Note: Please be sure to remind us who your employer is.  If you are not currently working, please answer the question based on a prior job.  If you have never worked, please answer the question based on an organization that is familiar to you such as a pharmacy or a doctor’s office.

Expenses 

1.  What grouping of expenses do you believe your organization uses? (traditional cost centers; diagnoses/procedures; care settings; other)

2.  From your perspective, would there be a better grouping possible? If so, why do you think it is not used?

Assessing and Planning Care for an Elderly Person

In order to gain an insight into the world of elder adults, it is important to understand how they view themselves and the values they hold. Additionally, it is important to assess and determine his/her needs and establish appropriate interventions for this individual.

In a Microsoft Word document of 4-5 pages formatted in APA 7 style, you will discuss your interview of an older adult. You can use a friend, family member, or co-worker. The older adult must be age 65 years or older.

There are two parts to this assignment – the psychosocial interview component and the functional assessment.

Interview

Download the patient questionnaire (see attachment). Use this format to record the person’s responses.

• Include 2–3 questions of your own to get a complete picture of the older adult.

• Summarize your findings.

• Include the questionnaire with responses in the Appendix of your paper.

Assessment

After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of a functional assessment.

• Use the tools discussed this week to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.

o Tinetti Balance and Gait Evaluation

o Katz Index of Activities of Daily Living

o Assessment of Home Safety

o The Barthel Index

o Do not include a name on each tool, but do include professional or other designation, and age. Your name should also be identified on the tool.

 Include these tools in the Appendix.

• Based on your assessment:

o Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment.

o Identify at least 4–6 preliminary issues.

o Identify three alterations in health that you would propose and describe them.

o Identify a minimum of three comprehensive interventions for each alteration.

o Integrate cultural considerations in your interventions.

On a separate references page, cite all sources using APA 7 format. Please note that the title and reference pages should not be included in the total page count of your paper.

prompt1

Please watch the film, And the Band Played On.   

This film may be available on the Internet through free sites such as Youtube 

What factors inhibited the early war against acquired immunodeficiency syndrome (AIDS)? Do you believe the AIDS outbreak could have been stopped? Why or why not?  What role does advocacy play in the film? How much publicity does HIV/AIDS receive today?  What’s the story of HIV/AIDS in the 21st century? Explain.

prompt2

How do occupation and culture influence psychosocial stressors that affect middle-aged adults? How does your occupation influence psychosocial stressors?

zero plagiarism

five references

please follow the information below

Students will:

• Create progress notes
• Create privileged notes
• Justify the inclusion or exclusion of information in progress and privileged notes
• Evaluate preceptor notes

To prepare:

• Reflect on the client family you selected for the Week 3 Practicum Assignment.

Assignment

Part 1: Progress NoteUsing the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following:

• Treatment modality used and efficacy of approach
• Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the treatment plan for progress toward goals)
• Modification(s) of the treatment plan that were made based on progress/lack of progress
• Clinical impressions regarding diagnosis and or symptoms
• Relevant psychosocial information or changes from original assessment (e.g., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job)
• Safety issues
• Clinical emergencies/actions taken
• Medications used by the patient, even if the nurse psychotherapist was not the one prescribing them
• Treatment compliance/lack of compliance
• Clinical consultations
• Collaboration with other professionals (e.g., phone consultations with physicians, psychiatrists, marriage/family therapists)
• The therapist’s recommendations, including whether the client agreed to the recommendations
• Referrals made/reasons for making referrals
• Termination/issues that are relevant to the termination process (e.g., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)
• Issues related to consent and/or informed consent for treatment
• Information concerning child abuse and/or elder or dependent adult abuse, including documentation as to where the abuse was reported
• Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

Part 2: Privileged NoteBased on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.In your progress note, address the following:

• Include items that you would not typically include in a note as part of the clinical record.
• Explain why the items you included in the privileged note would not be included in the client family’s progress note.
• Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

answer the attached assignment 

 Discuss the implications of providing a “lifetime voucher” that distributes a one-time savings amount to all citizens of the United States. This healthcare resource distribution system allocates the same amount of money to all citizens, allowing them the autonomy to use this money however they choose over a lifetime. Discuss the moral, ethical, and legal implications of using a “lifetime voucher” system. Discuss the implications of this arrangement from the perspective of distributive, compensatory, and social justice reasoning. What is an appropriate age for this “lifetime voucher” allocation to occur?  

1. Group 2 : 40-year-old black recent immigrant from Africa without health insurance

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

 Local Practice Problem Exploration: Cancer.

As we have chosen the same practice problem, to explore, I am curious how your facility (north shore medical center, Miami, Florida) has planned to (or currently has implemented) becoming an Age-Friendly institution?  Many of the interventions you described echo the “4 M” is of the Age-Friendly Institution: Mentation, Mobility, Medications, and What Matters Most.  How have you seen institutions adapting to this framework in anticipation of the needs of cancer patients and survivors? 

– How cancer impacts nurses, healthcare organizations, nursing care, and general health care quality?

– what is the real impact on your community? What is the cost to your local community (Miami, Florida)? 

Just as you sought out stakeholders when considering practice problems at the national level, an ongoing dialogue with stakeholders at your local level is equally important. Get to know your formal and informal leaders. Networking with stakeholders sets into motion a collaborative relationship that is needed to focus on a practice problem with the intention of translating the best available evidence. 

 – Key stakeholders affected by the problem and ones involved in the resolution. In your current practice, what contributes to the alarming rates across the known practice problems? During your journey this week, you’ll also examine the role of stakeholders in change and the role of translation science in influencing patient outcomes across known practice problems. During your readings, you probably noted that there are challenges and barriers to changing practice.    

