Chapter 28Mental Health Copyright © 2020 by Elsevier, In

Chapter 28
Mental Health
Copyright © 2020 by Elsevier, Inc. All rights reserved.
1
Mental Health
Mental health is not different in later life, but the level of
challenge may be greater
Well-being in late life can be predicted by cognitive and
affective functioning earlier in life
Mental health care for older adults lags behind that for other
age groups, and mental disorders have not yet received adequate
attention in global health
Globally, 5%-7% of older adults experience depression, 3.8%
experience anxiety and approximately 1% have substance use
issues
2
2
Mental Health
Many individuals in the baby boomer generation have

experienced mental health consequences from military conflict,
and the 20th century drug culture will add to the burden of
psychiatric illness in the future
The most prevalent mental health problems later in life are
anxiety, severe cognitive impairment, and mood disorders
Alcohol abuse and dependence is a growing concern
Healthy People 2020: Mental health and mental health disorders
(older adults) (Healthy People 2020 A)
3
Healthy People 2020
Reduce Suicide Rate
Reduce proportion of pts with major depressive disorder
Increase primary care facilities providing mental health care on
site/referral
Increase numbers who receive treatment for mental health
disorders
Increase treatment that address concurrent diseases like
substance abuse and other MH disorders
Increase depression screening
Increase treatment of homeless with MH disorders
3
Stress and Coping in Late Life
4
4

Stress and stressors
The experience of stress is an internal state accompanying
threats to self
The narrowing range of bio-psychosocial homeostatic resilience
and changing environmental needs as one ages may produce
stress overload
Effects of stress
Adults show greater immunological impairments associated with
distress or depression
Older people often experience multiple simultaneous stressors
(Box 28-2)
Any stressors that occur in the lives of older people may
actually be experienced as a crisis if the event occurs abruptly,
is unanticipated, or requires skills or resources the individual
does not possess
5
Stress can result in worsening of already present chronic health
conditions like CV disease and dementia
When we look at this age group, they may have more losses
piled on top of one another (older people die more
Often than younger, so imagine losing a spouse, a child, a

neighbor, experiencing an illness—no opportunity to rebound
Before getting clobbered again with another stressor!
Older adults tend to require more time to rebound from stress
Great difference between individuals, but anticipate the older
adult may have more issues
5
Factors affecting stress
Cognitive style, coping strategies, social resources, personal
efficacy, and personality characteristics have all been found to
be significant to stress management
Social relationships and social support are particularly salient to
stress management and coping
Factors influencing ability to manage stress (Box 28-3)
6
Health and fitness
Sense of control over events
Self awareness
Patience and tolerance
Coping skills
Resilence
Hardiness
Resourcefulness
Social support
Strong sense of self
6

Factors affecting stress
Coping
Coping strategies
Identification
Coordination
Appropriate use of personal and environmental resources
7
How does the person view the current stress?
Do they see it as a threat?
What tools do they have to address it?
7
Promoting Healthy Aging: Implications for Gerontological
Nursing
Assessment
General issues in the psychosocial assessment involve
distinguishing among normal, idiosyncratic, and diverse
characteristics of aging and pathological conditions
Includes examination for cognitive function and conditions of
anxiety and adjustment reactions, depression, paranoia,
substance use, depression, and suicidal risk
Obtaining assessment data from elders is best done during short
sessions after some rapport has been established
8
Understanding of past and present history is useful for
understanding the patient’s current reactions to what is
occurring

Sometimes it is impossible to get the information needed to
fully understand how a person will or is reacting to an issue
Think about how your younger years, including childhood and
young adult years have impacted how you cope or feel about
Things that happen in your life—it will affect your patient in a
similar manner, so try to get a picture of past experiences
Great time to try to get a “life story”
8
Nursing
Interventions
Enhancing functional status and independence, promoting a
sense of control, fostering social supports and relationships, and
connecting to resources are all important nursing interventions
to enhance coping ability
Meditation, yoga, HeartMath, mindfulness, exercise,
spirituality, and religiosity can enhance coping ability
Mind-body therapies are most helpful
Reminiscence is useful in understanding coping style
9
Factors Influencing Mental Health
10

