Person-Centered Therapy
Person-centered therapy is practiced world wide, especially
in areas of conflict.
Are genuineness, acceptance, and empathy cultural values
that are limited to certain cultures?
Does Rogers’s emphasis on the individual, conflict with the
family values of some cultures?
Slide 11 Chapter 6
© 2016 Cengage Learning.
All rights reserved.
Theories of Psychotherapy and
Counseling: Concepts
and Cases
6th Edition
Richard S. Sharf
Chapter 7
Gestalt Therapy: An Experiential Therapy
© 2016 Cengage Learning. All rights reserved.
© 2016 Cengage Learning.
All rights reserved.
Influences on Perls’s
Development of Gestalt Therapy
•Kurt Goldstein
–
•Wilhelm Reich
•Sigmund Freidlander
•Alfred Korzybski
•Kurt Lewin
•Existentialism
–
•Gestalt psychology
–
•Laura Posner Perls
–
Slide 1 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
holistic perspective, self actualization, importance of
language usage
bodily awareness within individuals
observation of balance and polarities
role of language in therapy
field theory, studying the whole field
phenomenology, direct experience of
existence
the whole is more than the sum of its
parts
respect for personal relationships
Gestalt Psychology
Psychological phenomena are organized by wholes rather
than by parts
Studied visual and auditory perception, mainly
Basic concepts
Field
Figure
Ground
Development of laws of perception
Gestalt psychologists critical of loose application of their
work by gestalt therapists
Slide 2 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Examples of Complete,
Incomplete, and Weak Gestalts
1
2
1
4
3
2
Slide 3 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
5
6
7
Complete gestalt
8
9
5
7
Incomplete gestalt
6
Weak gestalt
9
8
Gestalt Theory of Personality:
Contact
Levels of Contact – Five layers of neurosis
_____________________________________________________________
Phony – inauthentic communication
_____________________________________________________
Phobic – avoiding emotional pain
_________________________________________
Impasse – afraid to change
__________________________
Implosive – awareness
of feeling
_________________
Explosive- authentic
Slide 4 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Gestalt Theory of Personality:
Contact Boundaries
Four types of boundaries for viewing I-boundaries
Body boundaries
Value boundaries
I – boundaries
Familiarity boundaries
Slide 5 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Expressive boundaries
Gestalt Theory of Personality:
Contact Boundary Disturbances
Introjection
–
Taking in views of others uncritically
Projection
–
Pushing out or dismissing aspects of ourselves
by assigning them to others
Retroflection
–
Bending back on ourselves – doing to ourselves
what we want to do to someone else or have
done to us
Deflection
–
Indirect or minimal contact – avoiding the issue,
not getting to the point
Confluence
–
Lessening the boundary between ourselves and
others
Slide 6 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Gestalt Theory of Personality:
Awareness
Contact within self and with others:
Awareness of
Sensations
–
Seeing, hearing, touching, etc.
Feelings
–
Emotional and physical
Future events
–
Wants and desires
Values
–
Social, spiritual, and relationship
issues
Slide 7 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Gestalt Theory of Personality:
The Present
Past (unfinished business)
PRESENT
Future
Slide 8 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Goals of Gestalt Therapy
Become fully aware of oneself – Perls
Develop awareness of one’s
•Body
•Feeling
•Environment
•Experiences
•Needs
•Skills
•Sensations (seeing, hearing)
•Power to care for oneself
•Actions and their consequences
•Fantasies
Slide 9 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Gestalt Therapy: Enhancing
Awareness
Basic Awareness Techniques
Statements and questions
Emphasis through repetition or exaggeration
Language usage
I not you
won’t not can’t
want not need
choose to, not have to
Nonverbal behavior
Self – “Be the angry part of you.”
Slide 10 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Others – “Be your father.”
