1
Family Assessment and Psychotherapeutic Approaches
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychotherapy with Multiple Modalities
June 13, 2021
2
Abstract
As providers, it is vital to be open-minded, if you are not aware or do not understand a person’s
culture, show your patients respect. Be engaged, respectful, and ask questions. Learn from your
patients, this helps develop a rapport. As providers we are obligated to provide optimal care, if
we feel a patient's needs are out of our scope, the client should be referred to a provider that can
give them the help they need and deserve (Nichols & Davis, 2020).
The purpose of this paper is to provide documentation and a psychiatric comprehensive
assessment of a patient and family during a family therapy interview that highlights differences
in a multicultural family, respecting cultural norms and differences, and develop an
individualized treatment plan.
Keywords: Family therapy
3
Family Assessment and Psychotherapeutic Approaches
Subjective:
CC (chief complaint): “I like to learn to live on my own and not depend on the kids.”
HPI: A 40-year-old female (Patti) and her five children (Sheela age 24, Sharleen aged 23
and present today, Shireen age 21 recently reunited with family, Armin Jr. age 18, and Sam age
15), of Iranian descent, has been in individual and family therapy for the last 18 months. Patti
came to the clinic related to chaos in the home after her daughter was finally reunited with the
family after ten years. The family initially had rejoiced and celebrated, and after a few weeks,
Shireen began to tell her mother and siblings the emotional, physical, and sexual abuse at the
hands of her father. She blamed and felt abandoned by her mother. Patti needed necessary
surgery to both her feet after an injury, that has now left her disabled and with chronic pain. The
additional burden of surgery and disability has increased tension and stress in the home. Patti
lives with her two sons; her daughters live on their own. Shireen recently moved out, marrying
someone the family does not know, with little contact. Mother speaks and sees Sheela and
Sharleen daily. Patti has increasingly felt alone, depressed, hopeless, and helpless wanting her
daughters to stay and help her at her home. A psychiatric provider has been referred for a
medication evaluation.
Past Psychiatric History:
General Statement: Patti and her family began therapy 18 months ago after daughter
Shireen reunited with the family after 12 years of separation. Shireen shared significant abuse
she experienced, learning the trauma she went through brought on many emotions of the family
including blame, guilt, shame increasing stress on the family.
Caregivers: N/A
4
Hospitalizations: Patti denies any past psychiatric hospitalizations or history. The patient
has no history of substance abuse or residential treatment. Patti denies suicidal and homicid ...
Running head: COMPREHENSIVE ASSESSMENT 1
COMPREHENSIVE ASSESSMENT 1
Comprehensive Client Family Assessment and Genogram
Tania Gonzalez Diaz
Walden University
NURS:6640
March 14,2020
Comprehensive Assessment
1. Demographic information: The patient is a 17-year-old black girl. She is escorted by her parents to the clinic after a recommendation from the school counsellor.
2. Presenting problem: According to the father, "our daughter is not feeling well. She has not been attending classes and she tried to commit suicide. We think she is depressed".
3. History of present illness.: On today visit, patient present awake, alert and oriented, calm, cooperative, organized, with good hygiene.According to the young girl who was ready to share her feelings, she started feeling pressure from schoolwork when she was in her junior year. Her grades were not so good, and she felt useless and that is why she started being a truant. One year later, after starting her senior year, she feels the pressure is too much and she cannot manage to go through the year. One day before being referred to the clinic by the school counsellor, she was found bleeding in the school washroom after she slit her wrist.
4. Past psychiatric history: Since her frustration with school started a year ago, she has never been diagnosed with any psychiatric disorder. The parents though that she was simply going through a phase as a teenager and they were trying to help her cope with school and be a better person. No past psychiatric history. No history of Abuse.
5. Medical history: Despite her recent issue and the fact that she lost her weight suddenly, in the past few months, she is of perfect health. she had asthma and chicken pox when she was young, and she is allergic to penicillin.
6. Substance use history: She has no history of substance abuse. Her parents describe her as a very good girl.
7. Developmental history: Her mother had a successful pregnancy and gave birth to her through normal delivery. She grew up with her older siblings and she achieved all developmental milestones. They have been going to church every Sunday and she is part of the local church youths. Her parents have been married for a while and they are still together. She went through her education as a bright girl until her junior high level when she started failing and missing classes.
8. Family psychiatric history: Her older sister has epilepsy, but her seizures remain under control. There is no other form of psychiatric history in the family
9. Psychosocial history: She has always been an active member of the church youth and they have been doing many activities together since they were in Sunday school. She has also been making many friends from high school but recently, she just wants to be alone
10. History of abuse and trauma: T ...
The patient is a 45-year-old married female who has been experiencing psychiatric symptoms for 12 years. She initially presented with fear, talking to herself, and suspicious behavior. Medications provided minimal relief and her condition has worsened over time. She now experiences auditory hallucinations, delusions that she is being harassed, and shows unpredictable and aggressive behavior. A mental status examination revealed impaired thought processes and insight.
This document summarizes a case report of a successful treatment of a 32-year-old woman suffering from depression for four years. She was experiencing symptoms like fear, aggression, loss of interest and suicidal thoughts. Through inpatient treatment including antidepressants, anxiolytics, ECTs, psychotherapy and social support, her condition improved within 10 days. On follow up after one year, she was effectively managing her family and work responsibilities with only mild antidepressant maintenance and reported improved quality of life. The case highlights the importance of comprehensive treatment and social support for improving women's mental health issues.
Case#1A 24-year-old male graduate student without prior medical .docxtroutmanboris
Case#1
A 24-year-old male graduate student without prior medical or psychiatric history is reported by his mother to have been very anxious over the past 6 months, with increasing concern that people are watching him. He now claims to “hearing voices,” telling him what must be done to “ fix the country.” Important workup ? thyroid-stimulating hormone TSH, rapid plasma reagain (RPR), and brain imaging.
Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better prognosis?
Case#2
Ms. Torrez is a 17-year-old Caucasian woman without prior psychiatric history who is brought to the Emergency room by ambulance after her parents called 911 when they found her having a seizure in their living room. She was admitted to the medical intensive care units in status epilepticus and was quickly stabilized with intramuscular lorazepam and fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She does not suffer any medical conditions, and this is her first seizure. Laboratory workup shows an electrolyte imbalance as the most likely cause of the seizures. Although initially reluctant, she admits to purging with the use of ipecac several times this week. She reports that although she normally restricts her daily caloric intake to 500 calories, she regularly induces vomiting if her weight is above 100 lbs. Her last menstrual cycle was 1 year ago. Psychiatric consultation is requested in order to confirm the diagnosis
The on-call psychiatry notes in Terry’s chart
Patient appears underweight and younger than her stated age. She is mild distress, has a nasogastric tube in place, and exhibits poor eye contact. She reports feeling “sad” and admitted to experiencing constant preoccupation about her physical appearance and says, “I am fat; I hate my body.” She also reports insomnia, low energy levels, and history of self-harm behavior by cutting her forearms. She reports that she is careful hiding her symptoms from her parents, whom she describes as strict disciplinarians. She also expresses concerns that she will disappoint them.
Ms. Torrez’ parents describe her as a perfectionist. They say that she is involve in multiple school activities, takes advanced placement classes, and has been recently concerned about being accepted at her college of choice. They report that she maintains a 4.0 grade point average in high school, and they are expecting her to become a lawyer. Her parents have noticed that she is underweight and rarely see her eat but attributed this to stress from her many academic pursuits. Ms. Torrez’ mom was diagnosed with obsessive-compulsive disorder.
Qu.
· Referral information Client reported that she has been struggli.docxalinainglis
· Referral information: Client reported that she has been struggling with her mental health and symptoms have been worsening since last year. Being recommended by CMH to agency. Client said she wants to "Getting to what I used to be, being able to get to a functioning level, take care of my child and work". Specifically need therapy, case management.
· History of presenting problem(s):
· She reported that she sleeps all day, has difficulties getting out of bed, has low energy, low motivation and has been unable to attend work, has been hopelessness, worthlessness, isolating and not able to tend to her activities of daily living. Stated that she has been endorsing symptoms of depression for "quite a while" and the past several months things have been worsening.
· She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019. She also has history of suicide attempts prior to the most recent attempt stating that in the past she "has many overdoses mostly on pills that were prescribed and Tylenol". She reported a history of self-harming thoughts and behaviors. Stated that in the summer and fall of 2019 she has cut self and prior to that she hasn't cut herself since her early 20s.
· Client works at a Senior day program in Ypsilanti and has housing at this time however is at risk of losing employment and housing due to her worsening symptoms and inability to care for herself.
· Bio-psycho-social-spiritual history:
· Biological domain: Client is a 35years old female-single with two children. White. She reported that she was previously on the following: Paxil, Celexa, Lexapro however all have been discontinued and uncertain why.
· Psychological domain: Denied any auditory of visual hallucinations or paranoia. She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019 with an attempt in august.
· Social domain: Born and raised in Dexter by both parents. Her parents are still together and alive. She has three siblings (two brothers and a sister) and client is the middle child. She stated that her siblings and her "get along but aren't super close". She reported a history of sexual assault.
She shares custody of her 4years old son with her ex. Her son has been staying mostly with his father due to her worsening depression. She stated that she hopes to get better soon so he can return to her home. She stated that when she spends time with her 4 years old son she feels "drained" after her son leaves. She worked at the senior center after earned a Bachelors in Social Work at EMU. Is at risk of losing her employ.
· Referral information Client reported that she has been struggli.docxodiliagilby
· Referral information: Client reported that she has been struggling with her mental health and symptoms have been worsening since last year. Being recommended by CMH to agency. Client said she wants to "Getting to what I used to be, being able to get to a functioning level, take care of my child and work". Specifically need therapy, case management.
· History of presenting problem(s):
· She reported that she sleeps all day, has difficulties getting out of bed, has low energy, low motivation and has been unable to attend work, has been hopelessness, worthlessness, isolating and not able to tend to her activities of daily living. Stated that she has been endorsing symptoms of depression for "quite a while" and the past several months things have been worsening.
· She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019. She also has history of suicide attempts prior to the most recent attempt stating that in the past she "has many overdoses mostly on pills that were prescribed and Tylenol". She reported a history of self-harming thoughts and behaviors. Stated that in the summer and fall of 2019 she has cut self and prior to that she hasn't cut herself since her early 20s.
· Client works at a Senior day program in Ypsilanti and has housing at this time however is at risk of losing employment and housing due to her worsening symptoms and inability to care for herself.
· Bio-psycho-social-spiritual history:
· Biological domain: Client is a 35years old female-single with two children. White. She reported that she was previously on the following: Paxil, Celexa, Lexapro however all have been discontinued and uncertain why.
· Psychological domain: Denied any auditory of visual hallucinations or paranoia. She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019 with an attempt in august.
· Social domain: Born and raised in Dexter by both parents. Her parents are still together and alive. She has three siblings (two brothers and a sister) and client is the middle child. She stated that her siblings and her "get along but aren't super close". She reported a history of sexual assault.
She shares custody of her 4years old son with her ex. Her son has been staying mostly with his father due to her worsening depression. She stated that she hopes to get better soon so he can return to her home. She stated that when she spends time with her 4 years old son she feels "drained" after her son leaves. She worked at the senior center after earned a Bachelors in Social Work at EMU. Is at risk of losing her employ ...
2Assessing ClientsA comprehensive assessment of the patient who p.docxBHANU281672
2Assessing Clients“A comprehensive assessment of the patient who presents for psychotherapy is necessary to develop an appropriate treatment plan. This assessment is a relational process that sets the tone for subsequent sessions” (Wheeler, 2014, p. 131). As a future Psychiatric Mental Health Nurse Practitioner, it is essential to be able to accurately assess clients to determine whether yourtherapeutic approach would contribute to improved clinical outcomes. The purpose of this assignment is to select a client that was observed or counseled at my practicum site and completea comprehensive client assessment and genogram for the client selected.Comprehensive Client AssessmentDemographic information for the client chosen is as follows: The client is a 27-year-old African female who resides in Maryland. She is a single, heterosexual, mother of fraternal twins,a boy and a girl. She was referred by her psychiatrist to the current counselor for psychotherapy and is primarily followed by the psychiatrist for medication management. The client has been receiving psychotherapy for the past two years. Her presenting problem revolves around learning how to be independent while coping with her mental illness. She stated, “I need help with figuring out my finances.” History of present illness: Client has a history of bipolar and presented to the office with complaints about her “baby daddy” not wanting to help her out with their children and about how difficult it’s going to be when her cousin stops keeping her twins because daycare is expensive. She also expressed discontent towards her father interfering in herpsychiatric care because he shares the same Nigerian ethnicity as her psychiatrist and she wants to be on less medication and receives more psychotherapy. The client’s past psychiatric history includes two psychiatric hospitalizations for manic episodes with psychosis. Medical history includes a previous diagnosis of hypertension (HTN), but that diagnosis was later removed. The
3client never took any medications for HTN diagnosis, and HTN resolved through life modifiers. Currently takes Lithium and Cogentin. The client has no substance use history, and developmental milestones were reached as expected. No family psychiatric history reported. Psychosocial history: She currently lives with her father. Her youngest brother and cousin, who is married, also reside in the same house. She works a full-time minimum wage job and is recently single. She has been in contact with her ex-boyfriend who is trying to ‘hook up’ with her to have sex. She is the mother of fraternal twins, a boy and a girl. No history of abuse or trauma.Psychiatric Review of SystemsClient denies “shortness of breath, heart palpitations, panic attacks, sweating flushing, hyperventilation, sense of doom, fear of death or collapse, cold or clammy skin, and tingling sensations in extremities” (Wheeler, 2014, p. 140). Client denies feeling sad, irritable, tired, h.
Running head: COMPREHENSIVE ASSESSMENT 1
COMPREHENSIVE ASSESSMENT 1
Comprehensive Client Family Assessment and Genogram
Tania Gonzalez Diaz
Walden University
NURS:6640
March 14,2020
Comprehensive Assessment
1. Demographic information: The patient is a 17-year-old black girl. She is escorted by her parents to the clinic after a recommendation from the school counsellor.
2. Presenting problem: According to the father, "our daughter is not feeling well. She has not been attending classes and she tried to commit suicide. We think she is depressed".
3. History of present illness.: On today visit, patient present awake, alert and oriented, calm, cooperative, organized, with good hygiene.According to the young girl who was ready to share her feelings, she started feeling pressure from schoolwork when she was in her junior year. Her grades were not so good, and she felt useless and that is why she started being a truant. One year later, after starting her senior year, she feels the pressure is too much and she cannot manage to go through the year. One day before being referred to the clinic by the school counsellor, she was found bleeding in the school washroom after she slit her wrist.
4. Past psychiatric history: Since her frustration with school started a year ago, she has never been diagnosed with any psychiatric disorder. The parents though that she was simply going through a phase as a teenager and they were trying to help her cope with school and be a better person. No past psychiatric history. No history of Abuse.
5. Medical history: Despite her recent issue and the fact that she lost her weight suddenly, in the past few months, she is of perfect health. she had asthma and chicken pox when she was young, and she is allergic to penicillin.
6. Substance use history: She has no history of substance abuse. Her parents describe her as a very good girl.
7. Developmental history: Her mother had a successful pregnancy and gave birth to her through normal delivery. She grew up with her older siblings and she achieved all developmental milestones. They have been going to church every Sunday and she is part of the local church youths. Her parents have been married for a while and they are still together. She went through her education as a bright girl until her junior high level when she started failing and missing classes.
8. Family psychiatric history: Her older sister has epilepsy, but her seizures remain under control. There is no other form of psychiatric history in the family
9. Psychosocial history: She has always been an active member of the church youth and they have been doing many activities together since they were in Sunday school. She has also been making many friends from high school but recently, she just wants to be alone
10. History of abuse and trauma: T ...
The patient is a 45-year-old married female who has been experiencing psychiatric symptoms for 12 years. She initially presented with fear, talking to herself, and suspicious behavior. Medications provided minimal relief and her condition has worsened over time. She now experiences auditory hallucinations, delusions that she is being harassed, and shows unpredictable and aggressive behavior. A mental status examination revealed impaired thought processes and insight.
This document summarizes a case report of a successful treatment of a 32-year-old woman suffering from depression for four years. She was experiencing symptoms like fear, aggression, loss of interest and suicidal thoughts. Through inpatient treatment including antidepressants, anxiolytics, ECTs, psychotherapy and social support, her condition improved within 10 days. On follow up after one year, she was effectively managing her family and work responsibilities with only mild antidepressant maintenance and reported improved quality of life. The case highlights the importance of comprehensive treatment and social support for improving women's mental health issues.
Case#1A 24-year-old male graduate student without prior medical .docxtroutmanboris
Case#1
A 24-year-old male graduate student without prior medical or psychiatric history is reported by his mother to have been very anxious over the past 6 months, with increasing concern that people are watching him. He now claims to “hearing voices,” telling him what must be done to “ fix the country.” Important workup ? thyroid-stimulating hormone TSH, rapid plasma reagain (RPR), and brain imaging.
Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better prognosis?
Case#2
Ms. Torrez is a 17-year-old Caucasian woman without prior psychiatric history who is brought to the Emergency room by ambulance after her parents called 911 when they found her having a seizure in their living room. She was admitted to the medical intensive care units in status epilepticus and was quickly stabilized with intramuscular lorazepam and fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She does not suffer any medical conditions, and this is her first seizure. Laboratory workup shows an electrolyte imbalance as the most likely cause of the seizures. Although initially reluctant, she admits to purging with the use of ipecac several times this week. She reports that although she normally restricts her daily caloric intake to 500 calories, she regularly induces vomiting if her weight is above 100 lbs. Her last menstrual cycle was 1 year ago. Psychiatric consultation is requested in order to confirm the diagnosis
The on-call psychiatry notes in Terry’s chart
Patient appears underweight and younger than her stated age. She is mild distress, has a nasogastric tube in place, and exhibits poor eye contact. She reports feeling “sad” and admitted to experiencing constant preoccupation about her physical appearance and says, “I am fat; I hate my body.” She also reports insomnia, low energy levels, and history of self-harm behavior by cutting her forearms. She reports that she is careful hiding her symptoms from her parents, whom she describes as strict disciplinarians. She also expresses concerns that she will disappoint them.
Ms. Torrez’ parents describe her as a perfectionist. They say that she is involve in multiple school activities, takes advanced placement classes, and has been recently concerned about being accepted at her college of choice. They report that she maintains a 4.0 grade point average in high school, and they are expecting her to become a lawyer. Her parents have noticed that she is underweight and rarely see her eat but attributed this to stress from her many academic pursuits. Ms. Torrez’ mom was diagnosed with obsessive-compulsive disorder.
Qu.
· Referral information Client reported that she has been struggli.docxalinainglis
· Referral information: Client reported that she has been struggling with her mental health and symptoms have been worsening since last year. Being recommended by CMH to agency. Client said she wants to "Getting to what I used to be, being able to get to a functioning level, take care of my child and work". Specifically need therapy, case management.
· History of presenting problem(s):
· She reported that she sleeps all day, has difficulties getting out of bed, has low energy, low motivation and has been unable to attend work, has been hopelessness, worthlessness, isolating and not able to tend to her activities of daily living. Stated that she has been endorsing symptoms of depression for "quite a while" and the past several months things have been worsening.
· She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019. She also has history of suicide attempts prior to the most recent attempt stating that in the past she "has many overdoses mostly on pills that were prescribed and Tylenol". She reported a history of self-harming thoughts and behaviors. Stated that in the summer and fall of 2019 she has cut self and prior to that she hasn't cut herself since her early 20s.
· Client works at a Senior day program in Ypsilanti and has housing at this time however is at risk of losing employment and housing due to her worsening symptoms and inability to care for herself.
· Bio-psycho-social-spiritual history:
· Biological domain: Client is a 35years old female-single with two children. White. She reported that she was previously on the following: Paxil, Celexa, Lexapro however all have been discontinued and uncertain why.
· Psychological domain: Denied any auditory of visual hallucinations or paranoia. She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019 with an attempt in august.
· Social domain: Born and raised in Dexter by both parents. Her parents are still together and alive. She has three siblings (two brothers and a sister) and client is the middle child. She stated that her siblings and her "get along but aren't super close". She reported a history of sexual assault.
She shares custody of her 4years old son with her ex. Her son has been staying mostly with his father due to her worsening depression. She stated that she hopes to get better soon so he can return to her home. She stated that when she spends time with her 4 years old son she feels "drained" after her son leaves. She worked at the senior center after earned a Bachelors in Social Work at EMU. Is at risk of losing her employ.
· Referral information Client reported that she has been struggli.docxodiliagilby
· Referral information: Client reported that she has been struggling with her mental health and symptoms have been worsening since last year. Being recommended by CMH to agency. Client said she wants to "Getting to what I used to be, being able to get to a functioning level, take care of my child and work". Specifically need therapy, case management.
· History of presenting problem(s):
· She reported that she sleeps all day, has difficulties getting out of bed, has low energy, low motivation and has been unable to attend work, has been hopelessness, worthlessness, isolating and not able to tend to her activities of daily living. Stated that she has been endorsing symptoms of depression for "quite a while" and the past several months things have been worsening.
· She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019. She also has history of suicide attempts prior to the most recent attempt stating that in the past she "has many overdoses mostly on pills that were prescribed and Tylenol". She reported a history of self-harming thoughts and behaviors. Stated that in the summer and fall of 2019 she has cut self and prior to that she hasn't cut herself since her early 20s.
· Client works at a Senior day program in Ypsilanti and has housing at this time however is at risk of losing employment and housing due to her worsening symptoms and inability to care for herself.
· Bio-psycho-social-spiritual history:
· Biological domain: Client is a 35years old female-single with two children. White. She reported that she was previously on the following: Paxil, Celexa, Lexapro however all have been discontinued and uncertain why.
· Psychological domain: Denied any auditory of visual hallucinations or paranoia. She reported that she currently doesn't have any thoughts of hurting self however has a history of suicidal thoughts including attempts. Stated that she has had suicidality all throughout the Fall of 2019 with an attempt in august.
· Social domain: Born and raised in Dexter by both parents. Her parents are still together and alive. She has three siblings (two brothers and a sister) and client is the middle child. She stated that her siblings and her "get along but aren't super close". She reported a history of sexual assault.
She shares custody of her 4years old son with her ex. Her son has been staying mostly with his father due to her worsening depression. She stated that she hopes to get better soon so he can return to her home. She stated that when she spends time with her 4 years old son she feels "drained" after her son leaves. She worked at the senior center after earned a Bachelors in Social Work at EMU. Is at risk of losing her employ ...