Stigma
Ageism
10
Attitudes and beliefs
According to WHO, 15% of adults age 60 and older have a
mental disorder (frequently untreated)
Reasons include
reluctance on the part of older people to seek help because of
pride of independence
stoic acceptance of difficulty
unawareness of resources
lack of geriatric mental health professionals and services
lack of adequate insurance coverage
May be looked at as a normal consequence of aging or blamed
on dementia

Geropsychiatric nursing
A master’s level subspecialty within the adult-psychiatric
mental health nursing field
The Geropsychiatric nursing initiative has developed
geropsychiatric nursing competency enhancements for entry-
and advanced practice–level education
11
Culture and mental heealth
What may be defined as mental illness in one culture may be
viewed as normal in another
Cultural variations in expressing mental distress (Box 28-4)
Disparities in mental health service use by racial and ethnic
minority groups are well documented
Sexual minority individuals, particularly older gay men,
demonstrate higher rates of mental disorders, substance abuse,
suicidal ideation, and deliberate self-harm than heterosexual
populations
12
12
Culture and mental health

The newest version of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5) has an increased emphasis on culture
and mental health, including the range of psychopathology
across the globe
Cultural components of DSM-5 (Box 28-5)
Components of cultural formulation interview in DSM-5 (Box
28-6)
Cultural assessment (Box 28-7)
13
13
Availability of mental health care
Dedicated financing for older adult mental health is limited,
even though about 20% of Medicare beneficiaries experience
some mental disorder each year
Medicare spends five times more on beneficiaries with severe
mental illness and substance abuse disorders than on similar
beneficiaries without these disorders
The CMS health risk assessment and annual wellness visit for
Medicare beneficiaries includes screening for depression,
questions on alcohol consumption, and detection of cognitive
impairment
14
14

Settings of care
Older people receive psychiatric services across a wide range of
settings, including acute and long-term inpatient psychiatric
units, primary care, and community and institutional settings
The majority receive care from primary care providers
It is critical to integrate mental health and substance abuse with
other health services including primary care, specialty care,
home health care, and residential- and community-based care
15
Nursing homes and assisted living
Nursing homes, and increasingly residential care/assisted living
facilities, although not licensed, are providing the majority of
care given to older adults with psychiatric conditions
Obstacles to care in these settings:
Shortage of trained personnel
Limited availability and access for psychiatric services
Lack of staff training related to mental health/illness
Inadequate Medicaid/Medicare reimbursement
New models of mental health care services are needed in these
settings to address growing needs
16
Mental Health Disorders

Anxiety disorders
Unpleasant and unwarranted feelings of apprehension, which
may be accompanied by physical symptoms
Becomes problematic when prolonged, exaggerated, and
interferes with function
17
17
Prevalence and characteristics
17% of adults aged 65 and over experience a diagnosable
anxiety disorder
The prevalence is higher among individuals with physical
illnesses, particularly those in need of home health care or in
live-in residential settings
Anxiety disorders are not considered part of the normal aging
process
Late-life anxiety is often comorbid with major depressive
disorder, cognitive decline and dementia, and substance abuse
18
18
Consequences of anxiety
Anxiety symptoms and disorders are associated with many

negative consequences:
Increased hospitalizations
Decreased physical activity and functional status
Sleep disturbances
Increased health services use
Substance abuse
Decreased life satisfaction
Increased mortality
19
19
Nursing
Assessment
Nurses can identify anxiety-related symptoms and initiate
assessments leading to appropriate treatment and management
Assessment focuses on:
Physical, social, and environmental factors.
Past life history.
Long-standing personality.
Coping skills.
Recent events.
Anxiety is a common side effect of drugs (Box 28-8)
20
Antihypertensives
Corticosteroids
Anticholinergics
Caffeine
Nicotine

