Change within the healthcare setting is inevitable and as a nurse leader understanding how change occurs and strategically determining the change process or model needed to best suit the needs of the change is a valuable skill to possess. In this situation a change is needed surrounding the current organizational structure at a facility. This situation indicates that there is an in-proportionate number of leaders to staff creating a “top heavy” environment where multiple people are in charge of a single unit(s). This type of a change consists of organizational restructuring and can create threats to decision-making strategies, including information flow, relationships, and priority setting (Spiers, Lo, Hofmeyer, & Cummings, 2016). Restructuring the organizational structure will create a feelings of uncertainty among staff and this type of change should be mapped out and well communicated to ensure a smooth transition. With a top heavy scenario the goal of the organizational restructuring is to ultimately create a more streamlined and direct line of authority, eliminate any duplicate leaders and flatten out the line to reduce the expense.
The three change models discussed could theoretically all be used in this scenario however the one I opted to implement is the PDSA model of change. This scenario requires a rapid change in organizational structure and Kotter and Roger’s are by design a more slow measured change process. This organizational restructure requires a plan of action which is restructuring the leadership or reducing the number of leaders within each unit/department. The plan is then implemented by restructuring leadership or by eliminating excessive leadership in order to create a more direct line of authority and lessen the redundancy of leaders. If a alteration of the plan is needed upon further eval then the cycle continues. Flattening out the leadership or reducing the number of leaders is difficult but must be done in a precise manner, enacted upon evaluated and then adjusted if needed. Kotter and Rogers change models could be applied here but in my opinion the PDSA model and the quick four cycle process works best to implement a rapid change in leadership that is needed in this scenario.
Comparison of Urinary Elimination Disorders:
| Stress Incontinence | Benign Prostatic Hypertrophy | Pyelonephritis | |
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Comparison of Bowel Elimination Disorders:
| Diarrhea | Bowel Obstruction | Hemorrhoids | |
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Article: Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity, a multi-center qualitative study.
According to world health organization (WHO), more than 340 million children and adolescents aged 5-19 were overweight or obese in 2016. The complications of obesity are more apparent in adolescents. Adolescent with obesity are at risk for conditions including cardiovascular disease, depression, low self-esteem, diabetes, hypertension and psychological and social problems. Obesity have a negative impact on the individual, family and health care cost. To explore barriers and enablers influencing the adoption of lifestyle behaviors changes among adolescents receiving multidisciplinary clinical care for obesity management, researchers use purposeful sampling which means they select participants who will provide specific information according to research questions. The researchers selected individuals base on the characteristics of the population and specific objective of the study.
Two sites that were used to collect data to conduct this study are: PCWH (Pediatric Center for Weight and Health) and Center for Healthy Active Living (CHAL: Children’s Hospital of Eastern Ontario, Ottawa, ON). The researchers recruited adolescent between 13-17 years of age with Body mass index (BMI) more than or equal to 85th percentile and have been on weight management for three months or more at PCHW or CHAL, which indicates they have spent some time reflecting on their health behaviors and working with healthcare providers on weight management. To recruit samples the researchers displayed posters on each of the clinic waiting rooms and the administrative, clinical research staffs identified eligible adolescents/families from clinic data base who were then contacted through phone or in person to assess their interest. Interested adolescents were offered several dates and times to chose from to participate in the study. Most of the adolescent’s participants were female, Caucasian, Anglophone, who were living with severe obesity.
The research provides useful evidence to tailor interventions on healthcare services regarding obesity, a focus on psychological well-being, to support adolescent with obesity in making and maintaining appropriate healthy behavior changes.
The sampling methods had flaws in that Voluntary participants were offered incentives to participate on the survey and they were only a small percentage of the population and not diverse.
References:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsgov&AN=edsgcl.566222361&site=eds-live&scope=site
Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity: A multi-Centre, qualitative study
https://eds-a-ebscohost-com.lopes.idm.oclc.org/eds/detail/detail?vid=6&sid=a9d403d3-8f9b-4269-9ce7-ea8aa2f10b3e%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=000453774100044&db=edswss
Grand Canyon University. (2018). Applied Statistics for Health Care. Population and sampling distributions. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/2
Article Title: Perinatal Mental Health Care from the User and Provider perspective: Protocol for a Qualitative Study in Switzerland.
Permalink: https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswss&AN=000517156400002&site=eds-live&scope=site
Postpartum depression is a common mental health disorder that women can experience after birth. While we study and discuss postpartum depression a lot, we sometimes forget about other mental health disorders for mothers such as anxiety, psychotic disorders and drug abuse. This study looks at women with different mental health disorders to help improve the care they receive.