2Assessing ClientsA comprehensive assessment of the patient who p.docxBHANU281672
2Assessing Clients“A comprehensive assessment of the patient who presents for psychotherapy is necessary to develop an appropriate treatment plan. This assessment is a relational process that sets the tone for subsequent sessions” (Wheeler, 2014, p. 131). As a future Psychiatric Mental Health Nurse Practitioner, it is essential to be able to accurately assess clients to determine whether yourtherapeutic approach would contribute to improved clinical outcomes. The purpose of this assignment is to select a client that was observed or counseled at my practicum site and completea comprehensive client assessment and genogram for the client selected.Comprehensive Client AssessmentDemographic information for the client chosen is as follows: The client is a 27-year-old African female who resides in Maryland. She is a single, heterosexual, mother of fraternal twins,a boy and a girl. She was referred by her psychiatrist to the current counselor for psychotherapy and is primarily followed by the psychiatrist for medication management. The client has been receiving psychotherapy for the past two years. Her presenting problem revolves around learning how to be independent while coping with her mental illness. She stated, “I need help with figuring out my finances.” History of present illness: Client has a history of bipolar and presented to the office with complaints about her “baby daddy” not wanting to help her out with their children and about how difficult it’s going to be when her cousin stops keeping her twins because daycare is expensive. She also expressed discontent towards her father interfering in herpsychiatric care because he shares the same Nigerian ethnicity as her psychiatrist and she wants to be on less medication and receives more psychotherapy. The client’s past psychiatric history includes two psychiatric hospitalizations for manic episodes with psychosis. Medical history includes a previous diagnosis of hypertension (HTN), but that diagnosis was later removed. The
3client never took any medications for HTN diagnosis, and HTN resolved through life modifiers. Currently takes Lithium and Cogentin. The client has no substance use history, and developmental milestones were reached as expected. No family psychiatric history reported. Psychosocial history: She currently lives with her father. Her youngest brother and cousin, who is married, also reside in the same house. She works a full-time minimum wage job and is recently single. She has been in contact with her ex-boyfriend who is trying to ‘hook up’ with her to have sex. She is the mother of fraternal twins, a boy and a girl. No history of abuse or trauma.Psychiatric Review of SystemsClient denies “shortness of breath, heart palpitations, panic attacks, sweating flushing, hyperventilation, sense of doom, fear of death or collapse, cold or clammy skin, and tingling sensations in extremities” (Wheeler, 2014, p. 140). Client denies feeling sad, irritable, tired, h.
Comprehensive Psychiatric Evaluation Essay Example Paper.docx4934bk
The patient is a 40-year-old African American male who presents with depressive symptoms such as lack of interest, isolation, irritability, crying, overeating, and sleep problems. Based on diagnostic tests, he is diagnosed with major depressive disorder and moderate dementia. The treatment plan involves cognitive behavioral therapy and antidepressant medication with Duloxetine to target his depressive symptoms and improve his quality of life. Regular follow-ups will also be conducted to monitor his progress and medication adherence.
Diagnostic Skill Application IIFor this assignment, you are prov.docxmariona83
Diagnostic Skill Application II
For this assignment, you are provided with four case studies. Review the cases of Julio and Kimi and choose either Reese or Daneer for the third case.
The Case of Julio:
Julio is a 36-year-old single gay male. He is of Cuban descent. He was born and raised in Florida by his parents with his two sisters. He attended community college but did not follow through with his plan to obtain a four-year degree, because his poor test taking skills created barriers. He currently works for a sales promotion company, where he is tasked with creating ads for local businesses. He enjoys the more social aspects of his job, but tracking the details is challenging and has caused him to lose jobs in the past. He has been dating his partner, Justin, for five years. Justin feels it is time for them to commit and build a future. Justin is frustrated that Julio refuses to plan the wedding and tends to blame Julio’s family. While Julio’s parents hold some traditional religious values, they would welcome Justin into the family but are respectfully waiting for Julio to make his plans known. Justin is as overwhelmed by the details at home as he is at work.
The Case of Kimi:
Kimi is a 48-year-old female currently separated from her husband, Robert, of 16 years. They have no children, which was consistent with Kimi’s desire to focus on her career as a sales manager. She told Robert a pregnancy would wreck her efforts to maintain her body. His desire to have a family was a goal he decided he needed to pursue with someone else. He left Kimi six months ago for a much younger woman and filed for divorce. Kimi began having issues with food during high school when she was on the dance team and felt self-conscious wearing the form-fitting uniform. During college, she sought treatment because her roommate became alarmed by her issues around eating. She never told her parents about this and felt it was behind her. Her parents are Danish and value privacy. They always expected Kimi to be independent. Her lack of communication about her private life did not concern them. They are troubled by Robert’s behavior and consider his conspicuous infidelity as a poor reflection upon their family. Kimi has moved in with her parents while she and Robert are selling the house, which has upended the balance in their relationship.
For a third case, choose one of these videos:
The Case of Reese:
Reese is a 44-year-old married African American female. Her parents live in another state, and she is their only child. Her father is a retired Marine Lieutenant Colonel who was stationed both in the United States and overseas while Reese was growing up. She entered the Air Force as soon as she graduated high school at age 17 and has achieved the rank of Chief Master Sergeant. She has been married 15 years to John, and they recently discovered she is pregnant. The unexpected pregnancy has been quite disorienting for someone who has planned and structured major decision he.
Case Study Treatment PlanIntroductionStellaOscarIntroductionFor yo.docxketurahhazelhurst
Case Study Treatment PlanIntroductionStellaOscarIntroduction
For your course project, you will develop a treatment plan for one case study subject that you select from two possible candidates. These potential clients are ethnically diverse and are struggling with psychological disorders, which may require medication.
During the course of this project you will:Evaluate client information.Review possible assessment techniques.Offer a diagnostic impression.Review various behavioral and pharmacological treatments.Discuss the legal and ethical ramifications of the disorder and proposed treatments.Review the impact of diversity issues on various disorders and their treatments.Develop a suggested treatment plan for the client.
You will select one of the case studies presented on the next page of this presentation as your client for this treatment plan project. Then you will use the Case Study Treatment Plan Template, provided in the Resources to complete your assignments for this project. Each section of the template includes a description of the type of information you will need to include. You should type your paper directly into this template, save it as a Word document with your name, and then submit it to the assignment area.Stella's Case Study
Stella is a 38 year old biracial (African American and Native American) woman who has just been assigned to you as a client. You are currently working as a counselor for your county community mental health agency. You received the following information about her as background and history.
Stella is the only child of a Caucasian couple who are now deceased. She was adopted as an infant in a closed adoption, so that none of her birth parents' records are available. The only informal information that Stella remembers her parents telling her is that her mother was 16 years old at the time of Stella's birth and had been raped while at a high school football game.
Stella currently lives in a small city of 150,000 people where she is employed as a book-keeper for the local meat packing plant. She has worked there for 3 years. Her educational background includes an associate's degree in accounting and continuing education in tax preparation. Before working for this plant, she was employed as a tax preparer for a national company. She enjoys her work, saying that numbers are easier to get along with than people.
She has been married to her husband (Doug) for 18 years and has a 16 year old son (Tyrone), who is currently a junior in high school. Her son plays baseball on the school team and is a solid B student. Her husband is a long distance truck driver. He is often away from home for two weeks at a time. He is then at home for 3 to 4 days before he leaves on another trip. Stella reports that she stays at home and feels "blue" when her husband is on the road. Although there have been some problems in the marriage due to Stella's mental health concerns, the couple seems committed to each other and to staying in t ...
The document contains details of three case studies of patients with psychological disorders.
Case A involves a 24-year-old male driver who developed obsessions with cleanliness and compulsions like repetitive hand washing. He was diagnosed with obsessive-compulsive disorder based on symptoms meeting diagnostic criteria. Treatment involved medication and cognitive behavioral therapy like exposure and response prevention.
Case B describes a 29-year-old male teacher presenting with mood issues, abdominal pain, irritability and suicidal thoughts. He has a family history of mental illness. Testing showed moderate depression and he was diagnosed with somatization disorder. Treatment focused on psychotherapy and pharmacotherapy.
Case C provides limited details of a 42-year-old male driver
Sheela was a 30-year-old mother of four who lived in a small village and had just given birth to her fourth child three months ago without any medical care. She began exhibiting signs of depression a month after birth, becoming reclusive and neglecting her children, but her family was indifferent. One day when the family was working, Sheela set herself on fire and walked out of the house, later dying from her burns in the hospital. Her death could have been prevented with antenatal/postnatal care, recognition of her high-risk status and postpartum depression symptoms, and more support from her family.
Understanding cultural differences is a very important aspect of d.docxjolleybendicty
Understanding cultural differences is a very important aspect of delivering health care to various populations who have immigrated to the United States from various parts of the world. Collaborating with others to explore these differences allows you to gather varying viewpoints on these differences and how they might impact health care delivery.
Part I: Individual work
Select 1 chapter in The Spirit Catches You and You Fall Down that discusses Hmong history (Ch. 8 to 14) to read individually.
Write a 350-word summary of the chapter that includes the following:
·
Identify the historical events or cultural practices in your selected chapter.
·
Examine and describe how these differences create disparities between U.S. health care and the Hmong in California.
Share your summary with your team.
Part IA: Teamwork
Discuss as a team the key historical events or cultural practices you each found in your reading and summary.
As a team,
identify commonalities of Hmong history and cultural practices that recur throughout the chapters.
Create a list of 3 to 5 key cultural practices or factors that could impact health care program delivery to the Hmong community. Include a 2- to 3-sentence description to support your choices
.(All you need to do is come up with 1 key cultural with a 2-3 sentence description for this part)
Part B: Individual Reflection:
Write a 350-word summary explaining how the 3- to 5-key factors your team identified apply to the chapter you read. Describe how these factors impact the differences in disparities between U.S. health care and the Hmong in California.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
PART2::: DISCUSSION QUESTION
Visit the
Child Welfare Information Gateway.
· What are the primary responsibilities of the health care industry in preventing child abuse and neglect, responding to child abuse and neglect, and supporting and preserving families?
· What circumstances should be present (or what considerations should be made) before removing a child from the guardianship of the parent?
Include sources/references to support your perspective.
Classmate1:
Summary There were many historical events and cultural practices in the Hmong culture. First of all it was so hard to appropriately treat Lia's epilepsy due to unfortunate circumstances. The family had their cultural beliefs and secondly there was a language barrier that stood in the way, that did not allow them to fully understand the diagnosis, and the severity if not treated. They believed that the seizures she was having made her special. They believed in traditional healing per their cultural beliefs, and this was was to call back her soul. They believed that tradi.
The Hernandez family was referred for therapy due to concerns about their harsh disciplinary style. Both parents reported experiencing severe punishment as children. They believe strict discipline is necessary and part of their culture. The therapist's goals are to explore the family's parenting styles, create awareness of alternative discipline techniques, and address any stress or anger issues that may influence their methods. Treatment will involve family therapy, CBT, and behavioral learning approaches.
Answer below discussion. Two paragraphs and two references no later .docxnolanalgernon
Answer below discussion. Two paragraphs and two references no later than 5 years.
This week’s discussion questions caused a lot of reflection on how I practice nursing. The questions led me to reflect on what type of nurse I am. Am I doing the best I can, or have I done the best I could? While considering the six ways of knowing I kept coming back to unknowing. The act of being unaware or not being able to fully understand what the patient is experiencing or going through (Heath, 1998). That is how I approach every patient. I have no preconceived notion that I have even the faintest idea of what they must be feeling. It is the ability to be fully present of yourself and open to the patient and their life. The other is empirical knowing. Empirical knowing is the first introduction we have in nursing school. Understanding the science, the epidemiology, the physical nature of the illness or medical situation. I believe there is a lot of value in empirical knowing, as the patients want us to know why and how to do what we do. They place a lot of trust in us to do the right thing. It is part of our daily responsibility to assess and monitor therapeutic response to treatment (Zander, 2007).
Though the entire 6 ways of knowing were brand new to me and it took me some time to reflect on my understanding of these concepts, I fear the two I have put the least focus on in the past but am keenly aware of their implications are emancipatory and aesthetic knowing. This is not to say that I did not practice the art of nursing, using my years of experience to draw on and I am astutely aware of the social, cultural, and political implications of those in my care. I never was able to put a name or definition to them. Emancipatory knowing, the ability to be astutely aware of the social injustices and be able to act in a way to reduce the negative impact of these inequalities (Peart & MacKinnon 2018). Aesthetic knowing, the ability to interpret the patient’s behavior or expression of self and then asking what this means (Zander, 2007). Aesthetic knowing in a simpler phrase might be considered that gut feeling a nurse often refers to.
I am reminded of a recent experience I had when I was given the privilege to assist another nurse on a home visit. This nurse is an incredible pediatric nurse. I admire her aesthetic way of knowing and how she is so patient and kind with the children she cares for. This young boy, age 11, was recently diagnosed with Pediatric Autoimmune Neurological Disorders Associated with Streptococcal Infections (PANDAS). It is a horrid and unexpected disease that takes an otherwise perfectly healthy child and they become severely paranoid, have expressions of sudden onset OCD type behaviors, and a myriad of other symptoms (International OCD Foundation, n.d.). This young boy was to receive Intravenous Immunoglobulin (IVIG) at his home, requiring placement of a peripheral IV. I was called in for re.
The document outlines the objectives and case study of cirrhosis of the liver. It provides background information on the patient, including their health history, family history, physical examination findings, and developmental tasks. The key objectives of the case study are to gain in-depth knowledge of cirrhosis, gain confidence in handling similar cases, and fulfill partial course objectives. Cirrhosis is selected as it is a common cause of liver disease in the region due to alcoholism.
Behavioral Disorder: Schizophrenia & it's Case Study.pdfSELF-EXPLANATORY
This pdf is about the Behavioral Disorder: Schizophrenia & it's Case Study.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
Thanks...!
A 12-year-old female client wrote a suicide note and gave it to a friend after being molested by her stepfather for 2 years and 9 months. She previously attempted suicide. The client lives with her mother and has no siblings. She has a court appearance regarding the abuse and is increasingly frightened and depressed. The physician recommends inpatient treatment to address her suicide attempts and history of sexual abuse.
1. Social Work Research Couples CounselingKathleen is a 37-year.docxbraycarissa250
1. Social Work Research: Couples Counseling
Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.
Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.
Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.
I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.
I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.
The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on.
1. Social Work Research Couples CounselingKathleen is a 37-year.docxjeremylockett77
1. Social Work Research: Couples Counseling
Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.
Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.
Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.
I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.
I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.
The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on ...
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
12Working With FamiliesThe Case of Carol and JosephCa.docxAlyciaGold776
12
Working With Families:
The Case of Carol and Joseph
Carol is a 23-year-old, heterosexual, Caucasian female and the
mother of a 1-year-old baby girl. She is currently unemployed,
having previously worked for a house cleaning company. The
baby is healthy and developmentally on target, and she and the
parents appear to be well bonded with one another. Carol lives in
a rented house with her husband, Joseph. Joseph is a 27-year-old,
heterosexual, Hispanic male. He was recently arrested at their
home for a drug deal, which he asserts was a setup. Both parents
were charged with child endangerment because weapons were
found in the child’s crib and drugs were found in the home. The
parents assert that the child never sleeps in the crib but in their
bed. As a result of the parents’ arrest, social services was notified,
and the child was temporarily placed in a kinship care arrangement
with the maternal grandmother, who resides nearby. As a
result of Joseph’s arrest, he was fired from the cleaning company
where he worked, and the family is now experiencing financial
difficulties.
After initial contact was made with the parents, a number of
concerns were noted and the family was recommended for additional
case management. Carol’s mother indicated that she had
concerns about Carol’s drinking habits and stated that Carol’s
father and grandfather were alcoholics. She and the father separated
when Carol was a baby, and Carol has had only limited
contact with him. There appears to be significant tension between
the grandmother and Carol and Joseph. I addressed the alcohol
issue with both parents, who denied there was a problem, but
shortly after the discussion, Carol was involved in a serious car
accident with the baby in the car. She was determined to have been
under the influence of alcohol. I advised Carol that she could not
have any unsupervised contact with her child until she completed
intensive inpatient substance abuse treatment. I made arrangements
for her placement, but after a week, she was discharged
for noncompliance with the rules. She was then referred to an
intensive outpatient program and began therapy there. Initially
her attendance was erratic because she had lost her license as a
result of the DUI. Eventually, however, she became engaged in the
program and began to address her issues. She acknowledged that
she had started using drugs at a very young age but said that she
had only begun drinking in the previous year or so. We discussed
the genetics of her family, and she said that she realized that she
had deteriorated rapidly since beginning to drink and knew that
she simply could not drink alcohol.
Joseph’s mother is deceased, and his father travels extensively
in his job and is not available as a support. Joseph was
very devoted to his mother and was devastated by her premature
death. We discussed the strengths that he and Carol demonstrated
in staying together and working out their p.
This document presents a case report of an 18-year-old unmarried female student experiencing abnormal behavior, mutism, and decreased functioning for one month. Her father reports she began hearing voices commenting on her activities one month ago. Upon evaluation, she displayed bizarre postures, staring, stopped speaking a week ago, and decreased eating and sleeping for seven days. Her maternal grandmother had similar complaints. On examination, she was mute, not responding to commands, and maintaining rigid posture. Her mental status revealed decreased functioning and a flat affect.
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
A 53-year-old Caucasian male presented with symptoms of psychosis including delusions of people outside trying to harm him and poisoning his food on TV. He reported insomnia, paranoia, and hearing voices for weeks. His medical history included diabetes. A differential diagnosis of schizophrenia, schizoaffective disorder, and delusional of persecution was considered. The patient was started on antipsychotic medication and referred for supportive therapy and monitoring of his symptoms and medication side effects.
Rogerian ArgumentTaken from the principles of psychologi.docxdaniely50
Rogerian Argument
Taken from the principles of psychologist Carl Rogers
Origins of this
principle
Based on Carl Rogers’ theory that people involved in disputes should not respond to each other until they fully and fairly state the other person’s position.
4 Parts of the Rogerian Argument
1. Introduction
2. Contexts
3. Writer’s position
4. Benefits to opponent
1. Introduction
The writer describes an issue well enough to show that he/she fully understands and respects the alternative position.
“Let’s meet in the middle.”
2. Contexts
The writer describes cases/contexts in which the alternative position may be legitimate.
“You may be right sometimes…”
3. Writer’s
Position
The writer states her/his position and presents circumstances in which it is valid. This is where the writer supports her/his views with evidence.
“This is why my position is right.”
4. Benefits to
Opponent
The writer explains to the opponent how he/she would benefit from adopting the writer’s position.
“See what you might gain by agreeing
with me?”
Summation
Rogerian arguments steer clear of incendiary and stereotypical language.
They emphasize how both sides of the argument might benefit by working together.
They advocate a win-win outcome.
1
Comprehensive Client Family Assessment
Demographic Information
Date of assessment: 09/14/2018.
DOB: 011/01/1970.
Age: 48.
Race: Black.
SSN: 000000001. Ethnicity: African American.
Address: On file. Tel: 972-000-0000.
Residential Status: Homeless.
County: 9K. Military Status: None.
Language: English.
Interpreter Needed: No.
Primary Insurance: Uninsured.
Annual Gross Income: $0.
Employment Status: Unemployed.
Number of people in the household: 1.
Highest Grade: 11.
School Attendance for the past 3 Months: None.
Arrival Time: 1000 Time Disposition Completed: 1100
Location of client: Lake Worth Nursing Home
Presenting Problem
“My meds are not working.”
History of Present Illness
The patient is presenting with suicidal ideation with a plan and intent to jump off the bridge or self-stabs with a knife. The patient complained about his medication, Latuda is no longer working. Currently homeless with no job or income. Though calm, polite, and cooperative with organized thoughts, patient reports depression and anxiety (American Psychiatric Association, 2013).
Past psychiatric history
1- Major Depressive disorder, Recurrent Episode with psychotic features
2- Alcohol use disorder; severe
3- Bipolar I Disorder most recent episode depressed Severe
Medical history
None Reported
Substance use history
Alcohol Abuse: began drinking at age 15 and drinks 8 to 10 bottles of beer daily, yesterday was his last time he drank.
Developmental history
None Reported
Family psychiatric history
Positive for family history of mental illness on the paternal side.
Psychosocial history
The patient is unemployed and enjoys han.
The document discusses several prominent nursing theories:
- Henderson's 14 components of basic human needs that form the basis of nursing care.
- Orem's self-care deficit theory which identifies patient needs through assessment and focuses on developing self-care abilities.
- Roy's adaptation model which views individuals as systems striving for balance between stimuli. The model is used to assess a patient with a non-healing wound.
- Pender's health promotion model which aims to predict health behaviors and was applied to a case of smoking cessation counseling.
- Johnson's behavioral systems model which advocates fostering efficient behavioral functioning through assessment of seven behavioral subsystems.
You will submit your proposal as a text-based Word or PDF file. AnastaciaShadelb
You will submit your proposal as a text-based Word or PDF file.
Your research proposal should include the following:
Your selected global ethical dilemma
Background/explanation of why this is a global ethical issue
Make connections to issues of cultural diversity
Research question
Two scholarly, peer-reviewed sources connected to your selected topic (cited in current APA format)
***NOTE***
RESEARCH IS ON GENDER DISCRIMINATION
...
What is Family Resource Management and why is it important to tAnastaciaShadelb
"What is Family Resource Management and why is it important to today's American family?"
Goldsmith, E. B., & GOLDSMITH, E. B. (2003). Resource Management. In J. J. Ponzetti Jr. (Ed.),
International encyclopedia of marriage and family
(2nd ed.). Farmington, MI: Gale. Retrieved from
RESOURCE MANAGEMENT
from
International Encyclopedia of Marriage and Family
Resource management
is the process in which individuals and families use what they have to get what they want. It begins with thinking and planning and ends with the evaluation of actions taken. Three fundamental concepts in resource management are
values, goals
, and
decision making.
Values such as honesty and trust are principles that guide behavior. They are desirable or important and serve as underlying motivators. Values determine goals, which are sought-after end results. Goals can be implicit or explicit. They can be short-term, intermediate-, or long-term. Decisions are conclusions or judgments about some issue or matter.
Decision making
involves choosing between two or more alternatives and follows a series of steps from inception to evaluation.
Through choices, individuals and families define their lives and influence the lives of others. The study of resource management focuses on order, choices, and control, and how people use time, energy, money, physical space, and information. As an applied social science, it is an academic field that is fundamental to our understanding of human behavior. "The knowledge obtained through the study of management is evaluated in light of its ability to make an individual's or family's management practice more effective" (Goldsmith 2000, p. 5).
Individuals and families have characteristic ways of making decisions and acting called their
management style.
Although similar styles are exhibited within families (such as a tendency to be on time or to finish tasks to completion), there are also wide ranges of styles within families making the study of management intrinsically interesting, especially from a
socialization
point of view. Why do such differences exist and how does the individual's style mesh with that of the other members' styles in the family?
Measuring devices, techniques, or instruments that are used to make decisions and plan courses of action are called management tools. For example, time is a resource and a clock or stopwatch is a management tool.