Withdrawl form alcohol, sedatives
OTC appetite suppressants and cold preparations
20
Nursing
Interventions
Depends on symptoms, specific anxiety diagnosis, comorbid
medical conditions, and current medication regimen
Pharmacological
First line: selective serotonin reuptake inhibitors
Second line: short-acting benzodiazepines
Nonpharmacological
Cognitive behavioral therapy, exposure therapy, interpersonal
therapy
Interventions for anxiety (Box 28-9)
21
21
Posttraumatic stress disorder (PTSD)
Originally considered an anxiety disorder, the DSM-5 has
reclassified it in a new chapter, Trauma- and Stressor-Related
Disorders, which covers acute stress disorders, adjustment
disorders, and reactive attachment disorders
PTSD is a psychobiological mental disorder associated with
changes in brain function and structure affecting survivors of
combat, terrorist attacks, natural disasters, serious accidents,
assault/abuse, sudden and major emotional losses

22
22
Prevalence
War veterans have high prevalence for PTSD
Older women with a history of rape or abuse as a child may also
experience symptoms of PTSD when institutionalized,
particularly during the provision of intimate bodily care
activities, such as bathing
Clinical examples of PTSD in older adults (Box 28-10)
23
Interventions may need to be adjusted based on the reasons for
the symptoms—review Box 28-10
How much PTSD is missed?
How can we adjust the environment to support the patient?
23
Symptoms
DSM-5 includes four major symptom clusters for diagnosis:
Reexperiencing
Avoidance
Persistent negative alterations in cognition and mood
Alterations in arousal and receptivity

24
Consequences
Depression is present in half of individuals with PTSD
Co-occurring PTSD and depression is associated with greater
symptoms, reduced quality of life, and increased health care
utilization
There may be association between PTSD and greater incidence
and prevalence of dementia
25
Nursing
Assessment
Care of individuals with PTSD involves awareness that certain
events may trigger inappropriate reactions, and patterns should
be identified when possible
Knowing the person’s past history and life experiences is
essential in understanding behavior and implementing
appropriate interventions
Hartford Institute for Geriatric Nursing recommends the Impact
of Event Scale-Revised (IES-R) (Box 28-1)
26
26

Nursing
Interventions
Understanding of how to treat PTSD among older adults is still
developing
Recommendations are that older adults can benefit from
cognitive behavioral therapy and prolonged exposure therapy
Evidence-based psycho-spiritual interventions
Pharmacological therapy
Therapy should be individualized to meet specific concerns and
needs of each unique patient, and may include individual,
group, and family therapy
27
27
Schizophrenia
Prevalence
Older adults are the fastest growing segment of the total
schizophrenic population, and the numbers are expected to grow
with increased longevity of the population
Onset of schizophrenia after the age of 45 is identified as late -
onset; and after the age of 60 the onset of schizophrenia is
considered to be rare
28

Symptoms
Positive symptoms of delusions, hallucinations, disorganized
speech, disorganized behavior
Negative symptoms of flat or blunted affect, anhedonia,
avolition; and cognitive symptoms of poor executive
functioning, and limited attention span
29
Consequences
Persons with schizophrenia have a life expectancy 15 years
shorter than that of an unaffected person
Costly disease in terms of suffering and medical costs
The majority of older people with schizophrenia now reside in
nursing homes
30
Usually due to decreased access to regular health care and
interventions
Adverse effects related to medications used to treat
schizophrenia
30

Nursing
31
31
Interventions
Treatment includes both pharmacological and
nonpharmacological
Other important interventions include a combination of support,
education, physical activity, and cognitive-behavioral therapy
Psychotic Symptoms in Older Adults
Onset of true psychiatric disorders is low among older adults,
but psychotic manifestations may occur as a secondary
syndrome in a variety of disorders, the most common being
neurocognitive disorders and Parkinson disease
Paranoid symptoms
Delusions
Hallucinations
32