In order to effectively produce this study, researches chose two sample groups women who have had perinatal mental disorders and healthcare professionals who treat these patients. Using these two samples allows us to study this topic from the view of the patient, as well as the view of the provider. There are several criteria points that both the mother/patient and the healthcare provider must meet.
For the mother, she must have perinatal mental disorder (PMD) within the last 24 months, have recovered from the PMD and been stable for at least 12 months and have received a diagnosis from one of the following groups: mood disorders (such as anxiety), disorders of adult personality and behavior, mental and behavioral disorders due to psychoactive substances and psychosis and delusional disorders. The recruitment process for these women involve the hospital collecting patients that meet this criteria and calling them to ask if they would like to participate in the study. If they say yes, they must participate in two-hour interview and questionnaire.
For the health care provider, they must have at minimum 2 years of professional experience and have cared for at least 2 patients with a perinatal mental disorder. Healthcare providers are recruited through professional associations, communities and networks.
The sampling process for this research study is effective because it allows mothers with a perinatal mental disorder and the health care providers who treat them to be involved in the improvement of their care. It is completely voluntary by both parties and the mothers are recovered and not currently suffering from a PMD, causing the study to be more accurate.
References:
Berger, A., Schenk, K., Ging, A., Walther, S., & Cignacco, E. (n.d.). Perinatal mental health care from the user and provider perspective: protocol for a qualitative study in Switzerland. REPRODUCTIVE HEALTH, 17(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12978-020-0882-7
Instructions
You are required to produce a clinical formulation and support package based on a real case study
Pay close attention to the marking rubric as this should inform your approach to constructing the formulation and intervention and where you should focus all your efforts.
Word count 2500 with 10% up or down ( References not included)
Reference list and essay to be APA referenced
Remember to include a brief session plan for the therapy.
PS6003: 2020 Summative marking rubric
| Criteria | Ratings | Pts | |||||
| LO1: AwarenessAwareness of the range of psychological problems encountered in clinical practice in terms of clinical presentations (e.g clinical features and diagnostic criteria). |
12 PtsExcellent | 10 PtsVery good | 8 PtsGood | 6 PtsCompetent | 4.14ptsPass | 0.0 PtsFail | 12 Pts |
| LO2: AssessmentAbility to identify and implement appropriate assessment tools or strategies. |
18 Pts Excellent | 13.5 Pts Very good | 8.1 Pts Good | 6.3 Pts Competent | 5.4 Pts Pass | 0.0 Pts Fail | 18 Pts |
| LO3: FormulationDemonstrate an ability to conduct a clinical formulation in relation to psychological problems, e.g., 5 Ps of clinical formulation. |
18 Pts Excellent | 13.5 Pts Very good | 8.1 Pts Good | 6.3 Pts Competent | 5.4 Pts Pass | 0.0 Pts Fail | 18 Pts |
| LO4: Treatment & care packageDetail appropriate therapeutic treatments and recommendations for subsequent care plans relevant to the case study. |
18 Pts Excellent | 13.5 Pts Very good | 8.1 Pts Good | 6.3 Pts Competent | 5.4 Pts Pass | 0.0 Pts Fail | 18 Pts |
| Empirical evidenceEvidence of broad independent reading that details support for all sections (assessment, formulation and treatment recommendations). |
12 Pts Excellent | 10 Pts Very good | 8 Pts Good | 6 Pts Competent | 4.14 Pts Pass | 0.0 Pts Fail | 12 Pts |
| Critical evalulations are presented in a balanced way.Are you demonstrating the pros and cons of assessments, evaluations, and treatment strategies? |
12 Pts Excellent | 10.15 PtsVery good | 8.31 Pts Good | 7.07 Pts Competent | 6.15 Pts Pass | 0.0 Pts Fail | 12 Pts |
| Overall writing and referencingAs a L6 student, you should be able to demonstrate a high standard of writing, paraphasing and referencing. |
10 PtsExcellent | 6.93 PtsVery good | 6.15PtsGood | 5.38 Pts Competent | 4.62Pts Pass | 0.0 Pts Fail | 10 Pts |
| Total points: 100 |
Summative assignment case study: Kyle
This assessment is structured as a letter
structure below to help to do assessment
remember to do 5ps formation to highlight the symptoms
UPDATED 27 – 03 – 2016
Dear students,
Remember you are a Psychologist and you are writing a formal letter to a consultant Psychiatrist. You will write this letter professionally beginning with a line of who you are, then a short descriptive summary of the most salient details from the client’s case study (e.g. demographic information, the presenting problem, symptom duration and presentation.)
Ensure that you provide an evidence base and justification for the chosen assessment tool(s): pre-assessment, mid and/or post follow up. Reference studies which show that this is a robust tool that has been validated for the particular population or symptoms that you are targeting. Remember to ground this in evidence from the case study and illustrate the appropriateness/relevance for this particular client. For a more comprehensive assessment, you may wish to utilise multiple assessments which address a variety of potential concerns.