Resources can be divided up into human and material resources, assets that people have at their disposal.
Material resources
(e.g., bridges, roads, houses) decline through use whereas
human resources
(e.g., the ability to read, ride a bicycle) improve or increase through use.
Human capital
describes the sum total of a person's abilities, knowledge, and skills. Education is one way to develop human capital. Related to this is the concept of social capital. The term
social capital
is gaining in importance in the family-relations field and management is considered ...
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For this assignment, you are provided with four case studies. Review the cases of Julio and Kimi and choose either Reese or Daneer for the third case.
The Case of Julio:
Julio is a 36-year-old single gay male. He is of Cuban descent. He was born and raised in Florida by his parents with his two sisters. He attended community college but did not follow through with his plan to obtain a four-year degree, because his poor test taking skills created barriers. He currently works for a sales promotion company, where he is tasked with creating ads for local businesses. He enjoys the more social aspects of his job, but tracking the details is challenging and has caused him to lose jobs in the past. He has been dating his partner, Justin, for five years. Justin feels it is time for them to commit and build a future. Justin is frustrated that Julio refuses to plan the wedding and tends to blame Julio’s family. While Julio’s parents hold some traditional religious values, they would welcome Justin into the family but are respectfully waiting for Julio to make his plans known. Justin is as overwhelmed by the details at home as he is at work.
The Case of Kimi:
Kimi is a 48-year-old female currently separated from her husband, Robert, of 16 years. They have no children, which was consistent with Kimi’s desire to focus on her career as a sales manager. She told Robert a pregnancy would wreck her efforts to maintain her body. His desire to have a family was a goal he decided he needed to pursue with someone else. He left Kimi six months ago for a much younger woman and filed for divorce. Kimi began having issues with food during high school when she was on the dance team and felt self-conscious wearing the form-fitting uniform. During college, she sought treatment because her roommate became alarmed by her issues around eating. She never told her parents about this and felt it was behind her. Her parents are Danish and value privacy. They always expected Kimi to be independent. Her lack of communication about her private life did not concern them. They are troubled by Robert’s behavior and consider his conspicuous infidelity as a poor reflection upon their family. Kimi has moved in with her parents while she and Robert are selling the house, which has upended the balance in their relationship.
For a third case, choose one of these videos:
The Case of Reese:
Reese is a 44-year-old married African American female. Her parents live in another state, and she is their only child. Her father is a retired Marine Lieutenant Colonel who was stationed both in the United States and overseas while Reese was growing up. She entered the Air Force as soon as she graduated high school at age 17 and has achieved the rank of Chief Master Sergeant. She has been married 15 years to John, and they recently discovered she is pregnant. The unexpected pregnancy has been quite disorienting for someone who has planned and structured major decision he.
Case Study Treatment PlanIntroductionStellaOscarIntroductionFor yo.docxketurahhazelhurst
Case Study Treatment PlanIntroductionStellaOscarIntroduction
For your course project, you will develop a treatment plan for one case study subject that you select from two possible candidates. These potential clients are ethnically diverse and are struggling with psychological disorders, which may require medication.
During the course of this project you will:Evaluate client information.Review possible assessment techniques.Offer a diagnostic impression.Review various behavioral and pharmacological treatments.Discuss the legal and ethical ramifications of the disorder and proposed treatments.Review the impact of diversity issues on various disorders and their treatments.Develop a suggested treatment plan for the client.
You will select one of the case studies presented on the next page of this presentation as your client for this treatment plan project. Then you will use the Case Study Treatment Plan Template, provided in the Resources to complete your assignments for this project. Each section of the template includes a description of the type of information you will need to include. You should type your paper directly into this template, save it as a Word document with your name, and then submit it to the assignment area.Stella's Case Study
Stella is a 38 year old biracial (African American and Native American) woman who has just been assigned to you as a client. You are currently working as a counselor for your county community mental health agency. You received the following information about her as background and history.
Stella is the only child of a Caucasian couple who are now deceased. She was adopted as an infant in a closed adoption, so that none of her birth parents' records are available. The only informal information that Stella remembers her parents telling her is that her mother was 16 years old at the time of Stella's birth and had been raped while at a high school football game.
Stella currently lives in a small city of 150,000 people where she is employed as a book-keeper for the local meat packing plant. She has worked there for 3 years. Her educational background includes an associate's degree in accounting and continuing education in tax preparation. Before working for this plant, she was employed as a tax preparer for a national company. She enjoys her work, saying that numbers are easier to get along with than people.
She has been married to her husband (Doug) for 18 years and has a 16 year old son (Tyrone), who is currently a junior in high school. Her son plays baseball on the school team and is a solid B student. Her husband is a long distance truck driver. He is often away from home for two weeks at a time. He is then at home for 3 to 4 days before he leaves on another trip. Stella reports that she stays at home and feels "blue" when her husband is on the road. Although there have been some problems in the marriage due to Stella's mental health concerns, the couple seems committed to each other and to staying in t ...
The document contains details of three case studies of patients with psychological disorders.
Case A involves a 24-year-old male driver who developed obsessions with cleanliness and compulsions like repetitive hand washing. He was diagnosed with obsessive-compulsive disorder based on symptoms meeting diagnostic criteria. Treatment involved medication and cognitive behavioral therapy like exposure and response prevention.
Case B describes a 29-year-old male teacher presenting with mood issues, abdominal pain, irritability and suicidal thoughts. He has a family history of mental illness. Testing showed moderate depression and he was diagnosed with somatization disorder. Treatment focused on psychotherapy and pharmacotherapy.
Case C provides limited details of a 42-year-old male driver
Sheela was a 30-year-old mother of four who lived in a small village and had just given birth to her fourth child three months ago without any medical care. She began exhibiting signs of depression a month after birth, becoming reclusive and neglecting her children, but her family was indifferent. One day when the family was working, Sheela set herself on fire and walked out of the house, later dying from her burns in the hospital. Her death could have been prevented with antenatal/postnatal care, recognition of her high-risk status and postpartum depression symptoms, and more support from her family.
Understanding cultural differences is a very important aspect of d.docxjolleybendicty
Understanding cultural differences is a very important aspect of delivering health care to various populations who have immigrated to the United States from various parts of the world. Collaborating with others to explore these differences allows you to gather varying viewpoints on these differences and how they might impact health care delivery.
Part I: Individual work
Select 1 chapter in The Spirit Catches You and You Fall Down that discusses Hmong history (Ch. 8 to 14) to read individually.
Write a 350-word summary of the chapter that includes the following:
·
Identify the historical events or cultural practices in your selected chapter.
·
Examine and describe how these differences create disparities between U.S. health care and the Hmong in California.
Share your summary with your team.
Part IA: Teamwork
Discuss as a team the key historical events or cultural practices you each found in your reading and summary.
As a team,
identify commonalities of Hmong history and cultural practices that recur throughout the chapters.
Create a list of 3 to 5 key cultural practices or factors that could impact health care program delivery to the Hmong community. Include a 2- to 3-sentence description to support your choices
.(All you need to do is come up with 1 key cultural with a 2-3 sentence description for this part)
Part B: Individual Reflection:
Write a 350-word summary explaining how the 3- to 5-key factors your team identified apply to the chapter you read. Describe how these factors impact the differences in disparities between U.S. health care and the Hmong in California.
Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).
PART2::: DISCUSSION QUESTION
Visit the
Child Welfare Information Gateway.
· What are the primary responsibilities of the health care industry in preventing child abuse and neglect, responding to child abuse and neglect, and supporting and preserving families?
· What circumstances should be present (or what considerations should be made) before removing a child from the guardianship of the parent?
Include sources/references to support your perspective.
Classmate1:
Summary There were many historical events and cultural practices in the Hmong culture. First of all it was so hard to appropriately treat Lia's epilepsy due to unfortunate circumstances. The family had their cultural beliefs and secondly there was a language barrier that stood in the way, that did not allow them to fully understand the diagnosis, and the severity if not treated. They believed that the seizures she was having made her special. They believed in traditional healing per their cultural beliefs, and this was was to call back her soul. They believed that tradi.
The Hernandez family was referred for therapy due to concerns about their harsh disciplinary style. Both parents reported experiencing severe punishment as children. They believe strict discipline is necessary and part of their culture. The therapist's goals are to explore the family's parenting styles, create awareness of alternative discipline techniques, and address any stress or anger issues that may influence their methods. Treatment will involve family therapy, CBT, and behavioral learning approaches.
Answer below discussion. Two paragraphs and two references no later .docxnolanalgernon
Answer below discussion. Two paragraphs and two references no later than 5 years.
This week’s discussion questions caused a lot of reflection on how I practice nursing. The questions led me to reflect on what type of nurse I am. Am I doing the best I can, or have I done the best I could? While considering the six ways of knowing I kept coming back to unknowing. The act of being unaware or not being able to fully understand what the patient is experiencing or going through (Heath, 1998). That is how I approach every patient. I have no preconceived notion that I have even the faintest idea of what they must be feeling. It is the ability to be fully present of yourself and open to the patient and their life. The other is empirical knowing. Empirical knowing is the first introduction we have in nursing school. Understanding the science, the epidemiology, the physical nature of the illness or medical situation. I believe there is a lot of value in empirical knowing, as the patients want us to know why and how to do what we do. They place a lot of trust in us to do the right thing. It is part of our daily responsibility to assess and monitor therapeutic response to treatment (Zander, 2007).
Though the entire 6 ways of knowing were brand new to me and it took me some time to reflect on my understanding of these concepts, I fear the two I have put the least focus on in the past but am keenly aware of their implications are emancipatory and aesthetic knowing. This is not to say that I did not practice the art of nursing, using my years of experience to draw on and I am astutely aware of the social, cultural, and political implications of those in my care. I never was able to put a name or definition to them. Emancipatory knowing, the ability to be astutely aware of the social injustices and be able to act in a way to reduce the negative impact of these inequalities (Peart & MacKinnon 2018). Aesthetic knowing, the ability to interpret the patient’s behavior or expression of self and then asking what this means (Zander, 2007). Aesthetic knowing in a simpler phrase might be considered that gut feeling a nurse often refers to.
I am reminded of a recent experience I had when I was given the privilege to assist another nurse on a home visit. This nurse is an incredible pediatric nurse. I admire her aesthetic way of knowing and how she is so patient and kind with the children she cares for. This young boy, age 11, was recently diagnosed with Pediatric Autoimmune Neurological Disorders Associated with Streptococcal Infections (PANDAS). It is a horrid and unexpected disease that takes an otherwise perfectly healthy child and they become severely paranoid, have expressions of sudden onset OCD type behaviors, and a myriad of other symptoms (International OCD Foundation, n.d.). This young boy was to receive Intravenous Immunoglobulin (IVIG) at his home, requiring placement of a peripheral IV. I was called in for re.
The document outlines the objectives and case study of cirrhosis of the liver. It provides background information on the patient, including their health history, family history, physical examination findings, and developmental tasks. The key objectives of the case study are to gain in-depth knowledge of cirrhosis, gain confidence in handling similar cases, and fulfill partial course objectives. Cirrhosis is selected as it is a common cause of liver disease in the region due to alcoholism.
Behavioral Disorder: Schizophrenia & it's Case Study.pdfSELF-EXPLANATORY
This pdf is about the Behavioral Disorder: Schizophrenia & it's Case Study.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
Thanks...!
A 12-year-old female client wrote a suicide note and gave it to a friend after being molested by her stepfather for 2 years and 9 months. She previously attempted suicide. The client lives with her mother and has no siblings. She has a court appearance regarding the abuse and is increasingly frightened and depressed. The physician recommends inpatient treatment to address her suicide attempts and history of sexual abuse.
1. Social Work Research Couples CounselingKathleen is a 37-year.docxbraycarissa250
1. Social Work Research: Couples Counseling
Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.
Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.
Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.
I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.
I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.
The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on.
1. Social Work Research Couples CounselingKathleen is a 37-year.docxjeremylockett77
1. Social Work Research: Couples Counseling
Kathleen is a 37-year-old, Caucasian female of Irish descent, and her partner, Lisa, is a 38-year-old, Caucasian female with a Hungarian ethnic background. Kathleen reports that she has a long family history of substance use but has never used alcohol or drugs herself. She does not have a criminal history and utilized counseling services 10 years ago for family issues regarding her father’s alcohol use. Kathleen works as a nurse in a local hospital on the cardiac floor where she has been employed for 8 years.
Lisa reports experimenting with substances during college. She currently drinks wine on occasion. Lisa does not have a criminal history. Lisa has had many jobs and stated that she was unable to find her niche until recently when she took out a loan and opened a small Hungarian restaurant serving her grandmother’s recipes. Her restaurant has been open 1 year. Lisa reports that while she enjoys the work and has found her niche, she must work constantly to be successful, and she is worried the business might fail.
Kathleen and Lisa have been together for over 15 years. They have a close group of friends and see their families on major holidays. They came to outpatient counseling at a nonprofit agency to examine the possibility of starting a family together. They were both feeling ambivalent about it, and it had been the source of more than a few arguments, so they decided to come to counseling to address their concerns in a more productive way. They said they chose this agency because it was recognized as lesbian, gay, bisexual, and transgender (LGBT) friendly. They asked about my sexual orientation and my history because they were concerned about my level of experience working with the issues they were presenting.
I thanked Kathleen and Lisa for sharing this concern, and I informed them of various programs I had worked in within the agency, including supportive services for LGBT youth in schools and in the community. I also shared our agency philosophy and mission, which includes outcome measures and engaging clients in feedback to evaluate practice.
I explained the tools we used to measure outcomes. The first form measures how each of them are feeling with regard to their life and current circumstances. There are four different scales to measure aspects of their lives, such as social, family, emotional health, etc. I also provided the chart on which I score the scales and track progress. I explained that the purpose was to see where they began to demonstrate progress with the work we were doing.
The second form measures how well I am providing treatment. I demonstrated the four scales that measure if the client feels heard and understood and if we addressed in session what they wanted to. I explained that this should address their concern about my ability to assist them. Because we would be evaluating both how they felt and how the sessions were going each week, we could make adjustments on ...
A case study of a woman in a hispanic community who sought healthcare for a Urinary Tract Infection, but it was discovered that she was being seriously sexually abused. How it was handled and difficulties encountered.
12Working With FamiliesThe Case of Carol and JosephCa.docxAlyciaGold776
12
Working With Families:
The Case of Carol and Joseph
Carol is a 23-year-old, heterosexual, Caucasian female and the
mother of a 1-year-old baby girl. She is currently unemployed,
having previously worked for a house cleaning company. The
baby is healthy and developmentally on target, and she and the
parents appear to be well bonded with one another. Carol lives in
a rented house with her husband, Joseph. Joseph is a 27-year-old,
heterosexual, Hispanic male. He was recently arrested at their
home for a drug deal, which he asserts was a setup. Both parents
were charged with child endangerment because weapons were
found in the child’s crib and drugs were found in the home. The
parents assert that the child never sleeps in the crib but in their
bed. As a result of the parents’ arrest, social services was notified,
and the child was temporarily placed in a kinship care arrangement
with the maternal grandmother, who resides nearby. As a
result of Joseph’s arrest, he was fired from the cleaning company
where he worked, and the family is now experiencing financial
difficulties.
After initial contact was made with the parents, a number of
concerns were noted and the family was recommended for additional
case management. Carol’s mother indicated that she had
concerns about Carol’s drinking habits and stated that Carol’s
father and grandfather were alcoholics. She and the father separated
when Carol was a baby, and Carol has had only limited
contact with him. There appears to be significant tension between
the grandmother and Carol and Joseph. I addressed the alcohol
issue with both parents, who denied there was a problem, but
shortly after the discussion, Carol was involved in a serious car
accident with the baby in the car. She was determined to have been
under the influence of alcohol. I advised Carol that she could not
have any unsupervised contact with her child until she completed
intensive inpatient substance abuse treatment. I made arrangements
for her placement, but after a week, she was discharged
for noncompliance with the rules. She was then referred to an
intensive outpatient program and began therapy there. Initially
her attendance was erratic because she had lost her license as a
result of the DUI. Eventually, however, she became engaged in the
program and began to address her issues. She acknowledged that
she had started using drugs at a very young age but said that she
had only begun drinking in the previous year or so. We discussed
the genetics of her family, and she said that she realized that she
had deteriorated rapidly since beginning to drink and knew that
she simply could not drink alcohol.
Joseph’s mother is deceased, and his father travels extensively
in his job and is not available as a support. Joseph was
very devoted to his mother and was devastated by her premature
death. We discussed the strengths that he and Carol demonstrated
in staying together and working out their p.
This document presents a case report of an 18-year-old unmarried female student experiencing abnormal behavior, mutism, and decreased functioning for one month. Her father reports she began hearing voices commenting on her activities one month ago. Upon evaluation, she displayed bizarre postures, staring, stopped speaking a week ago, and decreased eating and sleeping for seven days. Her maternal grandmother had similar complaints. On examination, she was mute, not responding to commands, and maintaining rigid posture. Her mental status revealed decreased functioning and a flat affect.
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
A 53-year-old Caucasian male presented with symptoms of psychosis including delusions of people outside trying to harm him and poisoning his food on TV. He reported insomnia, paranoia, and hearing voices for weeks. His medical history included diabetes. A differential diagnosis of schizophrenia, schizoaffective disorder, and delusional of persecution was considered. The patient was started on antipsychotic medication and referred for supportive therapy and monitoring of his symptoms and medication side effects.
Rogerian ArgumentTaken from the principles of psychologi.docxdaniely50
Rogerian Argument
Taken from the principles of psychologist Carl Rogers
Origins of this
principle
Based on Carl Rogers’ theory that people involved in disputes should not respond to each other until they fully and fairly state the other person’s position.
4 Parts of the Rogerian Argument
1. Introduction
2. Contexts
3. Writer’s position
4. Benefits to opponent
1. Introduction
The writer describes an issue well enough to show that he/she fully understands and respects the alternative position.
“Let’s meet in the middle.”
2. Contexts
The writer describes cases/contexts in which the alternative position may be legitimate.
“You may be right sometimes…”
3. Writer’s
Position
The writer states her/his position and presents circumstances in which it is valid. This is where the writer supports her/his views with evidence.
“This is why my position is right.”
4. Benefits to
Opponent
The writer explains to the opponent how he/she would benefit from adopting the writer’s position.
“See what you might gain by agreeing
with me?”
Summation
Rogerian arguments steer clear of incendiary and stereotypical language.
They emphasize how both sides of the argument might benefit by working together.
They advocate a win-win outcome.
1
Comprehensive Client Family Assessment
Demographic Information
Date of assessment: 09/14/2018.
DOB: 011/01/1970.
Age: 48.
Race: Black.
SSN: 000000001. Ethnicity: African American.
Address: On file. Tel: 972-000-0000.
Residential Status: Homeless.
County: 9K. Military Status: None.
Language: English.
Interpreter Needed: No.
Primary Insurance: Uninsured.
Annual Gross Income: $0.
Employment Status: Unemployed.
Number of people in the household: 1.
Highest Grade: 11.
School Attendance for the past 3 Months: None.
Arrival Time: 1000 Time Disposition Completed: 1100
Location of client: Lake Worth Nursing Home
Presenting Problem
“My meds are not working.”
History of Present Illness
The patient is presenting with suicidal ideation with a plan and intent to jump off the bridge or self-stabs with a knife. The patient complained about his medication, Latuda is no longer working. Currently homeless with no job or income. Though calm, polite, and cooperative with organized thoughts, patient reports depression and anxiety (American Psychiatric Association, 2013).
Past psychiatric history
1- Major Depressive disorder, Recurrent Episode with psychotic features
2- Alcohol use disorder; severe
3- Bipolar I Disorder most recent episode depressed Severe
Medical history
None Reported
Substance use history
Alcohol Abuse: began drinking at age 15 and drinks 8 to 10 bottles of beer daily, yesterday was his last time he drank.
Developmental history
None Reported
Family psychiatric history
Positive for family history of mental illness on the paternal side.
Psychosocial history
The patient is unemployed and enjoys han.
The document discusses several prominent nursing theories:
- Henderson's 14 components of basic human needs that form the basis of nursing care.
- Orem's self-care deficit theory which identifies patient needs through assessment and focuses on developing self-care abilities.
- Roy's adaptation model which views individuals as systems striving for balance between stimuli. The model is used to assess a patient with a non-healing wound.
- Pender's health promotion model which aims to predict health behaviors and was applied to a case of smoking cessation counseling.
- Johnson's behavioral systems model which advocates fostering efficient behavioral functioning through assessment of seven behavioral subsystems.
Similar to 1Family Assessment and Psychotherapeutic ApproachesCol (20)
You will submit your proposal as a text-based Word or PDF file. AnastaciaShadelb
You will submit your proposal as a text-based Word or PDF file.
Your research proposal should include the following:
Your selected global ethical dilemma
Background/explanation of why this is a global ethical issue
Make connections to issues of cultural diversity
Research question
Two scholarly, peer-reviewed sources connected to your selected topic (cited in current APA format)
***NOTE***
RESEARCH IS ON GENDER DISCRIMINATION
...
What is Family Resource Management and why is it important to tAnastaciaShadelb
"What is Family Resource Management and why is it important to today's American family?"
Goldsmith, E. B., & GOLDSMITH, E. B. (2003). Resource Management. In J. J. Ponzetti Jr. (Ed.),
International encyclopedia of marriage and family
(2nd ed.). Farmington, MI: Gale. Retrieved from
RESOURCE MANAGEMENT
from
International Encyclopedia of Marriage and Family
Resource management
is the process in which individuals and families use what they have to get what they want. It begins with thinking and planning and ends with the evaluation of actions taken. Three fundamental concepts in resource management are
values, goals
, and
decision making.
Values such as honesty and trust are principles that guide behavior. They are desirable or important and serve as underlying motivators. Values determine goals, which are sought-after end results. Goals can be implicit or explicit. They can be short-term, intermediate-, or long-term. Decisions are conclusions or judgments about some issue or matter.
Decision making
involves choosing between two or more alternatives and follows a series of steps from inception to evaluation.
Through choices, individuals and families define their lives and influence the lives of others. The study of resource management focuses on order, choices, and control, and how people use time, energy, money, physical space, and information. As an applied social science, it is an academic field that is fundamental to our understanding of human behavior. "The knowledge obtained through the study of management is evaluated in light of its ability to make an individual's or family's management practice more effective" (Goldsmith 2000, p. 5).
Individuals and families have characteristic ways of making decisions and acting called their
management style.
Although similar styles are exhibited within families (such as a tendency to be on time or to finish tasks to completion), there are also wide ranges of styles within families making the study of management intrinsically interesting, especially from a
socialization
point of view. Why do such differences exist and how does the individual's style mesh with that of the other members' styles in the family?