Gestalt Therapy: Enhancing
Awareness
More Advanced Awareness Techniques
Feelings
–
Act out the emotion
Self-dialogue
–
Use of the empty chair to express polarities
Enactment
–
Dramatizing an experience or characteristic
Dreams
–
Acting out parts of the dream
Homework
–
Write dialogues, perform tasks
Avoidance
–
An active process that can be confronted
Creativity
–
Slide 11 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Gestalt Therapy: Risks
Because of the potential to hurt, therapists
need concern for client
focus on client not technique
need understanding of gestalt theory
apply the technique within the context of gestalt theory
Slide 12 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Psychological Disorders:
Examples of Gestalt Approaches
Disorder
Therapist
Patient
Depression
Strumpfel and
Goldman
Depressed woman
Anxiety
Naranjo
Anxious man
Posttraumatic stress
Serok
Holocaust survivor
Substance abuse
Clemmons
Mike
Slide 13 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Current Trends in
Gestalt Therapy
Integrating concepts from
self psychology
object relations
relational psychoanalysis
other psychoanalytic approaches
Attention to issues such as shame
Slide 14 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Gender Issues and Gestalt
Therapy
Leadership of gestalt therapy by both men and women
Gestalt therapy can help women develop a sense of
empowerment
Gestalt therapy can help men become more aware of emotions
and blocks that interfere with different roles
Slide 15 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Multicultural Issues and
Gestalt Therapy
Experiments designed to help individuals deal with their culture
Bicultural clients can see the two cultures as a polarity – two
chair technique
Gestalt therapy can arouse deep emotions in individuals whose
culture discourages emotionality
Apply gestalt therapy to treat social needs
Slide 16 Chapter 7
© 2016 Cengage Learning.
All rights reserved.
Theories of Psychotherapy and
Counseling: Concepts
and Cases
6th Edition
Richard S. Sharf
Chapter 8
Behavior Therapy
© 2016 Cengage Learning. All rights reserved.
© 2016 Cengage Learning.
All rights reserved.
Behavior Therapy:
Early Research
Classical Conditioning: Focus on antecedents of behavior
UCS
UCR
CS
CR
A neutral conditioned stimulus is presented just prior to the
unconditioned stimulus. Similar responses then are given
(unconditioned response, conditioned response) to the
conditioned stimulus.
Originator: Ivan Pavlov
Slide 1 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavior Therapy:
Early Research
Operant Conditioning:
Focus on antecedents and consequences of overt
behavior
Reinforce correct responses
Ignore incorrect responses
Shape behavior by controlling amount, frequency, and
conditions under which reinforcement occurs
Originators: E.L. Thorndike and B.F. Skinner
Slide 2 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavior Therapy: Contemporary
Research
Social cognitive theory: Covert behavior, includes role of thoughts
and behavior
Triadic Reciprocal Interaction System
Behavioral Actions
SELF-SYSTEM
Personal Factors
Originator: Albert Bandura
Slide 3 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Environment
Behavior Theory: Concepts Derived
From Operant Conditioning
Positive reinforcement – The introduction of a stimulus
increases the likelihood that behavior will be repeated
Negative reinforcement- An undesirable consequence of a
behavior is removed, increasing the likelihood the behavior
will be performed again.
Extinction – the process of no longer presenting a
reinforcement
Generalization- transferring the response from one type of
stimuli to similar stimuli
Discrimination- responding differently to stimuli based on cues
or antecedent events
Shaping- gradually reinforcing parts of a behavior to more
closely approximate the desired behavior
Slide 4 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavior Therapy: Concepts
Derived From
Observational Learning
Attending to a model
Retaining information about the model
Motor reproduction – Reproducing the behavior of the model
Motivational processes – Repeat reinforced behavior
Vicarious
Self-reinforcement
Self-efficacy – perceptions of one’s ability to perform in different
situations
Slide 5 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Goals of Behavior Therapy
Changing target behaviors – ones that can be defined clearly and
accurately
Goals preferably arrived at in collaboration with clients by
evaluating goals and possible outcomes
Goals for clients who can not choose raise ethical questions
Slide 6 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavioral Assessment
Assessing discrete behaviors and their antecedents and
consequences through the use of
Behavioral interviews – specific questions
Behavioral reports and ratings – e.g., BDI
Behavioral observations – natural or simulated
Physiological measurements – blood pressure, heart rate,
respiration
Slide 7 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavioral Therapies: Overview
Imaginal
In vivo
Virtual reality
Slide 8 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Gradual
Flooding
Systematic
desensitization
Implosive therapy
Behavior Therapy: Systematic Desensitization
Relaxation
–
Anxiety hierarchies
–
Relax body by learning a variety of
relaxation methods
a ladder of graded degrees of anxiety
using a subjective units of
discomfort scale (SUDs).