There are a variety of ways in which you can approach this:
(a) you could choose to use a syndrome specific tool which assesses a specific set of symptoms (e.g. psychosis) combined with a broader measure (e.g. daily functioning, sleep, suicide risk, co-morbid depression- depending on what is appropriate from the case study). Remember to evidence and justify each decision. For instance, if you choose a daily functioning assessment, you could reference literature which reports a functional decline associated with psychosis. If you choose to assess hopelessness, evidence literature which shows or accounts for the elevated suicide risk among psychotic populations.
(b) alternatively, you may opt for broader catch all assessment such as the PAI which examines multiple factors within one assessment. You may consider recommending further tests (e.g. neurological tests- if appropriate!) to rule out other potential explanations.
Consider the appropriateness and limitations of the assessment tools as a means of critique (e.g. utility of projective tests for schizophrenia compared to other disorders, level of standardisation, length and burden of assessment process, validity across populations). You might also rule out certain assessments if risk is deemed to be low e.g. no active ideation or suicide plan.
What has your assessment led you to believe about the 5Ps of formulation? Remember to provide insight into each of these. Do not simply describe your thinking but instead draw upon psychological theory (psychodynamic, cognitive etc.) and/or academic literature to help explain the relationship between Kyles prior/present experiences and his current behaviour/psychological state.
For example: some theories/studies can help explain the relationship between early trauma and psychosis through cognitive (e.g. negative cognitive biases or maladaptive schemas about beliefs about “self, world and others” etc.) or biological changes (e.g. dopamine activity). Studies show that social isolation and drug use can exacerbate or maintain problems whereas stress can be an important trigger event. You should ground your example(s) in published literature and better yet, with a close example if possible.
To critique, you may briefly consider what additional information you would need to confirm/refute your formulation. Remember that formulation is an iterative process and new information may arise and force you to revise your formulation over the course of the therapy process.
DO NOT FOCUS ON DIAGNOSIS in this section!
If you are proposing a particular psychological intervention(s), we expect you to break the weekly sessions down with a short sentence describing the activity what the client will be doing and the corresponding objective (e.g. session one- teaching the client the cognitive model to understand the link between thoughts, feelings and behaviours, session two- Socratic questioning to identify core beliefs & set homework task, session three: review homework and challenge negative core beliefs.
REMEMBER!
Best of luck.
Case study:
| This is a factual account of a current real-life case study at a MSU. |
| Kyle is a 42-year-old male, presently admitted to a medium-secure hospital (MSU). He has been detained under section 37/41 of the Mental Health Act (MHA), after committing a serious assault on an acquaintance. Kyle was transferred to the MSU from prison due to deterioration in his mental health. Kyle experiences intrusive commanding voices and paranoid thoughts. He has a diagnosis of paranoid schizophrenia.Kyle has not previously worked, and he no longer has a relationship with his family – his mother left him shortly after birth, and he has not seen his step-mother or father since he was 15 years of age. Kyle had a son when he was 22-years-old. However, he died within the first six-months of life. Kyle has a long history of poly-substance use, and he was a frequent heroin from the age of 19 until he went cold turkey during his recent admission to prison. Significant History Kyle was born into a home in a deprived area of a large English city. His father worked long hours in a factory and his mother was unemployed. During the first year of Kyle’s life, his father perpetrated serious violence towards his mother. There were frequent fights and the police attended the home multiple times. Due to this abuse, Kyle’s mother left the family home without him. When Kyle was approximately two years of age, his father remarried and his step-mother moved into the home. However, the violence continued, and their relationship was frequently punctuated by aggression and violence. Kyle felt a need to protect his mother. However, his father would call him a “pussy” if he showed any tenderness or upset in such situations. As such, his step-mother would tell Kyle that he needed to “man up” so that he didn’t become a victim too. Despite this, physical punishment was common, and his father would hit Kyle for even the slightest transgression. As Kyle developed, he learnt to keep his feelings hidden, maintain a smile on his face, and behave well at all times. He felt powerless in the home and would often daydream as a form of escape. Kyle was curious at school, though he often struggled. However, he did not wish to draw attention to himself or be exposed. Therefore, he faded into the background and behaved. His teachers described him as “quiet, well-behaved, though largely absent”. He had difficulty with peer relationships and was the target of bullying. He lacked assertiveness and would attempt to please others when he could. As Kyle got older, he became increasingly detached from the world around him. He spent large amounts of time outside of the house, walking aimlessly. He attempted to avoid his father, though the violence continued; Kyle developed an awareness of his father’s warning signs and tried hard to appease his father’s temper. His step-mother provided some