Measuring devices, techniques, or instruments that are used to make decisions and plan courses of action are called management tools. For example, time is a resource and a clock or stopwatch is a management tool.
Resources can be divided up into human and material resources, assets that people have at their disposal.
Material resources
(e.g., bridges, roads, houses) decline through use whereas
human resources
(e.g., the ability to read, ride a bicycle) improve or increase through use.
Human capital
describes the sum total of a person's abilities, knowledge, and skills. Education is one way to develop human capital. Related to this is the concept of social capital. The term
social capital
is gaining in importance in the family-relations field and management is considered ...
What can you do as a teacher to manage the dynamics of diversityAnastaciaShadelb
What can you do as a teacher to manage the dynamics of diversity in your classroom? How can you differentiate for the culturally diverse students in your classroom to ensure a safe, supportive, compassionate, and caring learning environment without compromising your personal values and spiritual beliefs?
...
Week 4 APN Professional Development Plan PaperPurpose The purAnastaciaShadelb
Week 4: APN Professional Development Plan Paper
Purpose
The purpose of this assignment is to provide the student with an opportunity to explore the nurse practitioner (NP) practice requirements in his/her state of practice, NP competencies and leadership skills to develop a plan to support professional development.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (CO1)
2. Analyze essential skills needed to lead within the context of complex systems. (CO3)
3. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (CO4)
Due Date
Assignment should be submitted to the Week 4 Roles in APN Professional Development Plan dropbox by Sunday 11:59 p.m. MST at the end of Week 4.
When the assignment is placed in the dropbox, it will automatically be submitted to Turnitin. You may submit the assignment one additional time before the due date to lower the Turnitin score. If you choose to resubmit, the second submission will be considered final and subject to grading. Once the due date for the assignment passes, you may not resubmit to lower a Turnitin score.
This assignment will follow the late assignment policy specified in the course syllabus.
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.
In the event of a situation that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student's rationale for the request and make a determination based on the merits of the student's appeal. Consideration of the student's total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.
Total Points Possible: 200
Requirements
A
Week 4 Paper Template to be used for your assignment is required for this assignment.
1. The
APN Professional Development Plan paper is worth 200 points and will be graded on the quality of the content, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.
2. Submit the paper as a Microsoft Word Document, which is the required format at Chamberlain University. You are encouraged to use the APA Academic Writer and G ...
TopicTransitions of Care in Long- Term Care (LTC)Discuss CAnastaciaShadelb
Topic:
Transitions of Care in Long- Term Care (LTC):
Discuss Care Coordination, Subacute Care, Post-Acute care, and the impact of U.S Healthcare Policies and Regulations on transitions of care
Details:
·
2 pages
·
APA 7 th edition reference style with recent references within the last 5 years
·
3 references
Health Financial ManagementRead this article: Hirsch, J.A., Harvey, H.B., Barr, R. M., Donovan, W. D., Duszak, R., Nicola, G. N., ... & Manchikanti, L. (2016): ‘’Sustainable Growth Rate Repealed, MACRA Revealed: Historical Context and Analysis of Recent Changes in Medicare Physician Payment Methodologies’’
Once you have read the article, discuss the Medicare Sustainable Growth Rate. “The SGR target is calculated on the basis of projected changes in 4 factors:
1) fees for physicians’ services,
2) the number of Medicare beneficiaries,
3) US gross domestic product, and
4) service expenditures based on changing law or regulations (Hirsch, et al. 2016).”
How have these 4 factors been tied to fiscal performance? Find some additional sources and support your position in few paragraphs.
Details
- 2 pages
- 3 PARAGRAPHS ONLY
· Paragraph 1 – answer the question, supporting your answer by citing from the RELIABLE SOURCES using proper APA format. Terms need to be defined in order to receive as many points as possible.
· Paragraph 2 – expand your answer by including additional information and opinions
·
· Paragraph 3 – Summarize your answer, concluding with a thought or an opinion of your own.
- APA 7 th edition reference style with recent references within the last 5 years
- 3 references
...
Topic Hepatitis B infection Clinical Practice PresenAnastaciaShadelb
Topic: Hepatitis B infection
Clinical Practice Presentation . The focus of the presentation
must reflect current treatment recommendations from accepted professional organizations.
Clinical Standard of Practice Presentation
Students are expected to expand their use of resources for evidence-based practice beyond the required text and explore nursing and related literature to improve their understanding and application of advanced interventions. Each student will present a Clinical Practice Presentation. The focus of the presentation must reflect current treatment recommendations from accepted professional organizations. Presentations will be evaluated related to the criteria listed.
Presentations must be no more than twelve slides in a PowerPoint format with a Reference List in APA format which once done must be sent by email to me and/or posted on week of the due time frame. Topics will be listed, and students must sign up for presentation by the second week of the course..
image1.png
...
The Fresh Detergent CaseEnterprise Industries produces Fresh, AnastaciaShadelb
The Fresh Detergent Case
Enterprise Industries produces Fresh, a brand of liquid detergent. In order to more effectively manage its inventory, the company would like to better predict demand for Fresh. To develop a prediction model, the company has gathered data concerning demand for Fresh over the last 33 sales periods. Each sales period is defined as one month. The variables are as follows:
·
Period = Time period in month
·
Demand = Y = demand for a large size bottle of Fresh (in 100,000)
·
Price = the price of Fresh as offered by Ent. Industries
·
AIP = the Average Industry Price
·
ADV = Enterprise Industries Advertising Expenditure (in $100,000) to Promote Fresh in the sales period.
·
DIFF = AIP - Price = the "price difference" in the sales period
Only the trend of PRICE is negative. Other four variables have positive trends. However, the R2 values suggest that for ADV and DEMAND only the linear model is explained by the data points moderately (66% and 51% respectively). For all the other three variables, the R2 values are too poor to accept the models as adequates because very few percent of data points actually represents the linear model.
As expected, the Demand is negatively correlated with Price. But the regression line equation cannot be relied upon due to poor R2 value. For other three variables, there is a positive correlation. Out of these, for the ADV variable, the regression line can be adequate for the R2 value is moderately higher.
Interpretation
Strong positive correlation is found between
1. PERIOD and ADV
2. PERIOD and DEMAND
3. AIP and DIFF
4. DIFF and ADV
5. DIFF and DEMAND
6. ADV and DEMAND
Strong negative correlation exists between
1. PRICE and DIFF
2. PRICE and ADV
3. PRICE and DEMAND
PERIOD
DEMAND
Forecast
MA(3)
Forecast
MA(6)
Absotute Error - MA(3)
Absotute Error - MA(6)
1
9.4
2
10.3
3
11.5
4
11.1
10.4
0.7
5
11
11.0
0.0
6
10.5
11.2
0.7
7
10.2
10.9
10.6
0.7
0.4
8
8.9
10.6
10.8
1.7
1.9
9
8.3
9.9
10.5
1.6
2.2
10
8.12
9.1
10.0
1.0
1.9
11
8.8
8.4
9.5
0.4
0.7
12
9.8
8.4
9.1
1.4
0.7
13
10.1
8.9
9.0
1.2
1.1
14
11.3
9.6
9.0
1.7
2.3
15
12.5
10.4
9.4
2.1
3.1
16
12.4
11.3
10.1
1.1
2.3
17
12.1
12.1
10.8
0.0
1.3
18
11.8
12.3
11.4
0.5
0.4
19
11.5
12.1
11.7
0.6
0.2
20
11
11.8
11.9
0.8
0.9
21
10.2
11.4
11.9
1.2
1.7
22
10.3
10.9
11.5
0.6
1.2
23
10.9
10.5
11.2
0.4
0.2
24
11.2
10.5
11.0
0.7
0.2
25
12.5
10.8
10.9
1.7
1.7
26
13.4
11.5
11.0
1.9
2.4
27
14.7
12.4
11.4
2.3
3.3
28
14.1
13.5
12.2
0.6
1.9
29
14
14.1
12.8
0.1
1.2
30
13.5
14.3
13.3
0.8
0.2
31
13.5
13.9
13.7
0.4
0.2
32
13.1
13.7
13.9
0.6
0.8
33
12.5
13.4
13.8
0.9
1.3
34
13.0
13.5
MAD =
0.9
1.3
Since MAD of MA(3) is less than that of MA(6), we should be preferring MA(3) over MA(6). However, Moving average may not be a good choice for predicting the demand because there is a clear p ...
tables, images, research tools, mail merges, and much more. Tell us AnastaciaShadelb
tables, images, research tools, mail merges, and much more. Tell us how these features can help you collaborate and work with others? What feature surprised you the most? Do you think you can do better research documents after this week? Why are tools such as spelling and translation so important specially in the United States? Add a PowerPoint and a word document
...
TBSB NetworkThe Best Sports Broadcasting Network is home to alAnastaciaShadelb
TBSB Network
The Best Sports Broadcasting Network is home to all college football games, events, and updates. From Alabama and Clemson to Mount Union and Wheaton College, Division 1 to Division 3 top to bottom 24/7 college football. Being a college football athlete myself and having played at Clemson University and now here at University of Maryland I understand the different levels of exposure programs and athletes get even across power 5 conferences there is some exposure but different and some more than others. What my goal and plan for TBSB is that we bring the same amounts of awareness and exposure to their programs that the Clemson’s and Alabama’s receive to their programs.
After conducting many research experiments on former college athletes as well as parents, family members of student athletes, and fans I learned that they are not happy with not having the chance to always support and watch programs who aren’t top tier and do not have the same lime light as others. I also found that there is not one particular network that shows all power 5 conference football games on Saturdays, there are different networks you have to pay for monthly to keep up with all football games from different conferences. For example, you have ACC Network, Big 10 Network, and SEC Network for each of these networks you need a different subscription and or certain cable plan. With TBSB we are putting all of these networks under one station to give families, fans, and much more the best possible experience.
I feel like this network will be beneficial to many different people starting with the players. Giving all players who are not receiving a lot of exposure this prime television opportunity for family and friends to watch and cheer them on. Also giving these players opportunities to be evaluated, and scouted by the NFL for those who have that desire. This network will also be beneficial to the university itself, football programs have a chance to increase school’s revenue at any given time. Putting these different schools in the lime light will increase the chances to help up school’s revenue. Last but not least TBSB will be beneficial to families, friends, fans, and much more the people who are not able to make it to the games but would still love to support and cheer on these programs. With the click of a button all of their problems are solved with TBSB giving them the chance to watch not only the games of their loved ones but any other college football games of their choice.
Currently, I am in the process of finalizing the concept and sources of revenue, as of now my guaranteed sources of revenue will come from customers who sign up they will pay a monthly fee. My next source of revenue I want to work with television companies to have TBSB added to their channel listings and work with these different companies for another stream of revenue. These are my biggest “road blocks” at the moment. I also will have to find workers who are willing and dedica ...
SU_NSG6430_week2_A2_Pand
ey_R.docx
by Ram Pandey
Submission date: 04-Sep-2020 06:47PM (UTC-0400)
Submission ID: 1379955415
File name: SU_NSG6430_week2_A2_Pandey_R.docx (20.8K)
Word count: 685
Character count: 4114
89%
SIMILARITY INDEX
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INTERNET SOURCES
2%
PUBLICATIONS
89%
STUDENT PAPERS
1 89%
Exclude quotes Off
Exclude bibliography Off
Exclude matches Off
SU_NSG6430_week2_A2_Pandey_R.docx
ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to South University
Student Paper
FINAL GRADE
/20
SU_NSG6430_week2_A2_Pandey_R.docx
GRADEMARK REPORT
GENERAL COMMENTS
Instructor
PAGE 1
PAGE 2
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SU_NSG6430_week2_A2_Pandey_R.docxby Ram PandeySU_NSG6430_week2_A2_Pandey_R.docxORIGINALITY REPORTPRIMARY SOURCESSU_NSG6430_week2_A2_Pandey_R.docxGRADEMARK REPORTFINAL GRADEGENERAL COMMENTSInstructor
SOAP NOTE
Name: MT
Date:12/3/19
Time: 0930
Encounter 2
Age: 32
Sex: Female
SUBJECTIVE
CC:
“I need to start on birth control, I just don’t know which one to go on as there are so many to choose from.”
HPI:
30 -year-old Asian American female that presents to the clinic requesting to start birth control.
Medication: (list with reason for med)
PT is not taking any medication currently
PMH: None
Allergies: Does not have any food or drug allergies
Medication Intolerances: None
Chronic Illnesses/Major traumas:
Patient denies any medical trauma
Chronic Health Problems: No known chronic health problems
Hospitalization/Surgeries: None
Family History: Mother Healthy. Father HTN. Sister Healthy. Brother autism
Social History:
Social history is negative for ETOH and she denies past or present illicit drug use. Denies present use of tobacco. States she does exercise regularly, and is not on a specific diet. Pt is currently in school for accounting.
ROS
General:
Patient denies weight change, fatigue, fever, chills, night sweats, energy level
Cardiovascular:
Denies any episodes of chest pain, palpitations, syncope or orthopnea.
Skin:
Denies any skin lesions.
Respiratory:
Patient denies dyspnea. Denies cough
Eyes:
Patient states no changes in vision, no blurred or double vision.
Gastrointestinal:
Patient denies any change in appetite, denies nausea and vomiting. denies any bowel changes
Ears:
No recent hearing loss, tinnitus, denies any ear discharge or pressure.
Genitourinary/Gynecological:
Patient denies any itching, burning or discharge
Last PAP: 9/11/18
Mammogram: 11/2/18
Pregnancy: G4P3
Not on any contraception, is currently sex ...
Sheet1Risk Register for Project NameDateProject NameID No.RankRisAnastaciaShadelb
This document appears to be a risk register template for a project that lists risks by ID number, rank, description, category, root cause, potential triggers, responses, risk owner, probability, impact, and status. However, the document contains no further details to summarize as it appears to be an empty template.
1
2
Final Project Topic
Final Project Topic
I selected the question: Analyze differences among research, evidence-based practice, practice-based evidence, comparative effectiveness research, outcomes research, and quality improvement. How do these practices affect nursing and patient outcomes?
Selected References
Davis, K., Gorst, S. L., Harman, N., Smith, V., Gargon, E., Altman, D. G., ... & Williamson, P. R. (2018). Choosing important health outcomes for comparative effectiveness research: An updated systematic review and involvement of low and middle-income countries. PloS one, 13(2), e0190695.
Davies, C., Lyons, C., & Whyte, R. (2019). Optimizing nursing time in a daycare unit: Quality improvement using Lean Six Sigma methodology. International Journal for Quality in Health Care, 31(Supplement_1), 22-28.
Eppley, K., Azano, A. P., Brenner, D. G., & Shannon, P. (2018). What counts as evidence in rural schools? Evidence-based practice and practice-based evidence for diverse settings. The Rural Educator, 39(2).
Fiset, V. J., Graham, I. D., & Davies, B. L. (2017). Evidence-based practice in clinical nursing education: A scoping review. Journal of Nursing Education, 56(9), 534-541.
Forsythe, L., Heckert, A., Margolis, M. K., Schrandt, S., & Frank, L. (2018). Methods and impact of engagement in research, from theory to practice and back again: early findings from the Patient-Centered Outcomes Research Institute. Quality of Life Research, 27(1), 17-31.
Gargon, E., Gorst, S. L., Harman, N. L., Smith, V., Matvienko-Sikar, K., & Williamson, P. R. (2018). Choosing important health outcomes for comparative effectiveness research: 4th annual update to a systematic review of core outcome sets for research. PloS one, 13(12), e0209869.
...
12
Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021
Capstone Project
There is a saying that states one can only learn through doing it, practically and physically. It is the explanation as to why it is very important to implement the skills acquired in theory into practice to ascertain one’s competence. This is even more crucial in the medical field as they have no choice but just to be perfect at what they are doing, the only secret is through practice. Practicums connect the two worlds of theory and classwork, thus breaking the monotony alongside connecting what was taught in class with what happens in the field. They are important as apart from sharpening the student’s skills, they also open a window of opportunity and build up connections that will come in handy for the student later on. They will feel the experience and the pressure that comes with it thus preparing themselves accordingly.
Statement of the Problem
Timing is essential in the nursing field and the Emergency Room is notorious for its long wait times. The goal of a clinical laboratory is to deliver medically useful results for patients on a timely basis. This goal can be hindered by the new paradigm of the modern laboratory – “do more with less" (Lopez, 2020). When implementing new care models for patients, the patient perspective is critical. The objective of this study was to describe and develop an understanding of the information needs of patients in the ED waiting room concerning ED wait time notification (Calder, 2021). As a patient arrives at the ER waiting area, it's critical to have lab results for the provider to evaluate. I can give you an example of a patient that waited in the waiting room for over 3 hours, no labs were completed because they were waiting for the patient to go back into a room. The patient was suffering from a heart attack and his troponins were elevated and no one knew until 3 hours later. If POC labs were done on all patients as soon as they arrived, mistakes like these can be avoided. Completed POC blood can cut the wait times in half and the laboratory also won't be backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency Department patient length of stay (LOS) for those whose blood was analyzed using POC testing versus those whose blood was analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in the emergency department (ED) is an issue that not only increases the severity of illnesses but also reduces the quality of patient care. Serious health conditions including diabetes and hypertension can worsen while patients are ...
12
First Name Last Name
Plaza College
MGT1003 Section 8 – Supervisory Management
Professor Aicha Cesar
Spring 2022
1. Do you believe that Joe Trosh has the right to carry a concealed weapon in the hospitaldue to being harassed for visiting casinos?
Part IA: The Purpose of the Report and the Problem
The purpose of the report is to solve the problem of whether or not Joe Trosh has the right to carry a concealed weapon in the hospital as a reason for self-defense against discrimination and harassment from the staff of a rural hospital in Oklahoma. According to the U.S. Equal Employment Opportunity Commission, harassment is a form of employment that violates Title VII of the Civil Rights Act of 1964, Age Discrimination Employment Act of 1967, and Americans with Disabilities Act of 1990 ("Equal Employment Opportunity Commission," n.d.).
The Equal Employment Opportunity Commission outlined that “harassment’’ based on race/color discrimination means unwelcome conduct that is based on color, religious background, sex, national origin, older age, disability, or genetic information that is based on medical history ("U.S. Equal Employment Opportunity Commission," n.d.).
Hirsch (2018) stated that the impact of discrimination on racism often creates challenges that the human resource manager is responsible for overcoming. In a workplace, racism is evident through macroaggression, defined as indirect, subtle, and unintentional acts of discrimination against marginalized groups.
Harassment based on stereotypes can affect an organization’s decision-making process in many ways, such as making a quick judgment without looking at the consequences. It also makes people feel preconceptions about a specific group of people leading to harsh treatment.in addition, harassment of stereotypes leads to fixed beliefs about the place of women and men in society.
Managers need to know about the Second Amendment right to bear arms and U.S. Supreme Court Cases that examine this issue because it will protect the hospital from legal matters ("Cornell Law School," n.d.). The District of Columbia v. Heller case in which the supreme court held in 2008 on the second Amendment regarding firearm possession. It gives one the right to possess firearms, independent of service in state militia use the guns for self-defense.
A potential legal issue the Supervisor must consider is how to handle discipline decisions that involve employees who have experienced discrimination through harassment by co-workers. According to the Oklahoma Self-Defense Act, it is “not right for a person to identify themselves as a licensed handgun or as lawfully in possession of any other firemen if the law does not demand information."
Part 1B The Research Experience
To perform my research, I began with online research. I used Google and searched for articles rights of carrying weapons to work as a form of self-defense and discrimination and harassment in the place of work.
I have foun ...
12Epic EMR ImplementationComment by Author 2 Need a AnastaciaShadelb
1
2
Epic EMR Implementation
Comment by Author 2: Need a running head. Ex:
RUNING HEAD: Implementation of EMR
Implementation of Electronic Medical Records (EMR) Comment by Author 2: Your topic is very broad. You should have a unique identification of basically what you are trying to investigate with your research. Basically, you need to try to funnel it. For instance, The impact of the EMR on ...... Comment by Author 2: Also, the title doesn't tell the story of your research. Basically, the reader should be attracted to your topic just by reading the title. That is why is very broad and doesn't present an attractive meaning. Comment by Author 2: Example: The Implementation of EMR: Tjhe Role of Data in ... Comment by Author 2: Or, Barriers to Implementing the EMR in ....
HCIN 699-51 – B-2021/Summer
Applied Project in Healthcare Informatic
Dr. Chaza Abdul and Dr. Glenn Mitchell
Prepared by:
Name: Bolade Yusuf
Student ID: 273092
Harrisburg University
08/18/21
Table of Contents
INTRODUCTION 3
1.1 Background to research problem 3
1.1.1 Electronic Medical Records (EMR) 3
1.1.2 Patient’s Data 4
1.2 Problem Statement 4
1.3 Objectives 5
1.4 Research Questions 5
1.5 Significance of the Research 5
LITERATURE REVIEW 6
2.1 Introduction 6
2.2 Features of an Effective EMR 6
2.3 Barriers to adoption of EMR 8
2.4 Addressing EMR adoption barriers 9
2.5 Related Work 11
RESEARCH METHODOLOGY 12
3.0 Introduction 12
3.1 Research Philosophy 12
3.2 Research design 12
3.3 Study Population Sample 13
3.4 Sample Size and Sampling Procedure 13
3.5 Data Collection 14
DATA ANALYSIS AND FINDINGS 15
4.1 Data Analysis 15
4.2 Findings 15
4.3 Benefits of epic EMR 16
Conclusion 17
References 18
Appendix 1: Survey Questionnaire 20
Appendix 2:Survey Questions Response Analysis 21
INTRODUCTION1.1 Background to research problem
Health care is critical in any society. Managing patient’s data goes a long way in ensuring good treatment measures are taken. Health care information therefore must be collected correctly and stored in a manner which abides by the principled of confidentiality, integrity and accessibility (Kaushal et al., 2009). Data regarding a patient should be kept confidential as much as possible and only retrieved when needed. A good health records management system should be able to confidentially store patient’s data. Each patient should have an account within the system where their data is stored. Access to this data should be given on privileges basis and only to individuals who will use it for treatment of the patient. The patient’s data in a good health information management system should be of high integrity. Data should be collected from the source (the patient) and recorded during the collection process. Having an intermediary stage where data is recorded in in a secondary avenue before being transferred to the primary system could lead to errors thus compromising its integrity. A good health information management system should also ...
12Facebook WebsiteAdriana C. HernandezRasmussen UnAnastaciaShadelb
1
2
Facebook Website
Adriana C. Hernandez
Rasmussen University
COURSE#: MA242/BSC2087C
Jenessa Gerling
05/01/2022
Thesis Statement: Facebook, which emerged as a standalone website, is used worldwide. Facebook has emerged as one of the 21st century's largest companies, with a consumer base of people who understand the word internet.
Title of Paper: Facebook Website
I. Introduction
A. Attention grabbing sentence about topic
Facebook, which emerged as a standalone website, is used worldwide. Skyrocketing revenues' simplified version of the term perception is a way of perceiving or viewing things and refers to how the brain knows how things are or processes things (Mosquera et al.,2020).
B. Thesis statement
Facebook, which emerged as a standalone website, is used worldwide. Facebook has emerged as one of the 21st century's largest companies, with a consumer base of people who understand the word internet.
II. First paragraph main point – topic sentence
The case in this study involves deciphering the website perception elements and related responses to the same crucial points as follows:
A. Supporting details (in-text citation for outside resource used as support/evidence)
1. Details about the supporting details
Sensory response refers to the way we respond to specific website visual elements. The website contains both a design pattern and a logo which most individuals worldwide are aware of today.
2. Details about the supporting details
The image of the logo is a letter f-like. The most dominant colour in the ad on Facebook is blue and white shades used to design and highlight the tangible symbol.
B. Supporting details (in-text citation)
There are also lines and shapes in the logo, and as mentioned, the logo lines include lines and a square box forming a bold character, 'f' and highlighting the Facebook company name (Plantin et al.,2018). Contrast and balance are also incorporated. There is contrast present and light colours in the image that easily distinguish the Facebook symbol from other symbols such as WhatsApp and YouTube. The balance is indicated in the proper depiction of the 'F' symbol, highlighting everything around the same.
C. Transition sentence
On the other hand, perceptual response refers to the number of groups of persons attracted to the ad and those not attracted.
III. Second paragraph main point – topic sentence
Though perceptual response targets a potential user base involving many people from any age group, ethnicity, or age, it is more dominant among the youth, in my view.
A. Supporting details (in-text citation)
The aged have no more time in the Facebook like the youth who are in desire remain informed and have interest in sharing their feelings and information through the platform (Plantin et al.,2018).
1. Details about the supporting details
The technical response involves specific elements, including buttons and dropdowns worldwide, which technically impact the user.
2. Details about the supporting details
T ...
1
2
Experience
During my clinical placement in a neurosurgical unit, we would occasionalJy exa mine epilepsy
patients to document any seizures. These patients rarely require substantial nursing care, and
most are self-sufficient with only 1-2 prescriptions administered every six hours. I was working
an early shift, and my buddy nurse assigned me to three patients, one of whom was under
examination for a seizure. My buddy nurse handed me the drawer keys and indicated the
medication was in the side drawer when I went with my nurse to provide the patient medication.
Looking over the initial purchase, I began my safety check prior to dispensing the prescription
and discovered that it had expired in February 2019. I requested that my preceptor come over
and take a look at the package. She realized the medication was out of date when she noticed the
expiration date. She then went out of the room with the packaging. When she returned, she
indicated that she had reported the event to the NUM. I then inquired if there was anything else
we needed to do, but I was respectfully told to stay out of it. I took a set of vitals on the patient,
which were all normal, and the buddy nurse was given a new pack of medication that was still
usable. I felt accomplished at the end of my shift since I had followed the procedure for providing
the correct medication and had identified the problem. Being a part. of event reporting and alerting
the doctors, on the other hand, would have been a great experience. Overall, I followed NSHQS's
safety requirements and medication standards when performing my nursing responsibilities.
h
...
1
2
Dissertation Topic Approval
Dissertation Topic Approval
Topic
How can the fourth industrial revolution technologies be used to address the current climatic issues facing the world?
General Reasoning
I selected this research topic because climatic change has become a major concern today, with world leaders and researchers trying to develop ways to address this concern. There are several adverse impacts of climatic change on the world. One of the adverse effects is that humans and animals face new challenges for their survival due to the consequences of climatic change. Climatic change has resulted in increased temperature levels in the world, rising sea levels, shrinking glaciers, and increased ocean temperatures. It has resulted in frequent and intense droughts, storms, and heat waves threatening animals' lives. It has also resulted in biodiversity loss due to limited adaptability and the economic implications of these climatic changes. One of the ways that can be used to deal with climatic issues is through the use of technology which can help reduce greenhouse gas emissions. The fourth revolution technologies such as the internet of things, artificial intelligence, and cloud computing can play a vital role in addressing these climatic challenges.
Potential thesis
The fourth industrial revolution technologies such as the internet of things, artificial intelligence, and cloud computing can play a vital role in addressing these climatic challenges; therefore, it is important to determine how these technologies can be utilized to achieve the environmental objectives of the world.
Thesis map for your Literature Review
The literature review will consist of articles that have been published over the five years. It will consist of journals and articles that have researched fourth industrial revolutions that can be used to address climatic change.
The research topic I selected for my dissertation is related to the program goals and core courses by addressing the revolution of technology and its applications in addressing the world's challenges.
...
12Essay TitleThesis Statement I. This is the topicAnastaciaShadelb
The document outlines the structure for a Rogerian argument essay on school uniforms. It provides instructions for introducing opposing viewpoints in three paragraphs, then addressing the proponents' viewpoints in three more paragraphs. It instructs to then write a paragraph presenting a compromise viewpoint. Each main point should have an introductory topic sentence, a quote or paraphrase with citation, commentary, and transitional statement. The outline concludes by stating the conclusion paragraph should reiterate the compromise and benefits of accepting it.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
1Family Assessment and Psychotherapeutic ApproachesCol
1. 1
Family Assessment and Psychotherapeutic Approaches
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychotherapy with Multiple Modalities
June 13, 2021
2
Abstract
As providers, it is vital to be open-minded, if you are not aware
or do not understand a person’s
culture, show your patients respect. Be engaged, respectful, and
ask questions. Learn from your
patients, this helps develop a rapport. As providers we ar e
obligated to provide optimal care, if
we feel a patient's needs are out of our scope, the client should
be referred to a provider that can
give them the help they need and deserve (Nichols & Davis,
2020).
The purpose of this paper is to provide documentation and a
2. psychiatric comprehensive
assessment of a patient and family during a family therapy
interview that highlights differences
in a multicultural family, respecting cultural norms and
differences, and develop an
individualized treatment plan.
Keywords: Family therapy
3
Family Assessment and Psychotherapeutic Approaches
Subjective:
CC (chief complaint): “I like to learn to live on my own and not
depend on the kids.”
HPI: A 40-year-old female (Patti) and her five children (Sheela
age 24, Sharleen aged 23
and present today, Shireen age 21 recently reunited with family,
Armin Jr. age 18, and Sam age
15), of Iranian descent, has been in individual and family
therapy for the last 18 months. Patti
came to the clinic related to chaos in the home after her
daughter was finally reunited with the
family after ten years. The family initially had rejoiced and
3. celebrated, and after a few weeks,
Shireen began to tell her mother and siblings the emotional,
physical, and sexual abuse at the
hands of her father. She blamed and felt abandoned by her
mother. Patti needed necessary
surgery to both her feet after an injury, that has now left her
disabled and with chronic pain. The
additional burden of surgery and disability has increased
tension and stress in the home. Patti
lives with her two sons; her daughters live on their own.
Shireen recently moved out, marrying
someone the family does not know, with little contact. Mother
speaks and sees Sheela and
Sharleen daily. Patti has increasingly felt alone, depressed,
hopeless, and helpless wanting her
daughters to stay and help her at her home. A psychiatric
provider has been referred for a
medication evaluation.
Past Psychiatric History:
General Statement: Patti and her family began therapy 18
months ago after daughter
Shireen reunited with the family after 12 years of separation.
Shireen shared significant abuse
4. she experienced, learning the trauma she went through brought
on many emotions of the family
including blame, guilt, shame increasing stress on the family.
Caregivers: N/A
4
Hospitalizations: Patti denies any past psychiatric
hospitalizations or history. The patient
has no history of substance abuse or residential treatment. Patti
denies suicidal and homicidal
ideation, denies hallucinations. The patient has had two-foot
surgeries secondary to arthritis,
hammer toe, and severe plantar fasciitis with no relief for over
2 years, patient in hospital
overnight after each surgery.
Medication trials:
Zoloft 50 mg every morning for depression, with limited relief.
Will feel helpless and
hopeless three to four days a week. The patient is tolerating the
Zoloft and has recently been
increased to 100 mg daily.
Patti reports no adverse effects of Zoloft.
5. Naproxen 500 mg twice a day
Psychotherapy or Previous Psychiatric Diagnosis:
Patti has been receiving individual and participated in family
therapy over the last 18
months. Shireen came once and has stopped attending and
refuses to continue at this time. The
family has come to therapy together five times, to heal and
move on together.
Patti had surgery in the last 6 months and is no longer able to
work related to the
deteriorating condition of her feet that arthritis has caused. This
has led to being unable to work
at home often alone. She is experiencing being independent and
providing, what she has done for
so long. This has caused stress, increased anxiety, and
depression for Patti.
Therapy over the last several months has also uncovered
differences in the bicultural
situations. Patti is wanting the care provided to her as in the
Iranian culture, where she is
dependent on her children. The children living in America for
the last 12 years are more
Americanized and have adapted to the culture, with their own
6. lives leaving less time for Patti.
5
Substance Current Use and History: Patti drinks 16 ounces of
caffeinated beverages
daily. She denies smoking or drinking alcohol.
Family Psychiatric/Substance Use History: Patti denies any
substance or alcohol
abuse. She is unaware of any of her family has any abused drugs
or alcohol. Her husband drinks
large amounts daily, has not received treatment for alcoholism.
Patti denies any psychiatric
history in herself or her family.
Psychosocial History: Patti was born in Luristan Iran, raised by
her mother and father.
She had no siblings. At 14, her parents arranged for her to be
married to Armin Ali, a 25-year-old
foreman of a prominent automobile company in Tehran. Patti
moved to Tehran and had five
children with Armin. Patti gave birth to Sheela at the age of 16,
Shareen at age 17, Shireen at age
19, Amir Jr at age 22, and Sam at age 25. Patti stayed at home
working in the home and raising
7. the children while Amir worked and provided for the family.
When Sheela and Shareen were 11 and 12, it was discovered
they had medical conditions
that needed treatment in the United States. Patti applied for
visas to come to the United States.
She was able to take all her children but Shireen. Amir
encouraged Patti to go, he would look
after Shireen and come to the United States later. Once Patti
arrived, she was able to get the
needed medical treatment for her daughters and started making
a home for her family She
believed Amir would later come with Shireen. After years went
by, this did not occur, only letters
of how she needed to raise her children. Patti did not want to
return to Iran. She struggled with
leaving Shireen behind and afraid for her other children if she
returned. Patti had been abused
emotionally, physically, and sexually by Amir from the time
they were married. Patti and her
four children made a home in the United States, Patti worked
two jobs, but also made time to
attend school functions and volunteer at her children’s school.
Patti continued to work at
8. 6
bringing Shireen to the United States, it took several years. She
was finally able to bring her,
Shireen was 18 when she arrived, and the family celebrated.
After a few weeks, Shireen began to
share her trauma of emotional, physical, and sexual abuse by
her father. Patty struggled to hear
the information, she was aware, as Amir would treat her the
same way, she would tell him to beat
her and not her children. Shireen was angry and blamed her
mother. Patti pursues help with
therapy to work through the guilt and shame of the trauma.
Medical History: Hammer toe, bilateral great toes, arthritis,
plantar fasciitis
Current Medications:
Zoloft 100 mg every morning for depression and anxiety
Naproxen 500 mg twice a day
Tramadol 100 mg twice a day as needed for severe pain.
Allergies:
No known drug allergies
9. No known seasonal allergies
No Known food allergies
Reproductive Hx: The patient is a Gravida 5 para 5. The patient
denies any abortions or
miscarriages. The patient has been celibate for the last 12 years
since arriving in the United
States. The patient denies any sexually transmitted infections,
started menses at age 14. The
patient has menses every month without any significant issues
or concerns.
ROS: Provided by a medical provider.
GENERAL: Alert and orientated x 4. No weight loss, fever,
chills, weakness, or fatigue.
HEENT: No hearing loss, sneezing, congestion, runny nose, or
sore throat.
7
SKIN: No rash or itching. Incisions on bilateral great toes
healed. The incision on
bilateral heels healed, with no redness or bruising.
CARDIOVASCULAR: No chest pain, chest pressure, or chest
discomfort. Regular rate
10. and rhythm, no murmurs, no rubs, no gallops. No palpitations
or edema.
RESPIRATORY: No wheezes, rales, or rhonchi. No shortness
of breath, cough, or
sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or
diarrhea. No abdominal
pain. No guarding or rebound tenderness.
GENITOURINARY: No burning on urination, urgency,
hesitancy, or odor.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia. No change in
bowel or bladder control.
Cranial Nerve 2: vision is grossly accurate.
Cranial Nerve 3,4,5,6: motor movements appear normal.
Cranial Nerve 7: facial muscles appear symmetrical.
Cranial Nerve 8: hearing is adequate for her age.
Cranial Nerve 9-12: swallows without difficulty.
MUSCULOSKELETAL: No muscle and back pain, chronic pain
in bilateral feet.
HEMATOLOGIC: No anemia, bleeding, or bruising.
11. LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat
intolerance. No polyuria
or polydipsia.
8
Physical exam:
Vital signs: B/P: 126/78, P: 88, Height: 63 inches, Weight:
225lbs, BMI: 39.9 (NIH.gov,
2020).
General: Alert and oriented to self, time, location, and situation.
Head: Symmetry
Eye: extraocular movements are intact, normal conjunctiva.
Vision: shortsighted, glasses
worn.
Ears: Symmetry. Normal hearing.
Neck: Symmetry. No swelling or palpable mass noted. Throat:
Symmetry. Oral
mucosa is moist.
Neck: Full ROM. Carotids no bruit or JVD.
12. Chest/Lungs: Lungs are clear to auscultation. Respirations are
non-labored.
Heart/Peripheral Vascular: Normal heart rate, regular rhythm,
no edema noted.
Abdomen: Round and large. Bowel sounds present in all four
quadrants. Negative
tenderness.
Genital/Rectal: No abnormalities. Menses started at 15 and are
regular.
Musculoskeletal: Normal ROM. muscle weakness due to
physical inactivity
Neurological: Cranel Nerves II-Xll grossly intact.
Skin: No clubbing or cyanosis.
Toes: Bilateral great toes, incisions healed.
Objective:
Diagnostic results:
CBC: within normal
9
Assessment:
Mental Status Examination: A 40-year-old Iranian female,
13. appearing stated age. The
patient is alert and oriented to self, place, time, and situation.
Patient cooperative, engaged in
conversation. Patient grooming clean, although shirt tight
fitting. Speech is clear, Iranian accent
with average tone. During the interview, when upset or arguing
with the daughter, her voice
becomes louder. Thought process goal-directed and logical. No
noted flight of ideas,
hallucinations, or delusions noted. No abnormal motor activity
noted. The patient’s mood is
depressed and anxious, affect blunted at times. The patient
denies being suicidal or homicidal
currently. The patient’s short-term and long-term memory
intact, good insight and judgment,
with good concentration. The patient has no legal history,
arrests, and no pending charges. Eye
contact is fair throughout the interview.
Differential Diagnoses:
Adjustment disorder with depressed mood – Patti’s children are
growing up; she is
feeling alone. She states when she is lonely, she feels hopeless
and helpless. She is wanting her
14. children to stay with her, having a difficult time adjusting to
them not home as much. She has
also had recent surgeries in the last 4 months, and she is
adjusting to not being as independent as
she was before with mobility and chronic pain issues. Patti is
exhibiting feelings of sadness and
hopelessness in response to three identifiable stressors; recent
surgeries and children moving out
of the home, and grief and guilt of past trauma her daughter
experienced. The patient meets the
criteria as a primary diagnosis (APA, 2013).
Depressive disorders not due to another medical condition;
grief, PTSD. Patti has
had depressive episodes prior to her surgeries, she has been in
therapy for the last 18 months, she
10
has had traumatic events in her life including abuse, and loss. It
is important to determine if the
medical condition is associated with depression. It i s necessary
to examine if an episode of
depression occurred prior to medical illness, the medical
condition promotes depression, and if
15. the symptoms after the start of the medical condition stabilized
(APA, 2013). A panel consisting
of psychiatric health professionals strongly recommends
interventions for patients with post-
traumatic stress disorder to include cognitive behavioral
therapy, cognitive therapy, and eye
movement desensitization and reprocessing (EMDR).
Medications recommended include Prozac,
Paxil, Zoloft, and Effexor("Summary of the Clinical Practice
Guideline for the Treatment of
Posttraumatic Stress Disorder (PTSD) in Adults," 2019).
Depressive Disorder Due to Another Medical Condition
(chronic pain) – It is noted
that after Patti’s surgeries, she became more depressed, with
feelings of hopelessness, and
needing her daughter increased("Mother and Daughter: A
Cultural Tale.”, directed by
Anonymous, 2003). Patti’s independence decreased, and she
was no longer interested in
activities that impacted her mobility. According to recent
studies, chronic pain has been
connected to family dynamic changes, causing family tension.
As the family burden occurs, an
16. individual can become depressed and have increased difficulty
managing their pain (Boone &
Kim, 2019). Patti does not meet the criteria listed for this
diagnosis, she does find pleasure with
her children, friends, and three dogs. Relational dynamics,
interactions, and symptoms causing
pain to influence an individual’s pain. People can be either
positively or negatively affected
depending on the emotional support they are feeling. people
with pain and their partners (Tankha
et al., 2020).
11
Reflections:
Case Formulation and Treatment Plan: include
psychotherapeutic interventions that
take into consideration the family’s culture and current
situation.
Diagnostic studies:
Order thyroid panel. The thyroid and hormones play a
significant role within the brain
and how the brain functions. According to research, individuals
17. that suffer from either
hypothyroid or hyperthyroid conditions, anywhere from 30-70%
suffer from symptoms of
depression or anxiety (Erensoy, 2019).
Referrals:
patient to engage in services
including a psychiatric provider for medication management and
peer specialist to engage
in activities including group and art therapy at the clinic.
management of medical
management
chronic pain of bilateral
feet.
prevent decompensation.
management increase self-confidence
and promote community engagement.
Therapeutic interventions:
18. Discussed the risks, benefits, side effects, alternatives of
medications, and the target
symptoms with the patient. Side effects of Zoloft reviewed
include weight gain, nausea,
12
vomiting, increased thirst, headache, weakness, increase in
suicidal ideation, and
constipation(Drugs.com, 2020). Reviewed significance of not
discontinuing any
medication without discussion with a provider, and to contact
the provider with any
adverse effects.
mixing medications
including over the counter, herbal supplements, alcohol, and
illegal substances may be
detrimental. Discussed the importance of abstaining from
alcohol and illegal substances,
as they may have a damaging influence on a patient’s mental
health, depression, sleep
cycle, and physical health.
19. rimary provider in 7 days.
children, the crisis line,
emergency services, and to go to the closest emergency
department if she starts having
feelings of self-harm, suicidal or homicidal thoughts.
The patient’s questions were answered. The patient verbally
stated that she understands
the discussion and is in agreement with the treatment plan. Pt
signed the treatment plan
willingly.
Reflections:
This was an interesting case, with many layers, and many things
that attributed to Patti’s
depression. Sandy, the therapist working with the family has
worked with the family, doing well
throughout the last eighteen months. Although the family is
currently stuck with moving
forward, I feel Sandy worked with the family with progress and
moving forward. I liked the
approach of having a team to examine and bring forward other
ideas and perspectives to help the
20. 13
family heal and move forward. The family initially came in
related to reuniting a family, as time
went on tensions of multicultural differences were also
addressed. It is obvious that although the
family is having some struggles, they love and care for each
other very much. The children want
their mothers to have a productive and independent life. It is
important to address and respect the
family’s differences in their beliefs. An important goal for the
family is to find a routine that
works for both mother and her adult children. It is important
that both mother and children feel
supported, and both have their independence.
The articles I have attached are considered scholarly as
evidence by, dated within the last
five years, peer-reviewed, and obtained from the Walden
Library.
14
References
21. APA. (2013). Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). [MBS Direct].
Retrieved from
https://mbsdirect.vitalsource.com/#/books/9780890425572/
Boone, D., & Kim, S. Y. (2019). Family Strain, Depression, and
Somatic Amplification in Adults
with Chronic Pain. International Journal of Behavioral
Medicine, 26(4), 427–436.
https://doi.org/waldenulibrary.org/10.1007/s12529-019-09799-y
Drugs.com. (2020). Interaction checker. Drug interaction report.
Retrieved June 12, 2021, from
https://www.drugs.com/interactions-check.php?drug_list=1476-
0,3266-0,1573-0,11-
12,276-
0&types%5B%5D=major&types%5B%5D=minor&types%5B
%5D=moderate&types%5B%5D=food&types%5B
%5D=therapeutic_duplication&professional=1
Erensoy, H. (2019). The association between anxiety and
depression with 25(OH)D and thyroid-
stimulating hormone levels. Neurosciences (Riyadh, Saudi
Arabia), 24(4), 290–295.
https://doi.org/.waldenulibrary.org/0.17712/nsj.2019.4.2019002
8
22. "Mother and Daughter: A Cultural Tale.”, directed by
Anonymous. (2003). Masterswork
Productions [Video]. Alexander Street.
https://video.alexanderstreet.com/watch/mother-
and-daughter-a-cultural-tale.
Nichols, M., & Davis, S. D. (2020). The essentials of family
therapy (7th ed.). Pearson.
NIH.gov. (2020, October 26). Standard BMI calculator.
National heart, lung and blood institute.
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmic
alc.htm
Summary of the clinical practice guideline for the treatment of
posttraumatic stress disorder
(PTSD) in adults. (2019). American Psychologist, 74(5), 596–
607.
https://doi.org/waldenulibrary.org/10.1037/amp0000473
file:///var/filecabinet/temp/converter_assets/35/e3/Retrieved%2
0from%20https://mbsdirect.vitalsource.com/#/books/978089042
5572/
https://doi.org/waldenulibrary.org/10.1037/amp0000473
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmic
alc.htm
https://video.alexanderstreet.com/watch/mother-and-daughter-a-
cultural-tale.
https://video.alexanderstreet.com/watch/mother-and-daughter-a-
cultural-tale.
24. Smart Systems – Extra Credit Project
Choose one of the following topics:
• Smart Highways * Smart Hospitals/Healthcare
• Smart Schools * Smart Businesses/Factories/Warehouses
• Smart Data Centers * Smart Buildings
NOTE: the purpose of this paper is conduct research to create a
list of “Requirements” to develop a
Smart System and then explain those “Requirements” within the
paper. The “Requirements” will be
shown in a table and be included at the start of your paper,
before your written document. The heading
for the table will be the name of the Smart System chosen. The
table will consist of 3 columns: 1.
Requirement #; 2. Smart Sub-System and 3. Requirement
statement (see details below). The reader
should be able to match each requirement in the table to its
explanation in the paper. 50% of your grade
on this assignment will be based on the Requirements table.
The Requirements table will include at
least 20 “requirements” and these requirements will be short,
focused, statement that states what the
system “must do”, “will do” or “should do”.
25. Write a 7-page Word document, double-spaced, that identifies
the requirements to implement the
smart system chosen and its sub-systems. The 7-pages does not
include the cover page, the
“Requirements” table and the reference page(s). Do not include
a Table-of-Contents or Abstract.
You must include at least 5 references with citations. Not all
references need to be scholarly and
can include videos, websites, blogs, etc. You might also view
YouTube videos on Augmented
Reality to extend your research on how Smart systems may
evolve over time (i.e. future
applications and requirements).
Your chosen smart system will include multiple sub-systems..
Note when thinking about sub-systems: consider a Smart Home
system. Within that
Smart Home, you might have a sub-system for HVAC, another
sub-system for electricity,
another sub-system for communications, and another sub-system
for security, etc.
Examples of “requirements” for a Smart Home are at the bottom
of this document
Your paper must include multiple topic sections/paragraphs,
26. each with a specific focus as defined below.
Make sure your paper flows logically. In your paper, provide
the following:
1. A Cover Page with the title of the project and your name.
2. The “Requirements table” with at least 20 identified
“requirements” from across the sub-systems
identified.
3. An Introduction paragraph that summarizes the project
details, identifies the Smart System
chosen, and summarizes the important findings from your paper.
Remember, the Introduction
paragraph is written AFTER the remainder of the paper has been
written because it uses the rest
of the paper to summarize and introduce your research.
4. A major paragraph(es) that summarizes and analyzes your
research of the Smart System (with an
appropriate section Heading). Cite all sources and enclose
directly copied source material in
double-quotes. Questions your research might answer include:
a. What is the Smart Systems purpose?
b. What operations does it performs?
c. What are its inputs (resources, interfaces, when used)?
d. What are its outputs (interfaces, data)?
e. How does the technology integrate within the system?
27. f. How important is the technology to the system?
g. The system’s complexity, cost, and feasibility.
h. Any constraints or risks found during the research.
i. How the various technologies integrate to accomplish the
system goals.
If your research identifies any sub-systems that are ‘futuristic’
(and not covered in the sub-
systems below), briefly describe them at the end of this section.
NOTE: this section will probably not have any requirements
(other than for futuristic
technology) since these requirements will most likely be
identified in the sub-systems below.
5. Next, include a paragraph(es) for each Sub-System (with an
appropriate section Heading) that
includes:
a. A description of this Sub-System.
b. Detailed “requirements” that drive the development of this
Sub-System.
Note: see the definition of a “requirement” provided at the top
of this page and the
examples at the end.
c. Conclude the section with any ‘futuristic’ requirements that
might be on the horizon for
this sub-system, based on emerging technologies.
28. 6. Conclude your paper with a Findings section the summarizes
the important areas of your
research.
To receive full credit for this assignment, you must provide a
table of “Requirements” at the start of the
paper, document the smart system and document how the sub-
systems are integrated as a process(es)
within that system (i.e. Smart Homes have a lot of smart tools
but these tools are integrated as a smart
system used across multiple platforms – HVAC, Electricity,
Communications, Security, etc.)
Example of Requirements for Smart Thermostats
Requirements
• Smart thermostats will learn clients’ temperature preferences
and establish a schedule that
automatically adjusts temperatures when clients are asleep or
away.
• Smart thermostat should know when clients are returning
home and automatically adjust clients
home temperature to preferences.
• Smart thermostats must allow clients to control home’s
heating and cooling remotely through
mobile devices.
29. • Smart thermostats must quickly enter a low-power standby
mode when inactive.
• Smart thermostats must provide equipment use and
temperature data clients can track and
manage.
• Smart thermostats must provide periodic software updates to
use the latest algorithms and
energy-saving features available.
NOTE: The example above contains short, direct statements that
provided specific details. Requirements
are then explained in the written paper. For this example,
“must” implies highest priority; “will” implies
medium priority; and “should” implies lowest priority.
1
Family Assessment and Psychotherapeutic Approaches
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychotherapy with Multiple Modalities
June 13, 2021
30. 2
Abstract
As providers, it is vital to be open-minded, if you are not aware
or do not understand a person’s
culture, show your patients respect. Be engaged, respectful, and
ask questions. Learn from your
patients, this helps develop a rapport. As providers we are
obligated to provide optimal care, if
we feel a patient's needs are out of our scope, the client should
be referred to a provider that can
give them the help they need and deserve (Nichols & Davis,
2020).
The purpose of this paper is to provide documentation and a
psychiatric comprehensive
assessment of a patient and family during a family therapy
interview that highlights differences
in a multicultural family, respecting cultural norms and
differences, and develop an
individualized treatment plan.
Keywords: Family therapy
31. 3
Family Assessment and Psychotherapeutic Approaches
Subjective:
CC (chief complaint): “I like to learn to live on my own and not
depend on the kids.”
HPI: A 40-year-old female (Patti) and her five children (Sheela
age 24, Sharleen aged 23
and present today, Shireen age 21 recently reunited with family,
Armin Jr. age 18, and Sam age
15), of Iranian descent, has been in individual and family
therapy for the last 18 months. Patti
came to the clinic related to chaos in the home after her
daughter was finally reunited with the
family after ten years. The family initially had rejoiced and
celebrated, and after a few weeks,
Shireen began to tell her mother and siblings the emotional,
physical, and sexual abuse at the
hands of her father. She blamed and felt abandoned by her
mother. Patti needed necessary
surgery to both her feet after an injury, that has now left her
disabled and with chronic pain. The
additional burden of surgery and disability has increased
tension and stress in the home. Patti
32. lives with her two sons; her daughters live on their own.
Shireen recently moved out, marrying
someone the family does not know, with little contact. Mother
speaks and sees Sheela and
Sharleen daily. Patti has increasingly felt alone, depressed,
hopeless, and helpless wanting her
daughters to stay and help her at her home. A psychiatric
provider has been referred for a
medication evaluation.
Past Psychiatric History:
General Statement: Patti and her family began therapy 18
months ago after daughter
Shireen reunited with the family after 12 years of separation.
Shireen shared significant abuse
she experienced, learning the trauma she went through brought
on many emotions of the family
including blame, guilt, shame increasing stress on the family.
Caregivers: N/A
4
Hospitalizations: Patti denies any past psychiatric
hospitalizations or history. The patient
33. has no history of substance abuse or residential treatment. Patti
denies suicidal and homicidal
ideation, denies hallucinations. The patient has had two-foot
surgeries secondary to arthritis,
hammer toe, and severe plantar fasciitis with no relief for over
2 years, patient in hospital
overnight after each surgery.
Medication trials:
Zoloft 50 mg every morning for depression, with limited relief.
Will feel helpless and
hopeless three to four days a week. The patient is tolerating the
Zoloft and has recently been
increased to 100 mg daily.
Patti reports no adverse effects of Zoloft.
Naproxen 500 mg twice a day
Psychotherapy or Previous Psychiatric Diagnosis:
Patti has been receiving individual and participated in family
therapy over the last 18
months. Shireen came once and has stopped attending and
refuses to continue at this time. The
family has come to therapy together five times, to heal and
move on together.
34. Patti had surgery in the last 6 months and is no longer able to
work related to the
deteriorating condition of her feet that arthritis has caused. This
has led to being unable to work
at home often alone. She is experiencing being independent and
providing, what she has done for
so long. This has caused stress, increased anxiety, and
depression for Patti.
Therapy over the last several months has also uncovered
differences in the bicultural
situations. Patti is wanting the care provided to her as in the
Iranian culture, where she is
dependent on her children. The children living in America for
the last 12 years are more
Americanized and have adapted to the culture, with their own
lives leaving less time for Patti.
5
Substance Current Use and History: Patti drinks 16 ounces of
caffeinated beverages
daily. She denies smoking or drinking alcohol.
Family Psychiatric/Substance Use History: Patti denies any
substance or alcohol
35. abuse. She is unaware of any of her family has any abused drugs
or alcohol. Her husband drinks
large amounts daily, has not received treatment for alcoholism.
Patti denies any psychiatric
history in herself or her family.
Psychosocial History: Patti was born in Luristan Iran, raised by
her mother and father.
She had no siblings. At 14, her parents arranged for her to be
married to Armin Ali, a 25-year-old
foreman of a prominent automobile company in Tehran. Patti
moved to Tehran and had five
children with Armin. Patti gave birth to Sheela at the age of 16,
Shareen at age 17, Shireen at age
19, Amir Jr at age 22, and Sam at age 25. Patti stayed at home
working in the home and raising
the children while Amir worked and provided for the family.
When Sheela and Shareen were 11 and 12, it was discovered
they had medical conditions
that needed treatment in the United States. Patti applied for
visas to come to the United States.
She was able to take all her children but Shireen. Amir
encouraged Patti to go, he would look
after Shireen and come to the United States later. Once Patti
36. arrived, she was able to get the
needed medical treatment for her daughters and started making
a home for her family She
believed Amir would later come with Shireen. After years went
by, this did not occur, only letters
of how she needed to raise her children. Patti did not want to
return to Iran. She struggled with
leaving Shireen behind and afraid for her other children if she
returned. Patti had been abused
emotionally, physically, and sexually by Amir from the time
they were married. Patti and her
four children made a home in the United States, Patti worked
two jobs, but also made time to
attend school functions and volunteer at her children’s school.
Patti continued to work at
6
bringing Shireen to the United States, it took several years. She
was finally able to bring her,
Shireen was 18 when she arrived, and the family celebrated.
After a few weeks, Shireen began to
share her trauma of emotional, physical, and sexual abuse by
her father. Patty struggled to hear
37. the information, she was aware, as Amir would treat her the
same way, she would tell him to beat
her and not her children. Shireen was angry and blamed her
mother. Patti pursues help with
therapy to work through the guilt and shame of the trauma.
Medical History: Hammer toe, bilateral great toes, arthritis,
plantar fasciitis
Current Medications:
Zoloft 100 mg every morning for depression and anxiety
Naproxen 500 mg twice a day
Tramadol 100 mg twice a day as needed for severe pain.
Allergies:
No known drug allergies
No known seasonal allergies
No Known food allergies
Reproductive Hx: The patient is a Gravida 5 para 5. The patient
denies any abortions or
miscarriages. The patient has been celibate for the last 12 years
since arriving in the United
States. The patient denies any sexually transmitted infections,
started menses at age 14. The
38. patient has menses every month without any significant issues
or concerns.
ROS: Provided by a medical provider.
GENERAL: Alert and orientated x 4. No weight loss, fever,
chills, weakness, or fatigue.
HEENT: No hearing loss, sneezing, congestion, runny nose, or
sore throat.
7
SKIN: No rash or itching. Incisions on bilateral great toes
healed. The incision on
bilateral heels healed, with no redness or bruising.
CARDIOVASCULAR: No chest pain, chest pressure, or chest
discomfort. Regular rate
and rhythm, no murmurs, no rubs, no gallops. No palpitations
or edema.
RESPIRATORY: No wheezes, rales, or rhonchi. No shortness
of breath, cough, or
sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or
diarrhea. No abdominal
pain. No guarding or rebound tenderness.
39. GENITOURINARY: No burning on urination, urgency,
hesitancy, or odor.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia. No change in
bowel or bladder control.
Cranial Nerve 2: vision is grossly accurate.
Cranial Nerve 3,4,5,6: motor movements appear normal.
Cranial Nerve 7: facial muscles appear symmetrical.
Cranial Nerve 8: hearing is adequate for her age.
Cranial Nerve 9-12: swallows without difficulty.
MUSCULOSKELETAL: No muscle and back pain, chronic pain
in bilateral feet.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat
intolerance. No polyuria
or polydipsia.
8
Physical exam:
40. Vital signs: B/P: 126/78, P: 88, Height: 63 inches, Weight:
225lbs, BMI: 39.9 (NIH.gov,
2020).
General: Alert and oriented to self, time, location, and situation.
Head: Symmetry
Eye: extraocular movements are intact, normal conjunctiva.
Vision: shortsighted, glasses
worn.
Ears: Symmetry. Normal hearing.
Neck: Symmetry. No swelling or palpable mass noted. Throat:
Symmetry. Oral
mucosa is moist.
Neck: Full ROM. Carotids no bruit or JVD.
Chest/Lungs: Lungs are clear to auscultation. Respirations are
non-labored.
Heart/Peripheral Vascular: Normal heart rate, regular rhythm,
no edema noted.
Abdomen: Round and large. Bowel sounds present in all four
quadrants. Negative
tenderness.
Genital/Rectal: No abnormalities. Menses started at 15 and are
regular.
41. Musculoskeletal: Normal ROM. muscle weakness due to
physical inactivity
Neurological: Cranel Nerves II-Xll grossly intact.
Skin: No clubbing or cyanosis.
Toes: Bilateral great toes, incisions healed.
Objective:
Diagnostic results:
CBC: within normal
9
Assessment:
Mental Status Examination: A 40-year-old Iranian female,
appearing stated age. The
patient is alert and oriented to self, place, time, and situation.
Patient cooperative, engaged in
conversation. Patient grooming clean, although shirt tight
fitting. Speech is clear, Iranian accent
with average tone. During the interview, when upset or arguing
with the daughter, her voice
becomes louder. Thought process goal-directed and logical. No
noted flight of ideas,
42. hallucinations, or delusions noted. No abnormal motor activity
noted. The patient’s mood is
depressed and anxious, affect blunted at times. The patient
denies being suicidal or homicidal
currently. The patient’s short-term and long-term memory
intact, good insight and judgment,
with good concentration. The patient has no legal history,
arrests, and no pending charges. Eye
contact is fair throughout the interview.
Differential Diagnoses:
Adjustment disorder with depressed mood – Patti’s children are
growing up; she is
feeling alone. She states when she is lonely, she feels hopeless
and helpless. She is wanting her
children to stay with her, having a difficult time adjusting to
them not home as much. She has
also had recent surgeries in the last 4 months, and she is
adjusting to not being as independent as
she was before with mobility and chronic pain issues. Patti is
exhibiting feelings of sadness and
hopelessness in response to three identifiable stressors; recent
surgeries and children moving out
43. of the home, and grief and guilt of past trauma her daughter
experienced. The patient meets the
criteria as a primary diagnosis (APA, 2013).
Depressive disorders not due to another medical condition;
grief, PTSD. Patti has
had depressive episodes prior to her surgeries, she has been in
therapy for the last 18 months, she
10
has had traumatic events in her life including abuse, and loss. It
is important to determine if the
medical condition is associated with depression. It is necessary
to examine if an episode of
depression occurred prior to medical illness, the medical
condition promotes depression, and if
the symptoms after the start of the medical condition stabilized
(APA, 2013). A panel consisting
of psychiatric health professionals strongly recommends
interventions for patients with post-
traumatic stress disorder to include cognitive behavioral
therapy, cognitive therapy, and eye
movement desensitization and reprocessing (EMDR).
Medications recommended include Prozac,
44. Paxil, Zoloft, and Effexor("Summary of the Clinical Practice
Guideline for the Treatment of
Posttraumatic Stress Disorder (PTSD) in Adults," 2019).
Depressive Disorder Due to Another Medical Condition
(chronic pain) – It is noted
that after Patti’s surgeries, she became more depressed, with
feelings of hopelessness, and
needing her daughter increased("Mother and Daughter: A
Cultural Tale.”, directed by
Anonymous, 2003). Patti’s independence decreased, and she
was no longer interested in
activities that impacted her mobility. According to recent
studies, chronic pain has been
connected to family dynamic changes, causing family tension.
As the family burden occurs, an
individual can become depressed and have increased difficulty
managing their pain (Boone &
Kim, 2019). Patti does not meet the criteria listed for this
diagnosis, she does find pleasure with
her children, friends, and three dogs. Relational dynamics,
interactions, and symptoms causing
pain to influence an individual’s pain. People can be either
positively or negatively affected
depending on the emotional support they are feeling. people
45. with pain and their partners (Tankha
et al., 2020).
11
Reflections:
Case Formulation and Treatment Plan: include
psychotherapeutic interventions that
take into consideration the family’s culture and current
situation.
Diagnostic studies:
Order thyroid panel. The thyroid and hormones play a
significant role within the brain
and how the brain functions. According to research, individuals
that suffer from either
hypothyroid or hyperthyroid conditions, anywhere from 30-70%
suffer from symptoms of
depression or anxiety (Erensoy, 2019).
Referrals:
patient to engage in services
including a psychiatric provider for medication management and
46. peer specialist to engage
in activities including group and art therapy at the clinic.
management of medical
management
chronic pain of bilateral
feet.
Referral to physical therapy for increased mobility and
prevent decompensation.
management increase self-confidence
and promote community engagement.
Therapeutic interventions:
Discussed the risks, benefits, side effects, alternatives of
medications, and the target
symptoms with the patient. Side effects of Zoloft reviewed
include weight gain, nausea,
12
vomiting, increased thirst, headache, weakness, increase in
suicidal ideation, and
47. constipation(Drugs.com, 2020). Reviewed significance of not
discontinuing any
medication without discussion with a provider, and to contact
the provider with any
adverse effects.
mixing medications
including over the counter, herbal supplements, alcohol, and
illegal substances may be
detrimental. Discussed the importance of abstaining from
alcohol and illegal substances,
as they may have a damaging influence on a patient’s mental
health, depression, sleep
cycle, and physical health.
children, the crisis line,
emergency services, and to go to the closest emergency
department if she starts having
feelings of self-harm, suicidal or homicidal thoughts.
The patient’s questions were answered. The patient verbally
48. stated that she understands
the discussion and is in agreement with the treatment plan. Pt
signed the treatment plan
willingly.
Reflections:
This was an interesting case, with many layers, and many things
that attributed to Patti’s
depression. Sandy, the therapist working with the family has
worked with the family, doing well
throughout the last eighteen months. Although the family is
currently stuck with moving
forward, I feel Sandy worked with the family with progress and
moving forward. I liked the
approach of having a team to examine and bring forward other
ideas and perspectives to help the
13
family heal and move forward. The family initially came in
related to reuniting a family, as time
went on tensions of multicultural differences were also
addressed. It is obvious that although the
family is having some struggles, they love and care for each
other very much. The children want
49. their mothers to have a productive and independent life. It is
important to address and respect the
family’s differences in their beliefs. An important goal for the
family is to find a routine that
works for both mother and her adult children. It is important
that both mother and children feel
supported, and both have their independence.
The articles I have attached are considered scholarl y as
evidence by, dated within the last
five years, peer-reviewed, and obtained from the Walden
Library.
14
References
APA. (2013). Diagnostic and Statistical Manual of Mental
Disorders (DSM-5). [MBS Direct].
Retrieved from
https://mbsdirect.vitalsource.com/#/books/9780890425572/
Boone, D., & Kim, S. Y. (2019). Family Strain, Depression, and
Somatic Amplification in Adults
with Chronic Pain. International Journal of Behavioral
Medicine, 26(4), 427–436.
50. https://doi.org/waldenulibrary.org/10.1007/s12529-019-09799-y
Drugs.com. (2020). Interaction checker. Drug interaction report.
Retrieved June 12, 2021, from
https://www.drugs.com/interactions-check.php?drug_list=1476-
0,3266-0,1573-0,11-
12,276-
0&types%5B%5D=major&types%5B%5D=minor&types%5B
%5D=moderate&types%5B%5D=food&types%5B
%5D=therapeutic_duplication&professional=1
Erensoy, H. (2019). The association between anxiety and
depression with 25(OH)D and thyroid-
stimulating hormone levels. Neurosciences (Riyadh, Saudi
Arabia), 24(4), 290–295.
https://doi.org/.waldenulibrary.org/0.17712/nsj.2019.4.2019002
8
"Mother and Daughter: A Cultural Tale.”, directed by
Anonymous. (2003). Masterswork
Productions [Video]. Alexander Street.
https://video.alexanderstreet.com/watch/mother-
and-daughter-a-cultural-tale.
Nichols, M., & Davis, S. D. (2020). The essentials of family
therapy (7th ed.). Pearson.
NIH.gov. (2020, October 26). Standard BMI calculator.
51. National heart, lung and blood institute.
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmic
alc.htm
Summary of the clinical practice guideline for the treatment of
posttraumatic stress disorder
(PTSD) in adults. (2019). American Psychologist, 74(5), 596–
607.
https://doi.org/waldenulibrary.org/10.1037/amp0000473
file:///var/filecabinet/temp/converter_assets/35/e3/Retrieved%2
0from%20https://mbsdirect.vitalsource.com/#/books/978089042
5572/
https://doi.org/waldenulibrary.org/10.1037/amp0000473
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmic
alc.htm
https://video.alexander street.com/watch/mother-and-daughter-a-
cultural-tale.
https://video.alexanderstreet.com/watch/mother-and-daughter-a-
cultural-tale.
https://doi.org/.waldenulibrary.org/0.17712/nsj.2019.4.2019002
8
https://www.drugs.com/interactions-check.php?drug_list=1476-
0,3266-0,1573-0,11-12,276-
0&types%5B%5D=major&types%5B%5D=minor&types%5B%5
D=moderate&types%5B%5D=food&types%5B%5D=therapeutic
_duplication&professional=1
https://www.drugs.com/interactions-check.php?drug_list=1476-
0,3266-0,1573-0,11-12,276-
0&types%5B%5D=major&types%5B%5D=minor&types%5B%5
D=moderate&types%5B%5D=food&types%5B%5D=therapeutic
_duplication&professional=1
https://www.drugs.com/interactions-check.php?drug_list=1476-
52. 0,3266-0,1573-0,11-12,276-
0&types%5B%5D=major&types%5B%5D=minor&types%5B%5
D=moderate&types%5B%5D=food&types%5B%5D=therapeutic
_duplication&professional=1
https://doi.org/waldenulibrary.org/10.1007/s12529-019-09799-y
15
Tankha, H., Cano, A., Corley, A., Dillaway, H., Lumley, M. A.,
& Clark, S. (2020). A novel
couple-based intervention for chronic pain and relationship
distress: A pilot study. Couple
and Family Psychology: Research and Practice, 9(1), 13–32.
https://doi.org/waldenulibrary.org/10.1037/cfp0000131.supp
(Supplemental)
https://doi.org/waldenulibrary.org/10.1037/cfp0000131.supp%2
0(Supplemental)References
Running head: PSYCHOTHERAPY
1
PSYCHOTHERAPY 5
0:00TRANSCRIPT OF VIDEO FILE:
00:00:00_____________________________________________
________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[music]
00:00:35A MOTHER and A DAUGHTER:
00:00:35A CULTURAL TALE
00:00:35AN INTERVIEW WITH
00:00:35GONZALO BACIGALUPE, PhD
00:00:35Produced by
53. 00:00:35Andrews & Clark
00:00:35Explorations, Inc.
00:00:35copyright 2003
00:00:35GONZALO BACIGALUPE When I'm asked to do a
consultation, one of the first things I ask is, what will be the
most benefit for the client and the therapist and in the case that
you're going to see I'm basically asked to have a reflecting team
and what we did was first have an interview with the therapist
and the family and ask them what they will find useful for the
interview and basically to ask them about the history of the
therapy and the history of what are the kinds of things that they
have been working on. I ask the reflecting team to come in and I
instructed them to think of themselves as so let the god mothers
of the therapist, who in a way, put them, himself, or in this
case herself at risk in front of her peers and another people. So,
I wanted them, the reflecting team to address the therapeutic
system as a whole not just to address the family, I wanted them
to talk also about the therapist and to be protective of them. I
also ask the reflecting team not to be too much of clinician, but
to really react on a more personal level around the family. I
sometimes reflected on what they were saying to clarify or to
expand the idea or how I understood it to give voice to other
possibilities, but respecting the personal peace, and then, I ask I
ask the family to come back to, in a classical way, to respond to
those comments what strike them. In the case that we watch, it
seems that the family was dealing with sort of like two forms of
trauma and/or three forms of trauma; one is, history of battering
the domestic violence, child sexual abuse, a history
of immigration that in some ways we lay it to that
trauma getting away from it and basically the mother of five
children deciding that they need to move out of the home, but in
the process leaving one behind who is later on sexually, I mean,
raped by the father. And then at the present moment mother
dealing with a fairly traumatic illness that have her, very
disable, unable to walk and to work. So, it's sort of like
the interview trying to address this different forms of
54. trauma and the way in which the young adults are trying to
make sense of their bicultural life and how the whole family is
trying to make sense of being bicultural and being immigrants.
The session doesn't end with a need or incredible intervention
of my part because I feel that this is the part of the therapist to
try to decide, this is the family that's been working this
therapist for year and half. Therefore, they have a relationship I
feel that I need to respect and so those are the
basic intercomments. So tell me how is it that you came out
with the idea of having this interview with me?
00:04:30Sharleen
00:04:30Patti
00:04:30SANDI Okay. I'm going to go back when Patti came in
for the first time. She came in because they were chaos at
her household.
00:04:45Sandi - their therapist
00:04:45SANDI She came to this country twelve years ago with
her four children and one was left behind, her daughter who was
10 years old at that time, eight years old at that time, was left
behind. Just two years back, finally they were able to get her
visa and she brought her to United States. So ever since she
came here chaos was created inside the household.
00:05:20GONZALO BACIGALUPE So I'm clear, Sharleen
you are?
00:05:25SHARLEEN Her daughter.
00:05:25GONZALO BACIGALUPE Her daughter. And how old
are you?
00:05:25SHARLEEN I'm 23.
00:05:25GONZALO BACIGALUPE 23, and how old are your
siblings?
00:05:30SHARLEEN 24.
00:05:30GONZALO BACIGALUPE And that's sister or
brother?
00:05:35PATTI Sister.
00:05:35SHARLEEN And then 21-year old sister and 18-year
old brother and a 15-year old brother.
55. 00:05:50GONZALO BACIGALUPE Okay, and which one is the
one that stayed there.
00:05:50SHARLEEN 21.
00:05:50SANDI 21.
00:05:50GONZALO BACIGALUPE 21. Okay. All right. Okay.
Go ahead, sorry.
00:05:55SANDI And I met with the entire family for two couple
of sessions and she really interested and wanted to be in
therapy 21, so.
00:06:10GONZALO BACIGALUPE What's her name?
00:06:10SANDI Shireen.
00:06:15Shireen - the 21 year old sister
00:06:15emigrated from Iran 2 years ago
00:06:15GONZALO BACIGALUPE Okay.
00:06:15SANDI She just felt that she needed the money more
than coming to therapy and she refused the entire time and mom
tried to she ask her, if she doesn't feel comfortable with me. She
said she has had all appointments with other therapists at this
clinic, still she refused to come in, but they kept on seeing Patti
and the oldest daughter Sheela for about a year and a half
now. Ever since then, we started working on the chaos in the
household, what is it that creating chaos and I found out that
Patti lives with traditional ways of living, their daughters are
trying to detach herself from Patti and grow on their own and
find their own individuality. So would ask where they have been
working on and every since then she had two surgeries.
00:07:30Patti had surgery on both feet.
00:07:30SANDI Every thing is started.
00:07:35GONZALO BACIGALUPE Who had two surgeries?
00:07:35SANDI Patti had two surgeries on her feet.
00:07:40Surgery failed - she is disabled.
00:07:40SANDI And that created more tension, anxiety in
the family.
00:07:50She is in constant pain.
00:07:50SANDI So -- and I have been seeing her after her
surgery and she has been referred to a psychiatrist for
56. medication because a lot of time she feels hopeless, helpless,
she feels her children are out of control, she can't be in charge,
they no need her anymore. So those are the major.
00:08:20GONZALO BACIGALUPE If you were to describe an
accomplishment and you have accomplishment with the
therapists during this time. Is there something that you will say,
it's an important accomplishment?
00:08:35SANDI Awareness of the difference
between individualist ways of living and collectivistic ways of
living and awareness that how they to respect and understand
the children are growing in this country and they are going to
try to detach themselves from Patti to be able to grow on their
own.
00:09:00GONZALO BACIGALUPE What has been for you this
work with Sandi?
00:09:05PATTI She helped me to understand the kids grow up
and left the house and they have been not to depend on them so
many times and try to live my life alone and then to take care of
my things, my problem in the life and respect them and give
them their freedom.
00:09:30GONZALO BACIGALUPE Do you have a sense that
that is sort word that has been accomplished that is more to
be done.
00:09:35PATTI I think I need more to be done, I'm not done.
No.
00:09:40GONZALO BACIGALUPE Do you have of sense of
what is that you would like to do?
00:09:45PATTI Yeah, I'd like to learn to lead my life alone and
depend on the kids a lot because in our custom when the parents
get old and especially when they are in my situation they can't
walk or take care of theirself, the kids are always there for
parents, but over here no, they have their own life. And I expect
them to be there all of the time for me and they can't, matter of
fact, I had a big argument with her last night about that, I had a
very bad back for few days I was done and last night, I called
her and I said come and spend a night with me and she said no,
57. I can't. I said, you should and you have to and we got into a
big argument.
00:10:30GONZALO BACIGALUPE So, you are on your own
right now, you're living in your own and each of the kids have
their own place or?
00:10:35PATTI Three of them, two of the boys lived with me 18
and 15 years old, but the 15 years old was with her for three
four days and I was with 18 years old a lot. I feel like they
doesn't do enough for me.
00:10:50SHARLEEN She makes her own plans for me, she
expects me to like to go with her and spend time with her
because she is bored. I have too much to do, I can't unwind your
boredness, find something else to do, but I have plans, I'm
24 and my world around me is happening and I need to be there,
I accomplish things. I can't sit down and like chitchat for a
whole day.
00:11:15PATTI And I feel I'm depressed I cannot move, I need
them to come and visit me, spend a night with me.
00:11:20SHARLEEN I spend, I -- out of the seven days, I
saw her for six days, I make sure, I saw her for six days out of
that week. I spent a day with a friend and I got some stuff done
and she felt like I owe her something because I didn't spend that
time with her. And she did a nice job raising us, she was a
wonderful mother, we all suffered through the good and the bad
in the family like every family does, but we have all grown up,
we can't stay in the nest forever. I'm trying to experience life
and my own good or bad, whether you approve it or not, it's my
life.
00:11:55GONZALO BACIGALUPE Sharleen, is this something
that you have had a discussion, the three of you, I mean this
particular or this is not like?
00:12:00SHARLEEN I think, I have mentioned to her, but she
takes it personal, she doesn't hear me out.
00:12:05GONZALO BACIGALUPE Is this something that you
have had conversations with the family?
00:12:10SANDI Over and over, yes. Especially with the oldest
58. daughter Sheela, she also, being the oldest, she feels that she
has been the parentified child all her life, she has played a role
of a man for -- in her mother's life and then the entire, I've
seen her for about four times right, four, five times and she used
to cry the entire time in the session.
00:12:40GONZALO BACIGALUPE And I realize that you're
being very touched by this, I mean this is not something that.
00:12:45SHARLEEN Yeah, it's something that I strive so hard
to accomplish and as soon as I feel like I got her on the
right step, there she goes falling depart again asking for like, I
give her what I can and she keeps on asking for more and more
and that's not how my life works.
00:13:05GONZALO BACIGALUPE What do you right now?
Are you working, studying?
00:13:05SHARLEEN Yeah, I work and I'm trying to get my
license. I'm trying to get accomplish things from now.
00:13:15GONZALO BACIGALUPE What kind of work are you
are doing right now?
00:13:15SHARLEEN I just -- I find promotional jobs and then,
I'm trying to get my real estate license.
00:13:25GONZALO BACIGALUPE And your sister?
00:13:30SHARLEEN Sheela?
00:13:30GONZALO BACIGALUPE Sheela, is she also on her
own?
00:13:30SHARLEEN Yeah.
00:13:30GONZALO BACIGALUPE She is also
working, studying? And the 18-year old, what is he doing?
00:13:35PATTI He is a student.
00:13:40GONZALO BACIGALUPE In high school?
00:13:40PATTI Yes.
00:13:40GONZALO BACIGALUPE So, he is finishing high
school right now?
00:13:40PATTI Yes, this year.
00:13:45GONZALO BACIGALUPE And is he talking also about
leaving home after finishing the high school or what are his
plans?
59. 00:13:50SHARLEEN He is not sure yet, depends on how the
family situation is going, you know, everybody looks for
happiness and peace of mind, depends like how he feels around
the home.
00:14:00GONZALO BACIGALUPE How about the 15-year
old?
00:14:00PATTI I have lots of problems with him, I don't get
long with him at all.
00:14:05SHARLEEN She has no patience. And she takes it out
on other people.
00:14:10PATTI Because I can't do anything, I walk fewer step
and that's it, I have a horrible pain after fewer step. And I have
to sit and wait for them to come and give me a glass of water.
00:14:25SHARLEEN Well, the thing is I want her not to wait
for us, I want her to be on her own, I want her to learn how to
like, you know there is a -- you know superman lost his both
feet and he sits on a wheel chair, but he is still going on
with life.
00:14:40PATTI But Superman has money, somebody take care
of him all of the time.
00:14:40SHARLEEN You have to learn how to ease your
own mind and not depend on other people. She is forty years
old, if she was 60, poor dying lady, I would be more
sympathetic, just 40 years old, there is much more for her to
experience. It's not time for her to start depending on her
children yet. We're only in our 20s, let me live life, let me
experience and do what you can, while you can. Give it
your best.
00:15:10GONZALO BACIGALUPE Sharleen, how is that you
decided to come today, I mean what's it?
00:15:10SHARLEEN Because I was with her last week and they
asked me to, they invited me to, so I thought maybe you would
like help as much as this is helping you.
00:15:20GONZALO BACIGALUPE Do you have a sense that
you are sort of being representative of the other of your siblings
that you are coming as a representative for all of them in some
60. way?
00:15:30SHARLEEN We are all trying to get her to be more
positive and feel like do a little step at a day, but try your best
to be better, to do a better in life. Every time I try to push her to
be more independent and not as much like do that all stuff with
her that she could do on her own, she keeps like she has a
broken wing that she wants to buoy on us, after a while, it gets
heavy. You just want it off because I want to breathe and I want
to experience my life. I cannot live like a 20-year old from Iran.
I have different things to experience than to sit at home. And
the thing is like I don't feel like I can accomplish with her when
I'm at home because she is either watching TV or on the phone,
which is just like sad people around and I can't hang out
like that.
00:16:20GONZALO BACIGALUPE Besides the -- your five
kids and yourself, is there anybody else in the family here who
immigrated with you guys or --?
00:16:25PATTI I have a cousin, but they live LA and I don't
even talk to them.
00:16:35GONZALO BACIGALUPE And so, in a way, when
you need something, basically the only thing that you feel like
you can go for your kids? When you -- we're talking about
chaos, there have been -- there were some chaos about a year
and half ago when we start through the work and can you tell
me little bit about what the chaos was about or what -- how you
define that?
00:17:00SANDI Okay. I just want to mention something
about before her surgery Patti has been a very independent
women as far as working hard, single mother, raising all
her children and they are all proud of her in many ways. When
they came she did not have the health problem as far as the pain
in her feet, constant pain and feeling hopeless and helpless.
They came for a different reason was for Shireen, because
Shireen came form Iran and two weeks everything
was wonderful, they all re-united, they enjoyed, celebrated for
two weeks, and then, she started telling him about the stories
61. that her father abused her sexually, physically and she was
abandoned in their house. So, that's where the explosion, the
chaos started. Before that --
00:18:05GONZALO BACIGALUPE When you say that the
chaos started, what started to happen?
00:18:05SANDI They were fighting, constant fighting,
screaming, yelling and cursing each other. Before that, my
understanding was that kind of was a very peaceful way of
living, am I correct in this?
00:18:25GONZALO BACIGALUPE Okay. All right, so the
tension has really sky rocketed after Sheela came back, I mean,
two weeks after one, and then, he came out of that -- there's
been this --?
00:18:35PATTI As she came back, she was blaming me, why
did you left me back home with my dad there, he did all of
those things to me. And my husband used to tell her, you was a
rotten fruit and she didn't take you, you are a rotten one. She
took the good ones and left you behind for me. And she was
blaming me for everything.
00:18:55GONZALO BACIGALUPE When you left, you had
separated from your husband?
00:19:00PATTI No, we were living together my daughter had a
medical problem, Sheela and matter of fact, her, and they give
me a medical visa to come here and Sheela and Sharleen born
here many years ago. And when I went to get a Visa, they told
me two of them are American citizen, you have to take them, we
cannot say no. And my boys were four years old then 18 months
old and Shireen was eight and they said, they decide Shireen
should be stayed home and make it sure I'll will be go back.
But after I came here, my daughter didn't have any problem any
more and they were find and I used to stay here and I decided to
live here. And my husband was keep telling me don't come,
don't come, stay there, I will come some day and he never sent
me any money, he never did anything for us at all except
sending the letter 10 pages every single day, what to do, how to
leave and how to raise the kids and I throw them all in the trash
62. because I didn't had a time to read them and I didn't had time to
practice anything he said and I ignored everything until like six,
seven years later, he just wrote a letter, I want you to be back
home, you are my wife, I order you to back home and I said,
forget about you, I have my life here. And who wants to go back
to that life. And I was thrown all of the time to bring Shireen
and I couldn't until three years ago. Finally, she came and for
couple of days, weeks everything was fine until she started
talking about every problem she had back home and for any
little mistakes she made, my husband used to beat her up and
keep her outside the house for all night and many, many things,
the things he used to do to me. And I know what she talking
about and what she had to go through, but I couldn't do anything
about it. I didn't have the choice. When I came here few week
after, few months after I was here I called my dad and I
said, I'm worried about Shireen, I afraid to beat her and I'm not
there to protect them because I was all this over to protect the
kids. Each time he wants to beat them, I was right ahead of
them and say, beat me, don't touch my kids, do whatever you
want with me. And my dad said you should imagine your house
was in the fire, you took four of them off the fire, you left
one behind, leave her behind and take care of those four you
have and I thought about it, I thought, he is very right,
absolutely right, I should take care of the four I have over
here. Why should I go back there. He would be --
make everybody miserable. I didn't have a very good life but
like she said, we all worked together and take care of each other
and like I was out all of the time and like Sheela said, she was
father of the kid, take care of the kids, take care of the bank
account, his groceries, everything. And I used to be a care giver
and save it all this and Sheela and Sharleen would stay home
and take care of the kids, two younger brother and each other.
And everything was okay until Shireen came. And then, after
few months, for a couple of years, we had a problem until,
thanks god, last May she got married with somebody behind our
back.
63. 00:22:25GONZALO BACIGALUPE Who got married?
00:22:25PATTI Shireen, we were on the camping three when
she ran away with one of my friend's son and got married
and she moved out the house and my house is so quiet and I
enjoy the life so much except I get so depressed because I feel
hopeless and I have so much pain and they can't do anything
about my pain, I'm always in pain.
00:22:50GONZALO BACIGALUPE As you must have seen,
when -- do you work on how they make sense of what happen to
Shireen, I mean, in Iran during the time that she was alone, was
that workout with the whole family, they were some sort of a
conversation in therapy?
00:23:05SANDI Yes, I met, as I remember, I met with all of
them and they expressed their feelings and shouting, yelling,
everything was going on in our session. And they
were expressing, Shireen was constantly blaming the mother for
all her pain and what happened to her to lead on and a mother
tried to explain her situation, the sisters also, brothers also. So,
we had few sessions like that.
00:23:35GONZALO BACIGALUPE What was your sense of
how it can -- that there were some sort a resolution around that
that people were able to make sense that Patti and the kids were
able to make sense of this or?
00:23:50SANDI I was hoping for that, that was my really aim
to discover, explore their meanings of the situation and.
00:24:00PATTI They got in fight, we couldn't keep
coming back, I couldn't make them to go back as a family.
00:24:05GONZALO BACIGALUPE Is it still something that is
very hard to talk about or not?
00:24:10PATTI About the rape you mean?
00:24:10GONZALO BACIGALUPE Yeah?
00:24:10PATTI What do you think?
00:24:15SHARLEEN Well, I'm not very worried about, I mean,
it's affecting her life and I feel sorry for her, but I try not to
think about it.
00:24:25GONZALO BACIGALUPE And do you have the sense
64. that that's what anybody else in the family tries to do that tries
hard so they doesn't affect?
00:24:30SHARLEEN Because we already did our crying over it
and I'm over it, I'm ready to move on about it.
00:24:40PATTI It's like when somebody die, you grieve for
it. When I heard about it, I was crying and crying and crying for
months and months, and then later on, it's something you can't
do any thing about this, something happened, what am I going
to do about it. I tried to take her to counseling, I take her to
Iranian psychologist, 200 dollars an hour. And she would then
go back, then what can I do. And I think I'm over with it, I feel
sorry for her, but what can I do. My older son doesn't want to
talk to this, his dad, nobody wants to contact him or have
any relationship or any thing to --
00:25:20GONZALO BACIGALUPE Has he acknowledged that
he did rape her?
00:25:25PATTI I told him once, and he will start cursing at me
and I hang up. I said, I pay a dollar fifty a minute, I don't want
to hear your cursing. I want to see what's going on,
what happened and you tell me if it happened or not and will
start cursing and I hang up. And after that, I never called back,
and he is remarried, he married to Iris after Shireen came,
during the three years, he got married twice and he has moved
on with his life.
00:25:55GONZALO BACIGALUPE Is there any, I mean, is
there a way in which you think, I mean you, Sharleen and
maybe some of your siblings, but just from your perspective,
is there where you think about how the relationship with your
mom should be, is it -- do you have a dream for how?
00:26:15SHARLEEN Yeah, I just wanted her to be more
peaceful. I want her to lower her expectations and to accept a
lot of things about life.
00:26:25GONZALO BACIGALUPE What do you mean lower
expectations, what?
00:26:25SHARLEEN Not to expect so much from people, not to
-- I think what she does is, she thinks of an idea and she reacts
65. on it so so quick without she calming herself down before she
like takes the reaction.
00:26:40GONZALO BACIGALUPE Do you have a sense that
your mom thinks that you can do more than what you can
actually do?
00:26:45SHARLEEN I have a sense that she is holding me back
from doing all that I could be doing and as soon as I could get
excited about her, every time I give her little bit of hope, there
she goes back expecting more, and then, getting angry at. She
has some thoughts then she is so hang up that these thoughts are
like so true and she gets angry about them and she hold on to
them, then she accuses people and all they are her thoughts in
her mind. And I just ask her to leave them alone, let people be
and everything is going to -- just then it's going to take its
course.
00:27:15GONZALO BACIGALUPE Am I trying to tell you,
if you were to think about how your ambition, how you see it in
the future, the relation how do you see it? I mean, if you were
to move in a way the direction that you want it to move, how
many times do you see yourself beside in her or interacting with
her?
00:27:35SHARLEEN I speak to her every day, I mean almost
everyday.
00:27:40GONZALO BACIGALUPE But again, I'm asking you
more about --
00:27:40SHARLEEN Like in the future, yeah, I just want her to
like be more calm about like life so that I could like through her
better. So that when I do spend time with her that I could enjoy
it better instead of her frightening my other siblings or telling
me about how so and so, this and that and this and that. I just
want her to be more calm so we could just enjoy the moment
when we hang out, rather than like.
00:28:05GONZALO BACIGALUPE What kinds of things do
you enjoy with her in the moment?
00:28:10SHARLEEN I try to tell her about my ideas, how she
is like be more relaxed and not -- you know same things.
66. 00:28:15GONZALO BACIGALUPE Patti, how do you ambition
the relationship with your daughter?
00:28:20PATTI I saw her on Sunday, Sunday night and Sunday
night, I went to visit my older daughter and she was aware that I
took the dinner for them. And after I laid down fully at my
daughter, older daughter house, I couldn't get up, they pulled
me and took me to the car and I came home. I didn't see her
until yesterday afternoon and I said, I have been done with my
bag. I just want them to spend time with me. I'm lonely, I get
depressed when I'm lonely. If she had a job, if she was working
like the other people, I would understand she is working
everyday like my older daughter, she go to her school, she
work, I understand she doesn't have a time, but I know she has
time and I expect her to come and spend the time. And I said, I
gave you whatever you want, whatever I have in the house like
furniture, this and that, anything she said, mom can I have this?
Sure, honey, doesn't matter you or me, you can have it. And
when I'm like that with you, I expect you to do something for
me too.
00:29:20GONZALO BACIGALUPE Patti, I understand how also
you are feeling upset about this, about and I know that the
question I'm asking is hard, I mean, how do ambition the
relationship with Sharleen? What will you like to happen in the
future?
00:29:40PATTI Between me and her? I want her to just spend
time with me whenever she can.
00:29:45GONZALO BACIGALUPE What kind of time for
instance would you like to --?
00:29:45PATTI She come and stay at my house because she
knows I cannot live with two boys and go to her house. She
most of the time ask me to come and stay at my house, but when
I go to her house and I spend over there, I'm worried about 18
years old I have at home.
00:30:05GONZALO BACIGALUPE And do you have a sense of
how many times, how many nights that you would like her to
spend with you in your home?
67. 00:30:10PATTI Once a week is good if she come and stay the
day or night, once a week with me is fine, but when she come
like one hour, half hour, she is for example, going to go see so
and so to keep a board work, she will stop at my house to have a
drink the water or say, hi mother, how are you?
00:30:30SHARLEEN Two, three hours?
00:30:30PATTI That's not a visit for me, I wanted to come with
me and spend the time with me and stay with me that day.
00:30:35SHARLEEN When I go over there, she is either on the
phone or she is watching TV, I'm very, very uncomfortable in
her house like to where I cannot stand sitting down because she
has two dogs around and I don't like those things. I don't like
the hair on my body. When I touch an animal, I wash my hands
before I eat. She has two dogs, there is dog here on the couch,
dog here on the floor, dog here on the chairs, there is dogs all
around. I don't want to eat anything because the dishes smell
like dogs, I'm not comfortable. I don't enjoy that, it's not
pleasant to me. I could only do it so much at a time. I express
that to her, you have dogs, I can't eat either your dishes. That's
my culture, that's how I was brought up and I thought that's how
she was brought up. So, she surprises me when she does these
things, she makes the family unhappy because nobody wants to
see dogs, it smells like dogs in her house.
00:31:25PATTI How come you don't do the other things, you
grow up and have a cold chill like, that's just the only thing you
know.
00:31:35SHARLEEN I don't -- I cannot stand it, I cannot stand
it.
00:31:35PATTI And they give me so much happiness, they
make me so happy, I love them so much.
00:31:40SHARLEEN I don't like it.
00:31:40PATTI And I never ever going to get rid of them.
00:31:45SHARLEEN I don't like it, don't ask me to sleep in the
pillow, it's that the dogs stinks.
00:31:45PATTI Actually, you know we have a guest room, the
dogs doesn't in that room.
68. 00:31:50SHARLEEN I cannot sleep in motels, I cannot
use other people's bed, I cannot sleep with dogs, I cannot do
these things.
00:31:55PATTI You know that bed brand new and you know the
sheets and everything brand new in the guest room and you
know that that door is closed.
00:32:05SHARLEEN I'm not enjoying it, I cannot eat breakfast,
when I'm thirsty I can't drink water there.
00:32:05GONZALO BACIGALUPE Let me ask you, is this the
kind of sometimes the -- where the discussions go?
00:32:10SHARLEEN Yeah.
00:32:10GONZALO BACIGA And if I were to let you go over
the discussion where will it end, one of you will leave the
room or --?
00:32:20SHARLEEN I will start screaming.
00:32:20PATTI Screaming, yeah.
00:32:20SHARLEEN And disrespecting and calling names.
00:32:25PATTI I do.
00:32:25SHARLEEN At this stage, I don't --
00:32:25GONZALO BACIGALUPE And you would be like, I
don't want to see you, I don't want to talk to you anymore.
00:32:30SHARLEEN I'm trying to become a woman, I'm trying
to became a lady. And when I go to her house, she treats me
disrespectfully like that about her dogs, she would curse me out
and I just feel, oh, what a mother.
00:32:40GONZALO BACIGALUPE Would you say both of you
that you would like that not to happen that you will not get into
this.
00:32:45PATTI Of course I love them.
00:32:50GONZALO BACIGALUPE Do you sometimes dream
with, been able to relate to each other without having to get into
this.
00:32:55SHARLEEN Of course, I do.
00:33:00PATTI I feel even we argue, we still love each other
and I feel like, they are my kids, they will be still here for me if
I need them really. And they have been until sometimes lately.
69. 00:33:10SHARLEEN I just want her to appreciate and not to
expect and expect just like take what people give you and just
be happy.
00:33:20GONZALO BACIGALUPE We're going to stop a little
bit now.
00:33:25Reflecting Team Enters
00:33:25Isaac
00:33:25ISAAC I'm Isaac and I really resonated with
Sharleen. I come from, well my parents emigrated here.
00:33:40GONZALO BACIGALUPE Where your parents came
from?
00:33:40ISAAC Korea, and I was born in the States, but there
are still this cultural tension that we experienced within our
family. And so when she was talking about the difference of
cultures and who she is and there was a little bit of disparity
between her Iranian culture and the American cultures in her
life and I experienced that in my life too. So, I really
understood that and I thought, you know what? I'm not the only
one that went through that. And if I'm not the only one then she
is not the only one either, so something that I guess happens in
a culture of people when they immigrate into another country.
00:34:30GONZALO BACIGALUPE How old were you when
you immigrated?
00:34:30ISAAC I was born here.
00:34:30GONZALO BACIGALUPE You were born here, but
still --
00:34:35ISAAC My parents, my parents moved here. When they
were in their mid-20s, they moved here. And then I was born
and shortly after they moved here. And so there was a been
influence there.
00:34:50GONZALO BACIGALUPE All right, cool.
00:34:50Roberta
00:34:50ROBERTA My name is Roberta and these things really
struck out with me because I have seen Patti before. I have been
on the reflecting team. And I'm amazed at the difference in her,
how much younger she looks and more vibrant than the last
70. month I had seen her. So, I was very impressed by her change.
Another thing that just really struck out from me was when
Sharleen was talking about what she didn't want to do, and then,
Patti talked about when her husband had sent her the letters and
said, come home and Patti didn't want to go home and it was
almost like it was the same conversation, only held with
different people. And I thought that was rather interesting that
they are both having the same things happen in their life at
different times, but they both wanted their independence. And I
saw that realistic out from me, so that was very interesting.
00:35:45GONZALO BACIGALUPE Yeah, it's interesting, I was
-- I don't know if it's the same you are saying, but how can you
have your independence, but at the same time, still stay
connected? It's a hard one.
00:35:55ROBERTA And they are fighting to stay connected.
00:36:00Dorothy
00:36:00DOROTHY First of all, I'm really impressed with
Sandi, the therapist and working with this family and having the
care and the love that it concerns between all of them, including
Sandi as a therapist. And I really relate it to Patti because I
have six children and I watched them one leave one at a time
and so I know what that feels like.
00:36:25GONZALO BACIGALUPE What it feels like?
00:36:25DOROTHY Well, it is -- it feels like a tragedy really
each time. There is always, there's something to deal with
because it's a grieving, you are letting go. You are letting go
and I really relate it to her on that level, completely, but I didn't
have the kind of real tragedies to deal with that Patti has had to
deal with, in addition to this letting go, okay. She has had the,
well, the disability to deal with in the pain, the constant pain
that she deals with and also then the tragedy in her daughter's
life and what must come up for a mother in dealing with that. I
mean, unavoidable in the situation, of course, but still she was
dealing with that. At the same time, with all of this
other emotional stuff that I know about. So, I just have a lot of
respect for her and I noticed that she has done a good job with
71. her children. How wise Sharleen is for a age, very wise, so.
00:37:35GONZALO BACIGALUPE In a way, Roberta?
00:37:40DOROTHY Dorothy.
00:37:40GONZALO BACIGALUPE Dorothy, in a way it is if
it's Sharleen's need for independence is in a way due to her
mom's wanting her to be independent to and sort of like I mean
she has to get it from somewhere right?
00:37:55DOROTHY Yes.
00:37:55GONZALO BACIGALUPE Yeah.
00:37:55Amber
00:37:55AMBER Yeah that was a kind of a question I had.
Well, what were Patti's dreams for her children in making this
enormous transition from Iran, right.
00:38:05GONZALO BACIGALUPE Yeah.
00:38:05AMBER To the States, this huge transition, I mean,
there must have been a dream, some purpose that was
bringing her over here, and I was really curious what her
thoughts back, I guess, 20 years ago or something like that. And
I loved Sharleen's metaphor of the birds, the wings feeling,
really weighing her down right now.
00:38:30GONZALO BACIGALUPE And at the same the time,
the wings are supposed to be as somewhat you fly on. Yeah.
00:38:35AMBER Yeah. And so at that kind tied into my
thoughts about what were Patti's dreams for her -- duckling in a
way. I do not just kind of rambling thoughts about duckling is
calling around and the infant their mom and their mind they
follow her around forever even when they grow up, but they
do eventually gained some distance more than they had.
00:39:00GONZALO BACIGALUPE Maybe one comment, so
maybe you want to say something else, I mean, maybe there is a
couple of burning comments that people want to --
00:39:05ISAAC I know the family really loves each other. Even
if they argue, you see that there is a sense of care and
compassion there for each other and I don't think that.
00:39:20GONZALO BACIGALUPE And in that sense, it must
be very frustrating to get into this stuff, it's like.
72. 00:39:25ISAAC Oh yeah, absolutely.
00:39:25AMBER Yeah Patti made that comment. Even when we
are fighting, I know we love each other.
00:39:30ISAAC I said they're going, you know, that's exactly
right, when she said that and even though, Sharleen is -- it
seems like it's little bit tough love going on, on behalf -- from
Sharleen's part of she representing all the kids, from kids
towards their mom, and saying, mom, they love you, but we
want you to be able to function on your own and I don't know
how that kind of fits in with everybody.
00:40:00GONZALO BACIGALUPE Yeah. I was wondering
what it is for a kid even if it's an adult, I mean and clearly these
are -- kids were becoming adults I mean, Sharleen put it very
well. But it must be really hard to see your mom becoming a
little bit, you know sometimes like a kid to, I mean, that they
need to take care of so soon.
00:40:25ISAAC Yeah.
00:40:25ROBERTA And she made that comment if she was
older it would be different, but she is younger. And I don't think
they expected, I imagine she is torn with wanting to live her
own life and wanting to take care of her mom, I'm sure she is
struggling deeply.
00:40:45GONZALO BACIGALUPE Any of you thinking as a
therapist, putting yourself in Sandi's shoes and anything
that you may think that Sandi is having to deal with or some
dilemma that she may be struggling with?
00:41:00ROBERTA What I felt for Sandi, because I think this
must be very difficult for her also to, because the families
seems even though they have said they have grown and they
have made changes that they are almost stuck on that and I
imagine Sandi is probably having a hard time getting over
that stuckness, and so that's what I see Sandi probably
struggling with. It's just being stuck and where do I go from
here, where do I take the family from here?
00:41:30GONZALO BACIGALUPE I was wondering, I mean,
and the reason I guess I had a self-interest in asking because I
73. was wondering and wanted to check with you guys, I mean,
since she's also from Iran I mean, people might think that she is
more of an expert on this family. And of course, there are things
that have to do with being from Iran. Also, the things that
probably have to do with being an immigrant, but also there is
some tragic things that have happened in this family and that
you know, so I wonder how she at sometimes might feel like not
necessary knowing what to do and while at the same time,
feeling very well connected with this family.
00:42:05AMBER Oh I think she is.
00:42:10ROBERTA She shows she's well connected with that.
00:42:10DOROTHY Oh yeah. And it must be very
frustrating because how do you improve the quality of life for
Patti, especially for the family in general, I mean, it must be
very frustrating. I mean, what concrete steps do to take.
00:42:30GONZALO BACIGALUPE Okay. Alright. Thank you.
00:42:35Family & Sandi Return
00:42:35GONZALO BACIGALUPE I generally ask after this,
we call this is a reflecting team, if you had any reactions, any
thoughts or -- and you don't need to address everything that was
-- I mean, anything that strike you?
00:42:50SANDI For me, I really felt that they hit -- they
touched the right sensitive part as far as being stuck, I'm always
thinking okay, what else, what can I do to really -- what can I,
I come with ideas of goal setting, achieving goals, and trying to
figure out what else can I do, so the family can --
00:43:25GONZALO BACIGALUPE Move forward.
00:43:25SANDI Move forward.
00:43:25GONZALO BACIGALUPE Patti, did you, of what, all
what you heard, there was something that struck you something
new or interesting or --?
00:43:35PATTI Nothing, they just talk about discipline on this -
- think you were asking me about Shireen, how do I feel and I
told you I have been grieved and it's over, but I was thinking
about, it's always in my head. I don't think I never going to
forget it. It's always in my head and sometimes I feel like,
74. maybe if I was there, it wouldn't happen and then I think
about rest of them, what could have happened to the rest of
them, maybe if I'd take them all, what would be happened to all
of them. So, I don't know.
00:44:20GONZALO BACIGALUPE Do you move back and
forth between that. Sharleen how about you, anything that strike
you as?
00:44:25SHARLEEN Oh pretty much everything everybody said
was really interesting to hear about.
00:44:30GONZALO BACIGALUPE Anything in
particular that?
00:44:35SHARLEEN I don't think so.
00:44:35GONZALO BACIGALUPE You don't think so. Is there
a movement and this is something that it's like you have been
working for a year and a half, you have been going
through some very difficult stuff. Do you see yourselves
and maybe you can imagine your siblings thinking about
this. Having other, so like very difficult conversations therapy,
I mean do you see yourselves having to deal with tough issues?
Or will you say that this is the worst so to speak?
00:45:25PATTI This is the worst. Just argue with them because
I love them and I don't want to argue with them. I want them to
have a good life and get married and move on with their life and
I see them happy in their life.
00:45:40SHARLEEN And sometimes she wants to choose our
happiness for us, and that's not going to work out here.
00:45:45GONZALO BACIGALUPE Tell me how that works, I
mean, you guys are --
00:45:45SHARLEEN She wants to like choose our friends or
choose where I hang out or boyfriends or husbands.
00:45:55GONZALO BACIGALUPE And she probably gave up
already.
00:45:55SHARLEEN No, no. That's the thing.
00:46:00GONZALO BACIGALUPE You really think that's not
the --
00:46:00SHARLEEN No, that's the thing, she hasn't given up.
75. 00:46:00PATTI I was supposed to.
00:46:05GONZALO BACIGALUPE She hasn't given up?
00:46:05SHARLEEN No.
00:46:05PATTI I was 14 when my parents chose my husband
for me and I got married. And he was a nightmare, he was a man
from hell, I think, sometimes. But I hate to say that especially
in front of the boys, but he was. But the thing is sometimes I
think is not fair what happened to me, I do it to them, but
sometimes, I feel like if I don't get involved they don't know
what to do.
00:46:30SHARLEEN She doesn't leave things alone like if the
water is all calm, she has to drop a rock. She doesn't let things
be.
00:46:35PATTI I see there are good looking guys, I keep telling
them, look at him, he is cute, look at him, get close to him or
something like that, I want them to get married.
00:46:50GONZALO BACIGALUPE But in a way you gave up
the notion that you're going to have to choose.
00:46:50PATTI Not they choose, yes.
00:46:55GONZALO BACIGALUPE A boy I mean, for them?
00:46:55PATTI Choose, yes, I don't want to choose her
husband.
00:46:55SHARLEEN Sometimes I feel like she suffocates us
with her opinions and her thoughts and her beliefs.
00:47:05GONZALO BACIGALUPE Tell me about an opinion
lately.
00:47:05SHARLEEN I mean, they are nice, but.
00:47:10GONZALO BACIGALUPE Some of the opinion that
really --
00:47:10SHARLEEN They make sense, but they make sense to
you, not everybody has to go along with what you thing is the
best way to do things. And she feels like, if you want to be a
winner, you have to do it her way.
00:47:20GONZALO BACIGALUPE Who is the more
opinionated at home? I mean, she has a strong opinion, but
who else?
76. 00:47:30SHARLEEN I think we all are that's why we don't get
along. Everybody has an input.
00:47:30GONZALO BACIGALUPE And do you have a strong
opinion of how your mom should behave, do you see --?
00:47:40SHARLEEN Yeah, I just wish she should be more
calm, and what just she acts, so.
00:47:40GONZALO BACIGALUPE Is there any space in this,
which I mean, you did say that before that you have the dream
that things were, that you were more calm, so that you could
relate with her in a different level. Is there some space for her
not be so calm?
00:47:55SHARLEEN I mean, her house is what she creates for
herself, to be calm or not be calm right.
00:48:00PATTI Sharleen, and most of the time you guys come
over there even with my bad fit dinner is ready, lunch is is
ready.
00:48:10SHARLEEN Yeah.
00:48:10PATTI We sit, talk and have fun, but sometimes
like well, yesterday when I asked you to spend time with me
you said, not it was an argument.
00:48:15SHARLEEN I can't, I had plans.
00:48:20PATTI And most of the time they come over there and
they have fun.
00:48:20GONZALO BACIGALUPE But aren't you --
00:48:20PATTI It's not always fun.
00:48:25SHARLEEN Of course.
00:48:25GONZALO BACIGALUPE Are you willing to allow
for your kids to sometimes not to respond to your demand of
what you want, I mean, is there sometimes some voice in you
says, you know, maybe I know I will like that, but it doesn't
make sense again.
00:48:40PATTI I do. You should have seen me before.
00:48:45GONZALO BACIGALUPE Tell me about that.
00:48:45PATTI No, honest, I used to want them to be there
all of the time, but not now.
00:48:50GONZALO BACIGALUPE I like your sense of humor
77. actually.
00:48:50PATTI Thank you. No, honest I used to be to be want
them to be there all of the time.
00:48:55GONZALO BACIGALUPE Ah, ha. So, now you want
them sometimes, not all the time.
00:49:00PATTI Like when they moved out, the first one moved
out, I want her to call every.
00:49:05GONZALO BACIGALUPE You were crazy.
00:49:05PATTI Every hour, every hour, tell me what is going
on, where is she going, what's she doing and everything. Now, I
changed a lot. Thanks to Sandi, I give them lots of freedom and
space and I let them to choose what they should do and give
them lots of freedom, don't I?
00:49:20GONZALO BACIGALUPE Have you been looking for
boys for her.
00:49:25SHARLEEN Nobody remind her too.
00:49:30GONZALO BACIGALUPE Won't you remind her to
look for boys for you.
00:49:30SHARLEEN Yeah, too much.
00:49:30GONZALO BACIGALUPE So sometimes, I mean, in a
way you're seeing the changes, but sometimes you get as
obnoxious about it.
00:49:40SHARLEEN No, sometimes I just give up on her
because I feel like, I don't know how to get through her.
00:49:45GONZALO BACIGALUPE Patti, let me switch a little
a bit, because she said something that you probably guys
can sort of like talk and addressing therapy. If you were
not having this pain and you were not having this serious
difficulty to walk, which is in a way sort of like a new member
in the family, I mean, is a new situation I guess for you, it was
not there. How -- what would you be doing?
00:50:10PATTI I was working first of all.
00:50:10GONZALO BACIGALUPE What were you doing?
00:50:10PATTI I was caregiver and I have told you. And --
00:50:15GONZALO BACIGALUPE Oh I'm sorry.
00:50:15PATTI I was a caregiver and I would be working 8, 12
78. hours a day and sometimes when I was off during the weekend I
was shopping at the mall. When I go to a store I see, for
example, meat are on sale I buy them all meats whatever it's out
there like, call her, I bought you meat, it's awesome, it was all
sometime I get it. Do things for them all.
00:50:35SHARLEEN And that's not right, because she is not
letting us grow up and have responsibility, she wants to do
things, these things for us and she --
00:50:45PATTI Who said it is not right?
00:50:45SHARLEEN She doesn't understand.
00:50:45PATTI Even if I don't call and still you come and take
it from the freezer.
00:50:45SHARLEEN Mom, the thing I'm trying to -- she cooks
everyday as she delivers it to my sister's food -- house
everyday. I tell her let her learn on her own, you do things for
yourself, go for -- don't meat stuff, go for a massage, go for this
and that, clean your room if you are bored. Learn how to read
and write if you are bored, do something else, stop
involving your plans so much around your children, find other
hobbies, find other things to entertain your life with.
00:51:15GONZALO BACIGALUPE What other things that she
does for you or your siblings you will like her to
continue doing?
00:51:25SHARLEEN Be the same mother that she has always
been, but just not expect so much because she gives, and then,
she expects so much back in return, her expectations are too
high.
00:51:35GONZALO BACIGALUPE So you will like her to
continue cooking and doing the things?
00:51:35SHARLEEN Once in a while. Once in -- don't make it
like, it's a family ritual every week. Let it -- let us -- treat us
like we have grown up and are out and doing our own life
because that's how it actually is. It's just too much sometimes. I
feel like, if it wasn't because of my involvement with --
so much of my energy involved with her, I would have probably
take off to Europe for six months, work out there, do something,
79. I would have a free mind to decide for myself, what to do for
like a summer time.
00:52:10GONZALO BACIGALUPE Do you have a sense that
your mom may think that if she doesn't do those things, that she
would be thinking that she is sort of like neglecting with you
guys?
00:52:20SHARLEEN Yeah, she would feel like she has left us
alone, that's just her habit or how she grew up, her mom
probably that these things.
00:52:25GONZALO BACIGALUPE The time I will report her
to child protector servants and doing the stuff.
00:52:30SHARLEEN I don't know about it, but she feels
like she's being the best mom.
00:52:35GONZALO BACIGALUPE Are you ever thought about
reporting her for, I mean for --
00:52:35SANDI For great mom.
00:52:40GONZALO BACIGALUPE For actually, no, for letting
them be their -- do their things.
00:52:45SANDI On their own.
00:52:45GONZALO BACIGALUPE Yeah. And have you
thought about you could be reported, if you let them to be more
independent or--?
00:52:50PATTI No, not.
00:52:50GONZALO BACIGALUPE I mean I never thought that
in a way, I mean, negligence can be different.
00:52:55PATTI I'd tell they love that.
00:52:55GONZALO BACIGALUPE I was wondering if what it
seems to bother you is not so much what she may do or what she
may expect after she does it?
00:53:05SHARLEEN I feel like I give her an inch and then she
expects a mile. I give her like, I try to please her and please her
let's say, three days in a row, and she gets overexcited, then she
thinks like it's a shopping for everyday.
00:53:15GONZALO BACIGALUPE What are you thinking Patti
when you hear that? I mean, you are not getting angry at this
point, you were so like maybe she has a point.
80. 00:53:25PATTI No, I will call her and I leave her home, but
no.
00:53:25SHARLEEN It's really that's how she things then, then
I try to --
00:53:25PATTI I swear to god, I will not call her.
00:53:25SHARLEEN See, that's --
00:53:30PATTI I will not contact her and just leave her alone
from now.
00:53:30SHARLEEN She's. I try to explain a point to her.
00:53:35PATTI No that's not the point.,
00:53:35SHARLEEN Then she feels this way, I'm here to like,
you know I feel.
00:53:35PATTI I will give you the space as much as you want.
00:53:40SHARLEEN That's how she feels and I feel like
sometimes she's like so in her zoom box that she's not willing to
like let them down.
00:53:45PATTI As a mother, how old your kids get then you see
them like they are catching the fire, you want to grab them and
not let them burn theirself.
00:53:55GONZALO BACIGALUPE Your kids are going to be
your kids.
00:53:55SHARLEEN Yeah, but you can't interfere.
00:53:55PATTI It doesn't matter how old they get, I want to go
take them, especially because I had that abuser husband, I don't
want she marry somebody abuser.
00:54:05GONZALO BACIGALUPE Let me -- we are going to
have to stop very soon and I was wondering Sandi, do you
sometimes, in the sessions struggle with helping them to feed
out how to negotiate these things.
00:54:15SANDI I do constantly.
00:54:20GONZALO BACIGALUPE And do you have a sense
that that is sort of like that the struggle is that you know the
man for mom to be more balanced, less the man they know
or whatever, or controlling or intuitive or whatever the way the
kids may see it, or the way Patti see it as, you know, this is the
way I understand being a mother and this is the way I do things