Example: Fear of exams
1.
2.
3.
10.
Slide 9 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Five minutes before the psychology mid-term (80)
Walking to the psychology mid-term (70)
Midnight before the psychology mid-term (65)
Thinking about last year’s math final (20)
Desensitization
Relax the client
Present a neutral scene
Present scenes of increasing anxiety
Relax the client if the client becomes anxious
Return to a less anxious scene
Continue to move slowly up the hierarchy
Behavior Therapy:
Imaginal Flooding Therapy
Develop scenes that the client imagines and are anxiety
producing to the client
Repeat the scenes again and again in the therapy hour
Rationale: Fear will be extinguished
Slide 10 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavioral Therapy:
Modeling Techniques
Types of Modeling
Live- Watching a model
Symbolic- Watching films, DVDs, photographs, or pictures
Role playing- Acting the part of someone or oneself in
different situations
Participant modeling- Therapists model behaviors and guide
the client in using them
Covert modeling- The client imagines a model that the
therapist describes
Slide 11 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Meichenbaum’s Self-Instructional
Training
•
Model appropriate behavior
•
Have client practice behavior
•
Client repeat’s instructions to self
•
Instructions may be taped
•
Records of practicing the instructions may be made
Slide 12 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Meichenbaum’s Stress
Inoculation Approach
•Conceptual phase
–
Gather information; teach client
how to think about problem
•Skills acquisition
–
Teach skill such as relaxation,
cognitive restructuring, or selfreinforcement
•Application
–
Rehearse statements, visualize
scenes, practice behavior
Slide 13 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Psychological Disorders:
Examples of Behavioral Approaches
Disorder
Therapist
Client
Anxiety
Brown, O’Leary and
Barlow
Claire
Depression
Hoberman and Clarke Jane
ObsessiveCompulsive
Riggs and Foa
June
Phobia
Johnson and
McGlynn
Six-year-old girl
All research-supported therapies
Slide 14 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Current Trends in
Behavior Therapy
•Behavioral activation therapy
•Eye movement desensitization and processing
•Dialectical behavior therapy
•Ethical issues
Slide 15 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Behavioral Activation
Therapy
1. Designed to treat depression
2. Based on positive reinforcement
3. Goal to change behavior which will change depressed
mood
4. Techniques increase clients activities
5. Therapist and clients plan a schedule of gradual
behaviors
6. Clients use a daily activity sheet
Slide 16 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Eye-Movement Desensitization
and Reprocessing (EMDR)
1.
2.
3.
4.
5.
Client history
Explanation of EMDR
Gather baseline data
Desensitization phase
Increase positive cognitions- eye movement processing
introduced
6. Body scan performed
7. Client maintains a log of distressing thoughts or images
8. Process reevaluated and reviewed
Slide 17 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Dialectical Behavior Therapy
•
Individual Therapy
• Therapeutic skills
• Validation and acceptance strategies
• Problem-solving and change strategies
• Dialectical persuasion
• Group Skills Training
Slide 18 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Gender Issues in
Behavior Therapy
Behavior therapy can be viewed in a social or
environmental context
Are gender stereotyped behaviors reinforced?
Are gender stereotyped behaviors modeled?
Slide 19 Chapter 8
© 2016 Cengage Learning.
All rights reserved.
Multicultural Issues in
Behavior Therapy
Environmental factors (including culture) interact with
behavior
Specify vague expressions of distress in culturally specific
terms
Use cultural norms to specify treatment strategies
Be aware of cultural definitions of what constitutes deviant
behavior
Slide 20 Chapter 8
© 2016 Cengage Learning.
All rights reserved.

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