support, though this was usually practical, and she did not encourage strong emotional expression. Kyle felt a strong urge to protect her and there were occasions whereby he would tend to her injuries after she had been assaulted by his father. At school, Kyle continued to drift. However, he had started getting into fights. These would occur in the context of pervasive bullying – of which Kyle was a victim. He would find that – when the provocation reached unbearable limits – he would ‘snap’. Kyle rarely remembered his actions after the event, though others reported that he became almost uncontrollable in his rage. Kyle was suspended several times for fighting; he felt singled out and as if his emotions were toxic and forbidden. Things at home continued to be bad for Kyle and his step-mother. Indeed, things came to a point whereby his step-mother left his father when Kyle was 15. This was a shock to Kyle. However, his step-mother cut all contact at this point. Kyle’s father blamed Kyle and the violence turned towards him. Eventually, his father ‘kicked him out’ of the home and Kyle became homeless. Kyle did not return to school and instead turned to drugs to help with the cold, the danger, and the intolerable negative feelings that were bubbling inside. He started using cannabis and alcohol, before moving onto take heroin when he was 19. Life on the streets was difficult for Kyle. He felt unsafe and became suspicious of people around him. He was targeted by thieves and verbally abused by members of the public. He became involved with a group of drug users, who would provide him with cheap heroin. However, the price he paid was severe. The group prostituted Kyle for money. He felt worthless, though also powerless to change anything. His use of heroin increased. At the age of 22, Kyle had his son, with his partner Naomi. Kyle was delighted about this, though disaster soon struck. The child was brought up around drug users and dealer – social services were involved, though slow to respond – his son died of cot death at the age of six months. Kyle increased his heroin usage to cope with this new pain. He separated from Naomi and soon returned to live on the streets. Back on the streets, Kyle started to hear voices. He heard two voices, one male and one female. The voices expressed their anger at the world and instructed Kyle to seek revenge for the injustices done to him. Kyle was terrified and attempted to quash these intrusions through increased heroin use and alcohol. He rarely felt ‘present’ and the world was foggy and indistinct. The next 18 years of Kyle’s life followed a repeating pattern, whereby he would try his best to survive in the dangerous world. He would use drugs to numb and only buy food as an afterthought. He was suspicious of others and did not become closely involved with anybody, preferring to keep people at arm’s length. He avoided conflict and was described by others as “incredibly passive and people-pleasing”. He spent time in prison and psychiatric hospitals – often a result of acquisitional offences (robbery, theft etc.) (he would be sentenced to serve time in prison before becoming psychotic and requiring transfer to hospital). When in hospital, he would acquiesce to the wants of the clinical team, though he rarely made any meaningful progress. He behaved and tended to pass quietly back onto the streets. At the age of 40, Kyle was discharged into the community and given a council flat. However, he struggled to maintain this lifestyle and found himself back on the streets. Kyle had been moved to a new area and he did not know anybody, nor how to buy drugs. He was target by some local youths in the community, who would pay him small amounts of money to do humiliating acts. They would also film themselves attacking him. Kyle was also suffering the challenges of heroin withdrawal, and he was finding that the voices were becoming intolerable and that his feelings of anger, fear, and loss were coming uncomfortably close to the surface. Eventually, it all became too much for Kyle and he snapped. He was in a local off-license. He was feeling paranoid, and the voices were particularly bad. A man pushed in front of him in the queue and Kyle attacked him. Kyle had no recollection of events, though the police report indicated that he had entered into a prolonged and vicious assault, which had only been stopped when three members of the public had restrained him. Kyle was sentenced to seven years in prison for the assault after being charged with section 18 wounding. However, at prison things did not go well. He started using drugs again and had frequent near-death experiences. He was soon referred and transferred to the MSU, after a psychiatrist noted his excessive paranoia and distressing voices. Current Status Kyle is now at the MSU and awaiting assessment. He keeps himself to himself and spends large amounts of the day sleeping or resting in his room. He is polite and pleasant with staff, though has a tendency to deflect enquiries as to his internal world. He does acknowledge the presence of voices, though indicates that he is “ok”. He denies the need for help and reports that he simply wants to leave. Notably, Kyle has a lot of interests and has expressed a desire to complete his education. He enjoys fantasy novels, television comedies, and puzzles. He has been introduced to mindfulness and has indicated that he might be interested in this. His psychologist is now preparing to assess him, with the following questions in his mind: 1. What are the presenting problems? 2. What are the factors that have led to his psychological difficulties, both environmental and psychological? 3. How can psychological intervention help to improve his wellbeing and reduce his risk? 4. What other support can be put in place to help support Kyle recover? · Here is a useful resource to improve your academic writingLinks to an external site. |