Nursing
Assessment
The assessment dilemma is often one of determining if paranoia,
delusions, and hallucinations are the result of medical illness,
medications, dementia, psychoses, and sensory deprivation or
overload because treatment will vary accordingly
Treatment must be based on comprehensive assessment
Assessment of vision and hearing is also important since these
impairments may predispose the older person to paranoia or
suspiciousness
33
33
Nursing
Interventions
Frightening hallucinations or delusions arise in response to
anxiety-provoking situations and are best managed by:
Reducing situational stress.
Being available to the person.
Providing a safe, nonjudgmental environment.
Attending to fears more than content of delusion or
hallucination
Identify the client’s strengths and build on them
If symptoms interfere with function and safety, consider
antipsychotics if other interventions don’t work

34
34
Bipolar disorder (BD)
DSM-5 defines BD as a recurrent mood disorder that includes
periods of mania and/or hypomania or major depression
(Bipolar 1) or major depression and hypomanic episodes
(Bipolar II)
20% of older adults with BD experience their first episode after
50 years of age
With the aging population, predictions are there will be a
drastic increase
BDs stabilize in later life, and individuals tend to have longer
periods of depression
Frequently misdiagnosed, underdiagnosed, and undertreated
35
Nursing
Assessment
Thorough physical examination and laboratory and radiological
testing to rule out physical causes of symptoms and identify
comorbidities
Accurate individual and family history
Episodes of mania combined with depressed features and a
family history of BD are highly indicative of the diagnosis

There is a strong hereditary component to BD (Box 28-13)
36
Nursing
Interventions
Pharmacotherapy
Lithium
Antidepressants
Anticonvulsants
Psychosocial
Intensive psychotherapy
Cognitive behavior therapy
Interpersonal and rhythm therapy
Family-focused therapy
37
37
Depression
Not a normal part of aging, most older people are satisfied with
their lives, despite physical problems
Important to understand the influence of late-life stressors and
changes and beliefs of older people, society, and health
professionals may have about depression and treatment
38

Prevalence
Depression remains underdiagnosed and undertreated in the
older population
Depression is a leading cause of disease burden globally and is
projected to increase
Prevalence rates of depression in older adults likely to double
by 2050
Stigma associated with depression may be more prevalent in
older people
Health professionals often expect older people to be depressed
and may not take appropriate action to assess and treat
depression
39
40
40
Consequences
Depression is a common and serious medical condition second

only to heart disease in causing disability and harm to an
individual’s health and quality of life
It is associated with negative consequences such as:
Delayed recovery from illness and surgery.
Excess use of health services
Cognitive impairment.
Exacerbation of co-existing medical illnesses.
Malnutrition.
Decreased quality of life.
Increased suicide and nonsuicide-related death.
Etiology
Causes of depression are complex and must be examined in a
bio-psychosocial framework
Factors of health, gender, developmental needs,

socioeconomics, environment, personality, losses, and
functional decline are all significant to the development of
depression in later life
Neurotransmitter imbalances have strong association with many
depressive disorders
Medical disorders and medications can result in depressive
symptoms (Boxes 28-14 and 28-15)
Common risk factors for depression (Box 28-16)
41
41
Nursing
Assessment
Older people who are depressed report more somatic complaints
such as insomnia, loss of appetite and weight loss, memory loss,
and chronic pain
Assessment of depression (Box 28-17)
Screening of all older adults for depression should be
incorporated into routine health assessments across the
continuum of care
42
Promoting Healthy Aging Implications for Gerontological

Nursing
43
43
Interventions
The goals of depression treatment in older adults are to decrease
symptoms, reduce relapse and recurrence, improve functi on and
quality of life, and reduce mortality and health care costs
Nonpharmacological
Exercise (Box 28-19)
Integrated care
Pharmacological
Other treatments, such as electroconvulsive therapy (ECT) or
Repetitive transcranial magnetic stimulation (rTMS)
Family and professional support (Box 28-19)

Suicide
The suicide rates for white males 85 years and older is high
Women in all countries have lower suicide rates
In most cases, depression and other mental health problems,
including anxiety, contribute significantly to suicide risk
Possible contributing factors to rising suicide rates include the
economic downturn, intentional overdoses associated with the
increase in use of prescription opioids, other substance use, and
a cohort effect based on the high suicide rates of this age-group
in their adolescent years
Many older adults who die by suicide reached out for help
before they took their own life
Suicide risk and recovery factors (Box 28-20)
44
Nursing
Assessment
The lethality potential of an elder must always be assessed
when elements of depression, disease, and spousal loss are
evident
Establish a trusting and respectful relationship with the person
Any direct, indirect, or enigmatic references to the ending of
life must be taken seriously and discussed
The Columbia-Suicide Severity Rating Scale (C-SSRS) is an
evidence-based suicide assessment tool used by many hospitals
and organizations
45

Nursing
Interventions
Have a suicide protocol in place if a positive response is
obtained from any of the questions
The person should never be left alone for any period until help
arrives to assist and care for the person
Patients at high risk should be hospitalized
Patients at moderate risk can be treated as outpatients provided
they have adequate social support and no access to lethal means
Patients at low risk should have a full psychiatric evaluation
and be followed carefully
46
Substance use disorders
Substance use disorders among older adults are a growing
public health concern
Baby boomer generation has had more exposure to alcohol and
illegal drugs in their youth and have a more lenient attitude
about substance use
Psychoactive drugs are more readily available for dealing with
anxiety, pain, and stress
Cocaine- and heroin-related admissions are on the rise in the
older adult population and the incidence of opioid abuse and
misuse is also increasing
Substance abuse objectives (Healthy People 2020 B)
47

Alcohol use disorder
Prevalence and characteristics
Alcohol use disorders are reported in 11% of adults aged 54-64
years and 6.7% of those older than 65
Alcoholism is the third most prevalent psychiatric disorder
(after dementia and anxiety) among older men
Late-onset drinking may be related to situational events such as
illness, retirement, or death of a spouse and includes a higher
number of women
Two-thirds of elderly alcoholics are EOS drinkers (30-40 years
of age)
48
48
Alcohol use disorder
Gender issues
Men are four times more likely to abuse alcohol
Women of all ages significantly more vulnerable to effects
Physiology
Older people develop higher blood alcohol levels because of
changes of aging altering absorption/distribution
Consequences
Cirrhosis of the liver, cancer, immune disorders,
cardiomyopathy, cerebral atrophy, dementia, delirium
Many drugs that elders use cause adverse effects when
combined with alcohol (Box 28-22)
49

Nursing
50
50
Assessment
Reasons for the low rate of alcohol detection in older adults:
poor symptom recognition, inadequate knowledge about
screening instruments, lack of age-appropriate diagnostic
criteria for abuse in older people, and ageism
Short Michigan Alcoholism Screening Test (Table 28-1)
Assessment of depression is important
Signs and symptoms of potential alcohol problems (Box 28-23)
Alcohol guidelines

Nursing
Interventions
Treatment and intervention strategies:
Cognitive-behavioral approaches
Individual and group counseling
Medical and psychiatric approaches
Alcoholics Anonymous
Family therapy
Case management and community home care services
Formalized substance abuse treatment
51
Acute alcohol withdrawal
Withdrawal from alcohol can become a life-threatening
emergency
Detoxification should be done in an inpatient setting
Symptoms of acute alcohol withdrawal vary but may be more
severe and last longer in older people
Delirium tremens: alcohol withdrawal delirium
Clinical Institute Withdrawal Assessment scale is recommended
as a valid and reliable screening instrument
52
Other substance abuse concerns
Misuse and abuse of prescription psychoactive medications

Dependence on sedative, hypnotic, or anxiolytic drugs
STAMP Out Prescription Drug Misuse and Abuse Toolkit
53
Question 1
Which condition is ranked as fourth leading cause of death for
older adults?
Schizophrenia
Anxiety
Major depressive disorder
Suicide
54
ANS: D
54
Question 2
The goals of depression treatment in the older adult include
which of the following?
Reduce mortality and health care costs.
Improve function and quality of life.
Reduce relapses and recurrence.
All of the above.
55
ANS: D
55

225
sch87956_ch10_223-248.indd 225 11/12/18 10:34 AM
Chapter Ten
Organizing for
Innovation
Organizing for Innovation at Google
Google was founded in 1998 by two Stanford Ph.D. students,
Sergey Brin and
Larry Page, who had developed a formula for rank ordering
random search
results by relevancy. Their formula gave rise to an incredibly
powerful Internet
search engine that rapidly attracted a loyal following. The
search engine enabled
users to quickly find information through a simple and intuitive
user interface.
It also enabled Google to sell highly targeted advertising space.
The company grew rapidly. In 2001, Brin and Page hired Eric
Schmidt, former
CTO of Sun Microsystems and former CEO of Novell, to be
Google’s CEO. In
2004, the company went public, raising $1.6 billion in one of
the most highly
anticipated IPOs ever. Under Schmidt, the company adhered to
a broad yet dis-
ciplined mission: “To organize the world’s information and
make it universally
accessible and useful.” This led the company to leverage its
core search and

advertising capabilities into blogging, online payments, social
networks, and
other information-driven businesses.
By 2014, Google had sales of over $66 billion, and employed
more than
57,000 people. Despite this size, however, the company
eschewed hierarchy
and bureaucracy and sought to maintain a small-company feel.
As noted by
Schmidt during an interview, “Innovation always has been
driven by a person or
a small team that has the luxury of thinking of a new idea and
pursuing it. There
are no counter examples. It was true 100 years ago and it’ll be
true for the next
100 years. Innovation is something that comes when you’re not
under the gun.
So it’s important that, even if you don’t have balance in your
life, you have some
time for reflection. So that you could say, ‘Well, maybe I’m not
working on the
right thing.’ Or, ‘maybe I should have this new idea.’ The
creative parts of one’s
mind are not on schedule.”a
In accordance with this belief, Google’s engineers were
organized into small
technology teams with considerable decision-making authority.
Every aspect of
the headquarters, from the shared offices with couches, to the
recreation facilities
and the large communal cafe known as “Charlie’s Place,” was
designed to foster
Final PDF to printer

sch87956_ch10_223-248.indd 226 11/12/18 10:34 AM
226 Part Three Implementing Technological Innovation
Strategy
informal communication and collaboration.b Managers referred
to Google as a flex-
ible and flat “technocracy,” where resources and control were
allocated based on
the quality of people’s ideas rather than seniority or
hierarchical status. Schmidt
remarked, “One of the things that we’ve tried very hard to avoid
at Google is the
sort of divisional structure that prevents collaboration across
units. It’s difficult. So I
understand why people want to build business units, and have
their presidents. But
by doing that you cut down the informal ties that, in an open
culture, drive so much
collaboration. If people in the organization understand the
values of the company,
they should be able to self-organize to work on the most
interesting problems.”c
A key ingredient in Google’s organization is an incentive
system that requires
all technical personnel to spend 20 percent of their time on
innovative proj-
ects of their own choosing. This budget for innovation is not
merely a device
for creating slack in the organization for creative employees—it
is an aggres-
sive mandate that employees develop new product ideas. As

noted by one
Google engineer, “This isn’t a matter of doing something in
your spare time, but
more of actively making time for it. Heck, I don’t have a good
20% project yet
and I need one. If I don’t come up with something I’m sure it
could negatively
impact my review.”d Managers face similar incentives. Each
manager is required
to spend 70 percent of his or her time on the core business, 20
percent on
related-but- different projects, and 10 percent on entirely new
products. Accord-
ing to Marissa Mayer, Google’s head of search products and
user experience, a
significant portion of Google’s new products and features
(including Gmail and
AdSense) resulted from the 20 percent time investments of
Google engineers.
In 2015, the company was reorganized into Alphabet Inc., a
holding com-
pany, wherein Google and other divisions such as Access,
Calico, CapitalG,
Nest, and others were wholly owned subsidiaries. The divisions
retained their
flat and flexible reporting structures.e
In a podcast interview at Stanford University, Andy Grove
(former CEO of Intel)
remarked that the company’s organization appeared chaotic,
even noting “From
the outside it looks like Google’s organizational structure is
best described by . . .
Brownian motion in an expanding model” and questioned
whether Schmidt

believed this model would continue to work forever. In his
response, Schmidt
responded, “There’s an important secret to tell, which is there
are parts of the
company that are not run chaotically. Our legal department, our
finances. Our
sales force has normal sales quotas. Our normal strategic
planning activities, our
normal investment activities, our M&A activities are run in a
very traditional way.
So the part of Google that gets all the attention is the creative
side, the part where
new products are being built and designed, and that is different.
And it looks to
us like that model will scale for quite some time . . . it looks
like small teams can
run ahead and that we can replicate that model for that part of
the company.”f
Discussion Questions
1. What are the advantages and disadvantages of the creative
side of Google
being run as a flexible and flat “technocracy”?
2. How does Google’s culture influence the kind of employees
it can attract
and retain?
Final PDF to printer
Part Three: Implementing Technological Innovation
StrategyChapter 10: Organizing for InnovationOrganizing for
Innovation at Google
Kingdom of Saudi Arabia
Ministry of Education

Saudi Electronic University
‫ة‬ ‫عودي‬ ‫س‬ ‫ال‬ ‫ية‬ ‫عرب‬ ‫ال‬ ‫كة‬ ‫ل‬ ‫مم‬ ‫ال‬
‫يم‬ ‫ل‬ ‫ع‬ ‫ت‬ ‫ال‬ ‫وزارة‬
‫ية‬ ‫ترون‬ ‫ك‬ ‫اإلل‬ ‫ة‬ ‫عودي‬ ‫س‬ ‫ال‬ ‫عة‬ ‫جام‬ ‫ال‬
College of Administrative and Financial
Sciences
Assignment 3
Management of Technology (MGT 325)
Deadline: 30/04/2022 @ 23:59
Course Name: Management of Technology
Student’s Name:
Course Code: MGT325
Student’s ID Number:
Semester: 2nd
CRN:
Academic Year:2021-22
For Instructor’s Use only
Instructor’s Name:
Students’ Grade:
Marks Obtained/Out of 10
Level of Marks: High/Middle/Low
Instructions – PLEASE READ THEM CAREFULLY
· The Assignment must be submitted on Blackboard (WORD
format only) via allocated folder.
· Assignments submitted through email will not be accepted.
· Students are advised to make their work clear and well
presented, marks may be reduced for poor presentation. This
includes filling your information on the cover page.
· Students must mention question number clearly in their
answer.

· Late submission will NOT be accepted.
· Avoid plagiarism, the work should be in your own words,
copying from students or other resources without proper
referencing will result in ZERO marks. No exceptions.
· All answered must be typed using Times New Roman (size 12,
double-spaced) font. No pictures containing text will be
accepted and will be considered plagiarism).
· Submissions without this cover page will NOT be accepted.
Course Learning Outcomes-Covered
· Explain of the concepts, models for formulating strategies,
defining the organizational strategic directions and crafting a
deployment strategy. (Lo 2.2)
Assignment 3Marks:10
Students are requested to read the opening case of chapter 10
“Organizing for Innovation” from their book Strategic
Management of Technological Innovation (Page Number-197-
200) of e-textbook. Based on your understanding of the case and
concepts studied until now answer the following question in
300-500 words each.
1.What are the advantages and disadvantages of the creative
side of Google being run as a flexible and flat ‘technocracy’?
(3 marks)
2. How does Google’s culture attract the kind of employees it
can attract and retain. (1.5 marks)
3.What do you believe the challenges are in having very
different structure and controls for Google’s creative side
versus the other parts of the company. (2.5 marks)
4. Some analysts have argued that Google’s free-form structure
and the 20 percent time to work on personal projects is possible
only because Google is prior success has created financial risk
in the company. Do you agree with this? Would Google be able

to continue this management style if it had closer competitors?
(3 marks)
NOTE: It is mandatory for the students to mention their
references, sources and support each answer with at least 2 peer
reviewed journal.
ANSWER
Case Study Mental Health Chapter 28
Read chapter 28 “Mental Health” in your course text Toward
Health Aging 10th Edition. Review the following conditions
Bipolar disorder, Depression, Generalized Anxiety Disorder,
Suicide, and Substance use disorders.
Instructions:
1. Carefully, read the following case study below and answer
the questions.
2.Be sure to format your work in a structured and organized
pattern.
3. Label each section and provide rationales and citations for all
of your in-text work.
4. Provide a separate reference page.
5. Answer the critical thinking questions at the end of the case
study. Provide citations for all answers with detailed rationales
Case Study
"Paul is a 71- year old white male had cared for his wife,
Emma, during a long and painful illness until she died 4 years
ago. He found that alcohol provided a way to cope with the
stress. His Past Medical history includes Type II diabetes,
hypertension, obesity, and mild congestive heart failure. He is
currently on several medications and has little help at home. He
presented to the outpatient family clinic with symptoms of
anhedonia, and feelings of persistent sadness. He reports
significant change in appetite and weight loss and fatigue. He
also reported issues with falling and staying asleep and low

energy level. He admitted to feeling like life was not worth
living but denied any suicidal attempts. He has not seen or spent
any time with friends or family recently and lack desire in any
of his social activities. He scored 13 out of 30 on the Geriatric
Depression Scale. His symptoms have been present for greater
than 1 month.
Based on the case study, develop a nursing care plan using the
following:
• List Jake’s comments that provide subjective data.
• List information that provides objective data.
• Read the following document
https://ar.israa.edu.ps/uploads/documents/2020/02/4gcM0.pdf
which includes appropriate use of NANDA approved nursing
diagnosis (must be written in this format). From these data
included in the client’s history and case, identify and state two
nursing diagnoses you determine are most significant to Paul at
this time.
• Determine and state outcome criteria for each diagnosis.
These criteria must reflect some alleviation of the problem
identified in the nursing diagnosis and must be stated in
concrete and measurable terms. For example, a measurable
outcome is behavior demonstrated by the client responsive to
nursing interventions. Outcomes should be identified before
nursing interventions are created. After nursing interventions
are implemented, the nurse evaluates if the outcomes were met
in a defined timeframe. Outcomes can be short term and long-
term goals. Example: A client with a diagnosis of Fluid Volume
Excess related to excess fluid intake as manifested by bilateral
basilar crackles in the lungs, bilateral +2 pitting edema of the
feet, and increased weight gain of 10 pounds. An example of an
expected outcome is “The client will have clear bilateral lung
sounds within the next 24 hours.”
• Plan and state one or more interventions for each diagnosed
problem. Provide specific documentation of the source used to
determine the appropriate intervention. Plan at least one
intervention that incorporates Jake’s existing strengths. Read

chapter 28 to identify nursing interventions. Be sure to also
research the online library for interventions with rationales and
citations.
• Evaluate the success of the intervention. Interventio ns must
correlate directly with the stated outcome criteria to measure
the outcome success." Include citations
Critical Thinking/Research Questions
1. What is the prevalence of mental health disorders in the
community-dwelling older adults? Provide citations and
references.
2. What are the most reliable tools for identifying depression in
cognitively intact and cognitively impaired older adults. Use
your course text and additional resources.
3. Discuss the variations in symptoms of depression in older
adults and younger adults? Provide in-text citations.
4. How would you address the possibility of suicidal thoughts if
you were the nurse in a primary care setting? What
interventions might you implement? Read chapter 28 and
additional resources. What is your responsibility as a student
nurse in the case of suspected suicidal thoughts?
5. What actions should be taken for Paul’s protection? What are
the clues or indications that older adults are thinking of
committing suicide?

Chapter 28Mental Health Copyright © 2020 by Elsevier, In

Recommended

Recommended

More Related Content

Similar to Chapter 28Mental Health Copyright © 2020 by Elsevier, In

Similar to Chapter 28Mental Health Copyright © 2020 by Elsevier, In (16)

More from EstelaJeffery653

More from EstelaJeffery653 (20)

Recently uploaded

Recently uploaded (20)

Chapter 28Mental Health Copyright © 2020 by Elsevier, In