Instructions:

Use an APA style and a minimum of 200 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. 

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website, or blogs should not be used. 

*Recommended resources:

The U.S. Burden of Disease Collaborators. (2018). The State of U.S. health, 1990-2016 burden of diseases, injuries, and risk factors among U.S. states. JAMA, 319(14), 1444-1472. https://doi.org/10.1001/jama.2018.0158

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.

https://www.medicare.gov/hospitalcompare/cancer-measures.html

Assignment: Assessing a Healthcare Program/Policy Evaluation

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

• Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
• Select an existing healthcare program or policy evaluation or choose one of interest to you.
• Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

• Describe the healthcare program or policy outcomes.
• How was the success of the program or policy measured?
• How many people were reached by the program or policy selected?
• How much of an impact was realized with the program or policy selected?
• At what point in program implementation was the program or policy evaluation conducted?
• What data was used to conduct the program or policy evaluation?
• What specific information on unintended consequences was identified?
• What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
• Did the program or policy meet the original intent and objectives? Why or why not?
• Would you recommend implementing this program or policy in your place of work? Why or why not?
• Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

 I need a response to this assignment

3 references

zero plagiarism

The psychotherapy I selected is cognitive behavioral therapy (CBT) which focuses on changing dysfunctional emotions, behaviors and thoughts by stopping the negative thought cycle. CBT is considered a solution-oriented form of therapy due to the idea of thoughts and perceptions having a big influence on how an individual behaves (Psychology Today, 2020). I selected CBT because it is appropriate for use in all age groups and it can be used to address many conditions with research showing that it is most effective in treating anxiety and depression. Although CBT might not be helpful in treating everyone, as not one type of therapy is effective for every individual, my preceptor and I have had the opportunity to use this form of therapy with many clients and it seems to show great results. The biggest goal of CBT is to change the way individuals think and behave, knowing that this will not take away their problems, but rather change the way they look at them and help manage in a more positive way (Your.MD, 2020). On the other hand, existential-humanistic therapy has a foundation on the emphasis of holism, self-actualization, enhanced communication, and the overall therapeutic relationship between the therapist and client. The focus is on understanding human experience and focusing on the client instead of focusing on their symptoms, with interventions focused on increasing self-awareness and making authentic decisions (American Psychiatric Association, 2013). Existential-humanistic approaches focus on the idea that people have the ability to make their own choices and have self-awareness while doing so as part of human experience, focusing on the here and now but with the understanding that reality is influenced by past experiences, current perceptions and future expectations (Center for Substance Abuse Treatment, 1999). The strengths of CBT include the way it is structured, that it can be helpful in a short period of time, it has a focus on thought retraining in order to refrain from past behaviors and make changes to current behaviors, as well as providing clients with useful skills that can be used in everyday life in order to cope with stress and difficult situations even when therapy has completed (The CBT Clinic, n.d.). On the contrary, some challenges of CBT might be as simple as this just might not all together be the right fit for everyone as each client has special and focused needs and concerns. In order for individuals to benefit from CBT they have to be committed and willing to work for change to happen, however this form of therapy might not be so suitable for individuals that have complex mental health needs or learning difficulties (Your.MD, 2020). Another disadvantage to using CBT might be the focus of the current problem instead of addressing underlying past experiences which could contribute to the current problem. Inversely, existential-humanistic therapy has its own pros and cons with its focus on establishing rapport and establishing meaningful engagement with the client in all aspects of the treatment process (Center for Substance Abuse Treatment, 1999). The humanistic approach views individuals as being good with a potential to maintain healthy relationships and make good choices that will benefit themselves and others, whereas the existentialist approach focuses on guiding the individual to find meaning while they face their problems in the way of making choice the act of importance and responsibility (CCPE, 2020). However, some people might not be okay with the idea of making their own decisions without feeling like they have any guidance, therefore this form of therapy might not be suitable for everyone as well. Nonetheless, a main goal of this therapy is to increase self-awareness, self-esteem and promote individuals to get in touch with their own thought process (Chopra, 2020). A fictional client that could be suitable for CBT would be a 15-year-old female with a history of depression and recurrent suicidal ideation, self-harm behavior who recently lost her brother by overdose. Client blames herself and thinks that she should have done better to help her brother with his addiction. Client reports having coping mechanisms to help with her self-injurious behaviors but could use some help when the urge comes on. This patient would benefit from CBT by working out her guilt as well as helping develop new coping skills. A fictional client that would be suitable for existential-humanistic therapy would be a 16-year-old female with a history of depression and eating disorder who has the tendency to self-harm when feeling low. Since the main goal of this therapy is to increase self-esteem and self-awareness, this would be a good form of therapy for this client by allowing the client view her choices and decisions in a more positive way. 

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

CCPE. (2020). Humanistic-existential approach. Retrieved from:

https://www.ccpeweb.ca/en/services/psychotherapy/humanistic-existential-approach/

Center for Substance Abuse Treatment. (1999). Brief Humanistic and Existential

Therapies. Brief Interventions and Brief Therapies for Substance Abuse. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK64939/

Chopra, P. K. (2020). Existential-Humanistic Psychology, Mindfulness and Global Change.

Retrieved from: http://www.human-studies.com/articles/existential-humanistic-psychology-mindfulness.php

Psychology Today. (2020). Cognitive Behavioral Therapy. Retrieved from:

https://www.psychologytoday.com/us/basics/cognitive-behavioral-therapy

The CBT Clinic. (n.d.). Pros & Cons of CBT Therapy. Retrieved from:

http://www.thecbtclinic.com/pros-cons-of-cbt-therapy

Your.MD. (2020). Cognitive Behavioural Therapy (CBT). Retrieved from: