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CLCPA Self-Assessment Results Reflection Sample Paper

Reflection of CLCPA Self-Assessment Results

Cultural competence is a critical factor for the success of modern organizations. Organizations need to identify values, behaviors, structures, and attitudes that enhance employee performance. Similarly, organizations need to cultivate a culture of linguistic competence. Effective communication in organizations creates more cohesive teamwork leading to enhanced productivity. Linguistic competence helps organizations to relay information in a way that is easily understandable to a diverse audience.

From the CLCPA Cultural and Linguistic Competence Policy Assessment, I learned that health organizations need to identify how culturally diverse the communities they serve are. Health organizations must realize that cultural beliefs, vulnerabilities, strengths, and values of different cultures influence their operations and profits. Today, customers prefer organizations that embrace cultural diversity over those that target only the dominant culture. Concerning linguistic competence, organizations must communicate effectively in a way that all members of the organization and the wider society understand (Georgetown University Center for Child and Human Development, 2021).

From the CLCPA assessment, I noticed that it is no longer tenable for organizations to only target the dominant cultures. Organizations have to appreciate that modern societies comprise divergent ethnic groups. These diverse groups have different languages, cultural practices, beliefs, and values. Based on this analogy, organizations must be sensitive to the needs of all cultures in their operating environment.

Knowledge of diverse communities helps organizations to improve services. From the CLCPA assessment, I gathered that it is vital for organizations to be familiar with both the current and the projected demographics in their area of service. For example, knowledge of current demography can help an organization to align its services with the prevailing trends (Kim, Halpin, & Morrison, 2017).

To illustrate this point, the organization I currently work with is based in a predominantly white area. However, in the last few years, the population of Hispanics and Blacks have increased rapidly. Based on this data, it is no longer tenable for the agency to focus its service delivery on whites only. The organization now has to accept the diversity and review its overall focus to embrace inclusivity.

Health organizations must be aware of the social and health problems of the diverse cultural groups in their service area. Awareness of health and social problems can help my organizations to deal effectively with arising problems. For example, some communities suffer more from certain illnesses compared to other communities. Consequently, health organizations must examine the cultural composition of their surrounding communities (Georgetown University Center for Child and Human Development, 2021).

Through this approach, organizations can effectively mobilize resources to deal firmly with the most pressing health needs of the communities. In the same manner, the identification of social problems is critical because health organizations can map out the risk factors that create health problems. My organization scores fairly well in this area since it has data on prevalent health and social problems in its service area.

As I have explored in this paper, knowledge of diverse communities and their respective unique needs helps organizations to improve service delivery. Through CLCPA, organizations can evaluate how much they know about the communities in which they operate, and how best they can serve its members. Important parameters in CLCPA include the ability to identify diverse communities, familiarity with current and projected demographics, ability to identify health disparities in the area, and identification of the prevailing social problems. Equally, health organizations must be aware of the health beliefs, cultural practices, values, and customs of the communities they serve for better interaction with the community.

References

• Georgetown University Centre for Child and Human Development. (2021). Leadership Institute. Retrieved January 26th, 2021, from https://nccc.georgetown.edu/
• Kim, U., Halpin, J., & Morrison, G. (2017). Diversity and Inclusion in Healthcare: A Leadership Perspective. The Graduate Schools Executive Guest Lecture Series. 1. https://digitalcommons.otterbein.edu/grad_guest/1

Setting clinical goals and objectives is crucial for personal and professional growth as a nursing student. These goals serve as a roadmap, guiding you through your clinical experiences in a nursing program and helping you develop the necessary skills and knowledge to become a competent and compassionate registered nurse.

What are Nursing Clinical Goals?

Nursing clinical goals are not just random targets but specific, measurable, achievable, relevant, and time-bound (SMART) objectives that nursing students set for themselves during their clinical rotations. These goals are your personal commitments to your growth and development.

They focus on developing essential nursing skills, knowledge, and attitudes to provide high-quality patient care. From mastering technical skills to improving communication and interpersonal skills, and critical thinking abilities, these goals are the stepping stones that will shape you into a competent and compassionate nurse.

Why Setting Clinical Goals Is Important For Nursing Students

Setting clinical goals is essential for nursing students for several reasons:

• Direction and focus: Clear goals help you focus on the most important aspects of your clinical experience, ensuring you maximize your time and resources. Whether you aim to administer medication accurately or improve your communication with an interdisciplinary team, having a SMART goal provides direction.
• Skill development: By setting specific goals related to nursing skills, you can actively work towards mastering these skills, which will benefit you throughout your career. For example, setting a goal to shadow a senior nurse or master the administration of dosages in real time can keep you on the right track.
• Personal and professional growth: Clinical goals encourage you to step out of your comfort zone, take on new challenges, and develop personally and professionally. Nursing students may find that setting professional goals related to nursing practice helps them align their career ambitions with real-world needs.
• Evaluation and feedback: Well-defined goals make it easier for clinical instructors and preceptors to provide targeted feedback and evaluate your progress. Goals like improving clinical immersion or mastering CPR and critical care ensure you’re making tangible progress.
• Confidence and motivation: Achieving your clinical goals can boost your confidence and motivation, helping you stay engaged and committed to your nursing education. This commitment is essential as you work toward a successful nursing career and ultimately become a nurse who provides quality care.

Clinical Goals for Nursing Students 

This section outlines a comprehensive set of objectives that nursing students should strive to achieve during their clinical rotations. These objectives cover skills development, critical thinking, communication, cultural competence, patient safety, and professionalism. They include the following:

Obtain clinical skills

One of the primary goals for nursing students is to acquire and master essential clinical skills. These skills include:

• Vital signs assessment
• Medication administration
• Wound care and dressing changes
• Catheterization and tube management
• Patient positioning and mobility assistance

To achieve this goal, practice these skills consistently under the guidance of your clinical instructors and preceptors. Seek feedback and use skill labs and simulation experiences to refine your techniques, ensuring that your goals are attainable and time-based.s.

Strengthen critical thinking

Strong critical thinking skills are crucial for making sound clinical judgments and providing effective patient care. To enhance your critical thinking abilities:

• Actively participate in patient care conferences and case studies
• Ask questions and seek clarification when uncertain; don’t hesitate to ask a question or request help with a particular concept
• Practice applying nursing theories and evidence-based practices to patient scenarios, aligning your actions with nursing goals
• Reflect on your clinical experiences and consider alternative approaches that align with your goal-setting process

Have a positive attitude

Maintaining a positive attitude during clinical rotations can greatly impact your learning experience and relationships with patients, colleagues, and instructors. To cultivate a positive mindset:

• Embrace challenges as opportunities for growth
• Learn from constructive criticism and feedback
• Celebrate your successes and the successes of others
• Practice self-care and stress management techniques

Focus on collaboration and teamwork

Effective collaboration and teamwork are essential for providing comprehensive patient care. To improve your collaboration skills:

• Actively contribute to team discussions and decision-making processes
• Offer assistance to your colleagues when appropriate
• Be open to learning from other healthcare professionals and taking every opportunity to practice within an interdisciplinary team
• Participate in interprofessional education opportunities, enhancing your overall experience

Communicate effectively

Clear, concise, and compassionate communication is vital for building trust with patients, families, and healthcare team members. To enhance your communication skills:

• Practice active listening and empathy
• Use clear and jargon-free language when explaining concepts to patients and families
• Document patient care accurately and thoroughly
• Develop strategies for communicating with diverse populations

Embrace cultural diversity

Providing culturally competent care is essential for meeting the unique needs of diverse patient populations. To promote cultural competence:

• Educate yourself about different cultures, beliefs, and traditions
• Be respectful and sensitive to cultural differences
• Adapt your communication style and approach to care as needed
• Advocate for culturally appropriate resources and services

Be aware of basic and special human needs

Understanding and addressing patients’ basic and special human needs is fundamental to providing holistic, patient-centered care. To meet these needs:

• Assess patients’ physical, emotional, social, and spiritual needs
• Prioritize care based on Maslow’s hierarchy of needs
• Collaborate with the healthcare team to develop individualized care plans
• Advocate for patients’ rights and preferences

Maintain an emotional balance

Nursing can be emotionally demanding, so it’s crucial to maintain an emotional balance to prevent burnout and provide optimal patient care. To achieve this balance:

• Practice healthy coping mechanisms, such as deep breathing, meditation, or exercise
• Establish clear boundaries between work and personal life
• Seek support from colleagues, mentors, or counseling services when needed
• Engage in hobbies and activities that bring you joy and relaxation

Care about integrity and ethics

Upholding the highest standards of integrity and ethics is essential for maintaining the trust of patients and the public. To demonstrate integrity and ethical behavior:

• Adhere to the nursing code of ethics and professional standards
• Maintain patient confidentiality and privacy
• Be honest and transparent in your actions and communications
• Report any unsafe or unethical practices through appropriate channels

Work on stress tolerance

Nursing can be high-stress, so developing effective stress management strategies is crucial for your well-being and ability to provide quality patient care. To improve your stress tolerance:

• Identify your stress triggers and early warning signs
• Practice relaxation techniques, such as deep breathing, progressive muscle relaxation, or mindfulness
• Engage in regular physical exercise and maintain a healthy diet
• Seek support from friends, family, or professional resources when needed

Learn to ensure basic patient safety

Ensuring patient safety is a fundamental responsibility of all nurses. To prioritize patient safety:

• Familiarize yourself with your institution’s safety protocols and policies
• Perform regular safety checks and risk assessments
• Use proper body mechanics and assistive devices when moving patients
• Double-check medication orders and follow the “five rights” of medication administration

Be attentive to detail

Attention to detail is critical for preventing errors and ensuring optimal patient outcomes. To cultivate attention to detail:

• Take thorough and accurate notes during patient assessments and interactions
• Review patient charts and orders carefully
• Follow checklists and protocols when performing procedures
• Verify patient information and double-check calculations

Show empathy

Empathy is a core component of compassionate nursing care. To demonstrate empathy:

• Actively listen to patients’ concerns and feelings
• Validate patients’ emotions and experiences
• Use nonverbal cues, such as eye contact and gentle touch, to convey understanding
• Tailor your approach to each patient’s unique needs and preferences

Say yes to learning opportunities

Embracing learning opportunities is essential for your personal and professional growth as a nursing student. To maximize your learning:

• Volunteer for new experiences and responsibilities when appropriate
• Attend workshops, seminars, and conferences related to your areas of interest
• Seek mentorship from experienced nurses and healthcare professionals
• Participate in research projects or quality improvement initiatives

Practice giving and receiving reports

Effective communication during patient handoffs is crucial for ensuring continuity of care and patient safety. To improve your report-giving and receiving skills:

• Use a standardized communication tool, such as SBAR (Situation, Background, Assessment, Recommendation)
• Be concise and organized when presenting patient information
• Ask clarifying questions and verify understanding when receiving reports
• Document any changes or updates in the patient’s condition or care plan

Observe as many procedures as you can

Observing a wide range of procedures can broaden your knowledge and skills as a nursing student. To make the most of observation opportunities:

• Ask for permission to observe procedures when appropriate
• Pay close attention to the techniques and steps involved
• Take notes and ask questions to deepen your understanding
• Reflect on how you can apply what you’ve learned to your practice

Practice medication calculations

Accurate medication calculations are essential for ensuring patient safety and preventing medication errors. To improve your calculation skills:

• Review basic math concepts, such as fractions, decimals, and conversions
• Practice solving sample medication calculation problems
• Use a systematic approach, such as dimensional analysis, to solve problems
• Double-check your calculations and have a colleague verify them

Don’t take things personally

Nursing can be emotionally challenging, and it’s important not to take patient behaviors or outcomes personally. To maintain a healthy perspective:

• Recognize that patients may be dealing with stress, pain, or fear
• Focus on providing the best possible care, regardless of a patient’s response
• Debrief with colleagues or mentors after difficult situations
• Practice self-reflection and self-compassion

Develop cultural competence

Providing culturally competent care is essential for meeting the diverse needs of patients and promoting health equity. To develop cultural competence:

• Educate yourself about different cultures, beliefs, and health practices
• Be aware of your own biases and work to overcome them
• Use culturally appropriate communication techniques and resources
• Collaborate with interpreters and cultural liaisons when needed

Practice professionalism

Professionalism is a key attribute of successful nurses. To demonstrate professionalism:

• Adhere to your institution’s dress code and personal hygiene standards
• Be punctual and dependable in your clinical assignments
• Maintain appropriate boundaries with patients and colleagues
• Respond to feedback and constructive criticism with a positive attitude

Setting and working towards clinical goals is essential to your nursing education and professional development. By focusing on these key areas – from mastering clinical skills to developing empathy and professionalism – you can lay the foundation for a successful and rewarding nursing career.

Clinical Information Systems Discussion NR706

Purpose

The purpose of this discussion is for you to analyze different clinical information systems’ features and functionality and determine the most beneficial system for your healthcare setting.

Instructions

Conduct an online search for two different electronic health record (EHR) software solutions you view as beneficial to your healthcare setting. Examples may include, but are not limited to, the following: eClinicalWorks, McKesson, Cerner, Allscripts, Athena Health, GE Healthcare, Epic, Care360, Practice Fusion, OptumInsight, and NEXTGEN.

Then, address the following:

1. Identify two selected EHR software solutions and describe three features of each software solution.
2. Compare and contrast the benefits of the two selected EHR software solutions.
3. Select an EHR software solution that is best suited for your workplace environment and provide the rationale for your selection.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

• Link (webpage): Graduate Discussion Grading Guidelines and RubricLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

2. Use information technology to collect and analyze data to generate evidence-based nursing practice across healthcare settings. (PC 4; PO 7)
3. Evaluate the types of healthcare information systems, knowledge-based systems, and patient care technology and the impact on patient safety, quality of care, and outcome measurement. (PC 4; PO 7)
4. Resolve ethical and legal issues related to the use of information, communication networks, and information and patient care technology. (PCs 2, 4; PO 6)

Due Dates

• Initial Post: By 11:59 p.m. MT on Wednesday
• Follow-Up Posts: By 11:59 p.m. MT on Sunday

NR 706 Week 3: Health Informatics Beyond the Acute Care Environment

Week 3 References

Benda, N., Veinot, T., Sieck, C., & Ancker, J. (2020). Broadband internet access is a social determinant of health! American Journal of Public Health, 110(8), 1123. https://doi.org/10.2105/AJPH.2020.305784

Brooks, R., Nieto, O., Swendeman, D., Myers, J., Lepe, R., Cabral, A., Kao, U., Donohoe, T., & Conulada, W. (2020). Qualitative evaluation of social media and mobile technology interventions designed to improve HIV health outcomes for youth and young adults living with HIV: A HRSA SPNS initiative. Health Promotion Practice 21(5), 693-704. https://doi.org/10.1177/1524839920938704

McBride, S., & Tietze, M. (2023).?Nursing informatics for the advanced practice nurse:?Patient safety, quality, outcomes, and interprofessionalism (3rd ed.). Springer Publishing Company.

Week 3 Consumer Informatics/Telehealth Case Study Discussion

Purpose

The purpose of this discussion is for you to investigate telehealth and technology relationships to social justice principles.

Case Study Scenario

Watch the following video.

Consumer Informatics/Telehealth Case Study (1:55)

Transcript

[MUSIC] Mr. Kasich is a 77-year old who was recently taken to the emergency room after he fell when trying to get out of bed. There, he was found to have a blood glucose level of 35 milligrams per deciliter and was diagnosed with uncontrolled type 2 diabetes mellitus and hypoglycemia despite many years of well-maintained the blood glucose levels. After further assessment, Mr. Kasich was transferred to a medical room in the hospital. 

His background includes diagnosed with type two diabetes mellitus, advanced congestive heart failure and lung cancer. Has Medicare parts A and B. Lives with wife in a remote area that is 40 miles from the closest healthcare provider. Is proficient using his home computer. Mr. Lane is a 42-year old who was admitted for exacerbation of heart failure. 

His background includes has diabetes mellitus type two. Is a long-haul truck driver with a large trucking company. Is privately insured. Is single and primarily lives in his truck. Both Mr. Kasich and Mr. Lane are going home with telehealth consisting of a telemonitoring device that transmits weight, blood pressure, blood glucose levels and pulse oximetry to a remote telehealth nurse.

Even though the use of telehealth does not often include hands on interaction, the goal of keeping patients out of a hospital is consistent with quality nursing practice. Telehealth applications are designed to enhance the patient experience and improve clinical outcomes while providing care for patients in their home environment rather than an institutional setting. Telehealth supports self-care by empowering patients, which is a central tenet of nursing practice.

Instructions

Review the case scenario above and address the following:

1. Examine concepts such as equity, respect, self-determinism, health literacy, cyclic disadvantage, and healthcare disparities among marginalized populations or groups and how they affect patient outcomes.
2. Compare and contrast how each patient in the video may benefit from telehealth services and the ethical considerations from the viewpoint of the nurse.
3. Propose barriers that must be removed to achieve well-being, sufficiency, and healthcare access for all.

Please click on the following link to review the DNP Discussion Guidelines on the Student Resource Center program page:

• Link (webpage): Graduate Discussion Grading Guidelines and RubricLinks to an external site.

Program Competencies

This discussion enables the student to meet the following program competencies:

2. Applies organizational and system leadership skills to affect systemic changes in corporate culture and to promote continuous improvement in clinical outcomes. (PO 6)
3. Appraises current information systems and technologies to improve health care. (POs 6, 7)

Course Outcomes

This discussion enables the student to meet the following course outcomes:

3. Design programs that monitor and evaluate outcomes of care, care systems, and quality improvement. (PC 4; PO 7)
4. Evaluate the types of healthcare information systems, knowledge-based systems, and patient care technology and the impact on patient safety, quality of care, and outcome measurement. (PC 4; PO 7)
5. Appraise consumer health information sources for accuracy, timeliness, and appropriateness. (PC 4; PO 7)
6. Resolve ethical and legal issues related to the use of information, communication networks, and information and patient care technology. (PCs 2, 4; PO 6)

Due Dates

• Initial Post: By 11:59 p.m. MT on Wednesday
• Follow-Up Posts: By 11:59 p.m. MT on Sunday

NR 706 Week 4: Information Technology as the Basis for Quality Improvement

Week 4 References

Harris, C., Garrubba, M., Melder, A., Voutier, C., Waller, C., King, R., & Ramsey, W. (2018). Sustainability in healthcare by allocating resources effectively (SHARE) 8: Developing, implementing and evaluating an evidence dissemination service in a local healthcare setting. BMC Health Services Research, 18(1), 151. https://doi.org/10.1186/s12913-018-2932-1

McBride, S., & Tietze, M. (2023). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (3rd ed.). Springer Publishing Company.

Otitigbe, J. (2017). Fishbone facilitation reflection: Team-based cause-and-effect study can point the way to the real problem. ISE: Industrial & Systems Engineering at Work, 49(7), 48-51.

Reed, J. E., Howe, C., Doyle, C., & Bell, D. (2018). Simple rules for evidence translation in complex systems: A qualitative study. BMC Medicine, 16(1) 92. https://doi.org/10.1186/s12916-018-1076-9

Schaefer, J. D., & Welton, J. M. (2018). Evidence-based practice readiness: A concept analysis. Journal of Nursing Management, 26(6), 621-629. https://doi.org/10.1111/jonm.12599

Warnick, R. E., Lusk, A. R., Thaman, J. L., Levick, A. H., & Seitz, A. D. (2020). Failure mode and effect analysis (FMEA) to enhance safety and efficiency of Gamma Knife radiosurgery. Journal of Radiosurgery and SBRT, 7(2), 115-125.

Clinical Judgment and Practice Excellence Discussion

Clinical Judgment and Practice Excellence Discussion

Synthesize components of practice excellence, clinical judgment, and personal knowing as a foundation for complex client care and lifelong learning.

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Clinical Judgment and Practice Excellence Discussion Scenario

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After completing your BSN degree, you accepted a promotion to a clinical educator in the facility where you work. You recently participated in inter-professional grand rounds and described a scenario in which your clinical decisions had positive impacts on client outcomes.

You described how your pursuit of practice excellence, use of clinical judgment, and passion for lifelong learning had positive impacts on your nursing career. The Director of Nursing was impressed with your ideas and passion for nursing and asked you to be a speaker at a nursing recruitment luncheon for new graduates.

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Clinical Judgment and Practice Excellence Discussion Instructions

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Create a presentation no longer than eight minutes. The content of the presentation should be in PowerPoint and include:

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• Title Slide (1 slide). Description of the clinical scenario you consider most impactful to your current role as a nurse, including the components of the clinical judgement process: (2 slides)

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• • Cue recognition and clustering
  • Generation and prioritization of hypotheses
  • Actions taken
  • Outcomes evaluated
• Description of how you pursue practice excellence, including a specific example related to your current role as a nurse including (2 slide)
• The challenge to the status quo
• Courage to do the right thing
• Integrate a collaborative approach to nursing practice
• Exemplary description of the meaning of practice excellence, clearly and strongly relating a specific personal example of nursing to these components of excellence: Challenging the status quo, demonstrating the courage to do the right thing, and integrating a collaborative approach to nursing practice.

• Description of how achieving your BSN will impact your pursuit of lifelong learning (2 slide)
• Exemplary description of how achieving a BSN degree will impact the personal pursuit of lifelong learning. Description included a specific example of a plan for lifelong learning.
• Reference list (1 slide)
• Ideas stated with professional language and attribution for credible sources within 5 the past 5 years, with correct APA citation, spelling, and grammar

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Clinical Reasoning in Healthcare Sample Paper

Clinical Reasoning in Advanced Health History and Physical Assessment Skills

Clinical reasoning exploits the clinician’s background knowledge in making judgments in clinical situations. The thinking behind clinical reasoning requires proper translation of information into knowledge and finally, wisdom. Clinical reasoning does not necessarily rely on evidence-based practice and past experiences. The purpose of this paper is twofold, first, to describe the application of clinical reasoning in developing advanced patient history taking and physical assessment skills and second, to explain the use of the nursing process in enhancing critical thinking, clinical reasoning, and clinical judgment while providing clinical examples.

Clinical Reasoning

Clinical reasoning is a critical skill that is useful in gathering relevant clinical data from the patient and making decisions for further care based on this data. It is applied in all cadres of care by nurses and doctors. To achieve clinical competency, the nurse must be able to process several clinical data and investigative results to develop differential diagnoses that would inform further plans of care and referral. Various theoretical concepts have explained clinical reasoning among clinicians.

The dual processing theory espouse that a clinician may make decisions based on the intuitions, through recognition of patterns, or based on previous experiences or heuristics. Otherwise, the clinical reasoning may be analytical and involves a stepwise approach to achieve a clinical decision. While the nurse cannot use the two concepts of decision-making at the same time, they can always switch their model of reasoning based on the type and complexity of the clinical situation (Thampy, Willert, & Ramani, 2019). A more experienced clinician would make decisions in a shorter time compared to a just graduated nurse who is yet to gain more experience and skills in the clinical setup.

Nonetheless, a graduate-level nurse should be able to take a clinical history and perform a physical clinical examination. In the clinical setup, the bulk of work may require that a lot of such clerkship is done in limited time duration. Therefore, the nurse would require their clinical reasoning skills to collect appropriate, focused, and relevant information that would guide their physical examination concepts. According to Barratt (2018), one can assess a nurse’s level of competency based on the kind of information collected and the outcome of the nurses’ decisions made based on such data. A more experienced nurse would perform a physical examination while taking the history in some cases. Clinical reasoning skills usually sharpen with time just like other learned skills such as surgical skills.

The Nursing Processes

The nursing process is a universal practice that involves specific steps in providing holistic patient care. The nursing care steps include assessment, diagnosis, care outcomes, implementations, and evaluation (American Nurses Association et al., n.d.). The nurses start by gathering the subjective and objective data from their clients in the assessment step. Based on the objective and subjective data, the nurse then makes the nursing diagnosis and differential diagnoses (Falcó-Pegueroles et al., 2021). This forms the basis of the expected outcomes or goals of the care. The nurse then administers and evaluates the planned care according to the patient improvement or adjustment in status.

The process described requires the appropriate nursing critical thinking, clinical reasoning, and clinical judgment. Wong and Kowitlawakul (2020) note that the process entirely involves problem-solving. The nurse applies their critical thinking abilities to identify possible differential diagnoses. Clinical reasoning is required in prioritizing the most likely diagnosis out of the differential diagnoses. Clinical judgment and clinical reasoning would be useful in choosing the best care methods for the patient. The nurses are obliged to follow the nursing process to ensure the best outcomes for the patient. In so doing, they enhance their critical thinking, clinical reasoning, and clinical judgment skills with time. Their experience and competency levels advance with improvement in the above skills. Arguably, graduate-level nurses practice these skills during their training programs (Wong & Kowitlawakul, 2020) and are expected to translate the same in their professional practice.

Clinical Example

A patient presents to a busy outpatient clinic with a 2-week history of postprandial epigastric pain and 2 episodes of hematemesis last week. The nurse takes a full history and conducts a full abdominal exam but admits the patient for further inpatient care. Before admission, the nurse administers painkillers while awaiting esophagogastroduodenoscopy for the patient. She then informs the gastroenterologist on call that day to come and review this new admission. The nurses make differential diagnoses but chooses to relieve the patient’s pain before offering further care. This demonstrates clinical reasoning and judgment. The referral to a physician portrays her collaborative care skills, clinical judgment, and communication capabilities after realizing that this is a complicated case requiring more advanced care. Critical thinking enabled her to make differentials and to make the decision of managing pain over the medical diagnoses.

Conclusion

In sum, clinical reasoning, critical thinking, and clinical judgment are essential skills that a graduate nurse must be acquainted with to ensure higher competency levels. The skills are related and their application in the nursing process is intertwined. Their relationship with the nursing process is mutual and their absence causes disorganization in the patient’s care. The described clinical example exposes the nurse’s exquisite skills that ensured safe patient care requiring collaborative care approach.

References

• American Nurses Association, American Nurses Credentialing Center, & American Nurses Foundation. (n.d.). The Nursing Process. Nursingworld.Org. Retrieved March 17, 2021, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/
• Barratt, J. (2018). Developing clinical reasoning and effective communication skills in advanced practice. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 34(2), 37–44. https://doi.org/10.7748/ns.2018.e11109
• Falcó-Pegueroles, A., Rodríguez-Martín, D., Ramos-Pozón, S., & Zuriguel-Pérez, E. (2021). Critical thinking in nursing clinical practice, education, and research: From attitudes to virtue. Nursing Philosophy: An International Journal for Healthcare Professionals, 22(1), e12332. https://doi.org/10.1111/nup.12332
• Thampy, H., Willert, E., & Ramani, S. (2019). Assessing clinical reasoning: Targeting the higher levels of the pyramid. Journal of General Internal Medicine, 34(8), 1631–1636. https://doi.org/10.1007/s11606-019-04953-4
• Wong, S. H. V., & Kowitlawakul, Y. (2020). Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study. Nurse Education Today, 95(104600), 104600. https://doi.org/10.1016/j.nedt.2020.104600

CN 4002 Part 2 Written Response to Fact Sheet Sample

Introduction

            The nursing practitioner plays a key role in the education and management of various patients presenting at the health care institution. Nursing practitioners have adequate training in assessment, diagnosis, ordering and interpretation of medical results, prescription of medication, and play a key collaborative role in the management of patients (Riordan et al., 2017). This essay aims at expounding on the role of the nurse in advocating for a patient with diabetes, and key ethical considerations to be addressed.

Role of the nurse

The nursing practitioner plays a key role in the provision of care and the promotion of self-care management. The nurse has a vital role to play in offering prevention advice and other lifestyle change and health adoption techniques. The screening, early detection and prevention is another key role played by the nursing team (Drincic et al., 2017). The nurse is also responsible for promoting self-care while also taking part in the assessment of the patient’s nutritional requirements. Urine and blood glucose monitoring as well as the administration of both oral and injectable medication is another key role of the nurse in diabetes management.

Ethical considerations

Nursing practice requires striking a balance when delivering care to the patient. A nursing practitioner must, therefore, take into consideration various ethical considerations in the delivery of care. Some of the key considerations to take into account include autonomy, justice, beneficence and non-maleficence (Abbasinia et al., 2020). The nurse must always ensure that they provide the patient with all the necessary information required for the patient to make a well-informed decision concerning his care. The nursing practitioner must also ensure that no harm comes to the patient while also treating every patient equally and fairly (Murgia et al., 2020). The nurse should display the highest form of respect towards every individual and portray dignity in the way he or she offers care and communication.

The nurses’ priority is towards the patient. It is therefore paramount for the nursing practitioner to include the individual’s beliefs, thoughts and suggestions during the administration of care (Koskenvuori, 2020). Any conflicting interests should be well dealt with without interfering with the patient’s care. The nurse also has a key role to play in advocation and protection of the patient’s rights while also ensuring the patient’s safety. The aim of these all is to ensure that the patient receives optimal care guaranteeing positive health outcomes.

Conclusion

In conclusion, the nurse plays a vital role in the management of the patient diagnosed with diabetes. Screening, early detection and management are but some of the roles that fall in the hands of the nurse. The nurse has the obligation to offer the highest standard care to the patient while also providing the patient with all the information concerning his condition to enable him or her make well informed choices concerning his care.

References

• Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2020). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141-151. https://doi.org/10.1177/0969733019832950
• Drincic, A., Pfeffer, E., Luo, J., & Goldner, W. S. (2017). The effect of diabetes case management and Diabetes Resource Nurse program on readmissions of patients with diabetes mellitus. Journal of Clinical & Translational Endocrinology, 8, 29-34. https://doi.org/10.1016/j.jcte.2017.03.003
• Koskenvuori, J., Numminen, O., & Suhonen, R. (2019). Ethical climate in nursing environment: a scoping review. Nursing Ethics, 26(2), 327-345. https://doi.org/10.1177/0969733017712081
• Murgia, C., Notarnicola, I., Rocco, G., & Stievano, A. (2020). Spirituality in nursing: a concept analysis. Nursing Ethics, 27(5), 1327-1343. https://doi.org/10.1177/0969733020909534
• Riordan, F., McHugh, S. M., Murphy, K., Barrett, J., & Kearney, P. M. (2017). The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services. BMJ Open, 7(8), e015049. https://doi.org/10.1136/bmjopen-2016-015049

Co-payments and Deductibles Play for Insurance Coverage

Co-payments and Deductibles Play for Insurance Coverage

1.What incentive function do co-payments and deductibles play for insurance coverage?

2.How might high overtime pay discourage productivity?

3.In an iterated prisoner’s dilemma game, one may decide to punish an opponent who has defected by responding with defection for a certain number of rounds, then reverting to cooperation.

This strategy would result in the punished player losing, say, $x each round (starting next round) for n rounds. Show that the present value of the money lost is (? – ?n + 1) x/(1 – ?).[Hint: Call the present value of these loses T and parallel the work above.] (5.2)

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Co-payments and Deductibles Play for Insurance Coverage Instructions

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

• Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
• Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
• One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
• I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

• Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
• In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
• Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
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• Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
• Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
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• I highly recommend using the APA Publication Manual, 6th edition.

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• I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
• As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
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LopesWrite Policy

• For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
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• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

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• The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
• Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
• If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
• I do not accept assignments that are two or more weeks late unless we have worked out an extension.
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Communication is so very important. There are multiple ways to communicate with me:

• Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
• Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Code of Ethics and Conduct Poor Judgement Discussion

Introduction

Chiropractors, like medical doctors, are bound by a code of ethics based on certain responsibilities to the profession, the public, and their patients. Chiropractors must observe and uphold certain fundamental principles, professionalism, and standards of excellence. The foundation of chiropractic practice is based on established moral ethics and obligations that promote dignity and integrity (Rasoal et al., 2017). Chiropractors have a duty to the profession to ensure that they do not engage in behaviors that bring disrepute to the practice. Professional impropriety by chiropractors erodes public trust. To this end, this paper examines the code of ethics and conduct that guide chiropractic practice.

Ethical Codes for Healthcare Professionals

The objective of healthcare professionals is to enhance the quality of life, promote the well-being of the public as well as upholding the dignity of patients. In fulfilling these objectives, chiropractors and other healthcare professionals must conduct themselves through acceptable behaviors that do not bring disrepute to the profession nor erode public trust (Robinson, & Doody, 2021). Healthcare professionals are seen as advocates for morals and ethics hence held to higher standards than most people. Below is a discussion of violations committed by the chiropractor in the case study.

Gregory Poor violated his professional conduct by engaging in illegal activities that brought disrepute to the chiropractic practice. To begin with, Poor was found with heroin and other banned substances such as GHB (gamma hydroxybutyrate) with the intention of distribution. Poor pleaded guilty to the charge of conspiracy to manufacture and distribute GHB, an an illegal drug. Poor was also charged with introducing adulterated drugs into the interstate drug trade. The possession of cocaine and the manufacture of illegal and banned drugs is a violation of Nebraska’s laws on illegal drugs. Apart from breaking Nebraska’s drug laws, Poor’s conduct violated his professional code of conduct because his behavior amounted to professional impropriety.

One of the codes of ethics contained in the American Chiropractic Association Code of Ethics (ACACE) is that:

“Doctors of chiropractic have an obligation to the profession to endeavor to assure that their behavior does not give the appearance of professional impropriety. Any actions that benefit a practitioner to the detriment of the profession must be avoided to not erode the public trust,” (Council on Chiropractic Orthopedics, 2021).

Poor profited from the manufacture and sale of banned drugs such as cocaine and GBH. These actions go against the professional conduct expected from a healthcare professional. Even more serious is Poor’s failure to warn his prospective customers about the serious dangers caused by ingesting GBH especially when combined with alcohol. GBH is a schedule 1 drug that can only be dispensed by licensed healthcare professionals. The manufacture of GBH by Poor is a grievous violation of the code of ethics expected of chiropractors.

Prevailing Ethical Codes and Principles

Another critical principle observed by healthcare professionals is veracity. Veracity refers to the act of being truthful and honest. This principle defines the relationship between healthcare workers/providers and patients/the public (Amer, 2019). Poor also lied to an investigator during the investigation of his activities. The act of conspiring to manufacture and sell GBH and other misbranded drugs depict Poor as a dishonest person. Lying to an investigator is serious and it makes Poor look bad in the face of the public because a person who willingly lies to an investigator can also willingly lie to his customers/public. Healthcare professionals are some of the workers expected to uphold the principle of veracity at all times when dealing with their patients and the outside public.

Poor broke the principle of nonmaleficence by selling cocaine and GBH. The principle of nonmaleficence states that healthcare professionals must not cause harm to others (Ebbs, Carver & Moritz, 2020). This principle outlaw inflicting intentional harm on others and engaging in activities that pose the risk of harm to other people. Even though Poor did not break this principle in a doctor-patient situation, his behavior outside his work setting did. For example, Poor willingly distributed GBH drug to his companions and the public without informing them how dangerous this drug is; this is intentional harm. Besides, Poor consumed and distributed cocaine and also engaged in drunk driving. These are activities that put others in the way of harm.

Impact of Personal Life on a Professional Career

Health care professionals are held to a high standard of ethics by the virtue of their jobs. As such, healthcare professionals are expected to observe and safeguard the rights, interests, and needs of the society. Doing so makes them the moral advocates and role models of ethical behavior and good conduct. As role models, their actions, decisions, and conduct reflect on their personal and professional integrity.

Gregory Poor led a double life where he was both a drug dealer and a professional chiropractor. He made wrong personal choices of selling cocaine and GBH as well as driving under the influence of alcohol. These are serious personal life choices that harm one’s personal life and wellbeing as well as one’s professional career. In Poor’s case, not only did he violate Nebraska’s State laws on drugs, but he also violated his professional code of conduct. Violation of State/National laws by selling banned drugs essentially made Poor a criminal. By being a criminal, Poor also brought disrepute to him personality and his profession. Most importantly, Poor’s behavior eroded the public trust which means the public no longer trusted him as a moral advocate of ethics and conduct expected in health professionals.

Bad decisions in one’s personal life affect their professional working life. Compromising one’s values may create problems for one’s professional career. For example, by involving in the distribution of banned drugs, Poor lost his personal and professional integrity. At this point, the public cannot trust him to continue dispensing his professional duties as a healthcare worker while on the other hand, he is ruining lives by selling to the public dangerous drugs such as cocaine and GBH.

Conclusion

All healthcare workers must adhere to a professional code of conduct as well as observe ethics. Chiropractors are primary healthcare providers which means that they are bound by a code of ethics to conduct themselves in a manner that does not bring disrepute to their profession. In the case study of Poor v. State, Poor violated his professional code of conduct by engaging in criminal activities. Poor manufactured and sold GBH, a deadly schedule 1 drug, without authorization. Secondly, as is required by law, Poor did not inform his victims about how dangerous GBH drug is to a person’s health. Other behaviors by Poor that brought disrepute to his profession are the distribution of cocaine and driving under the influence of alcohol. Healthcare professionals must observe the rule of doing good and not bringing harm to other people, something that Poor failed to uphold.

References

• Amer, A. B. (2019). The Ethics of Veracity and It Is Importance in the Medical Ethics. Open Journal of Nursing, 9(2), 194-198. DOI:10.4236/ojn.2019.92019
• Council on Chiropractic Orthopedics. (2021). CCODC. Retrieved from http://www.ccodc.org/ethics.html
• Ebbs, P., Carver, H., & Moritz, D. (2020). Principlism in paramedicine: an examination of applied healthcare ethics. Journal of Paramedic Practice, 12(8), 1-6. https://doi.org/10.12968/jpar.2020.12.8.CPD1
• Rasoal, D., Skovdahl, K., Gifford, M., & Kihlgren, A. (2017, December). Clinical ethics support for healthcare personnel: an integrative literature review. In Hec Forum (Vol. 29, No. 4, pp. 313-346). Springer Netherlands.
• Robinson, S., & Doody, O. (2021). Nursing & Healthcare Ethics. Elsevier Health Sciences

Cognitive Behavioral Therapy Sample Paper

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy is a form of psychotherapy that has progressively become popular over the past decades since taking its roots in the 1960s. This form of therapy has been utilized broadly to treat a variety of disorders such as anxiety, substance abuse, depression, eating and personality disorders among others. Similarly, CBT is currently accepted as an adjunctive intervention to medications in patients with serious mental disorders such as bipolar and schizophrenia.

Chand et al. (2021), define CBT as a goal-oriented, structured, and deductive hands-on form of therapy in which the therapist and the patient work in a collaborative manner with the target of modifying patterns of behavior and thinking to effectuate beneficial transformation in the patient’s mood and way of living. CBT is essential since our thoughts, emotions, and activities are interconnected. In this paper, I will explore cognitive behavioral therapy across its modalities and provide a description of challenges that could affect its effectiveness, as well as strategies to counter the challenges.

Cognitive Behavioral Therapy Across Individual, Family and Group Settings

The efficacy of cognitive-behavioral therapy has been demonstrated across multiple settings including individual, group, and family settings. Individual cognitive-behavioral therapy involves a therapist engaging an individual to identify and change core dysfunctional beliefs (Neufeld et al., 2020). The therapist attempts to divert from maladaptive behaviors and thoughts by stimulating the patient to unfold unhackneyed ways of thinking and undertakings to enhance his psychological and physical well-being. For instance, the patient in the video (what a cognitive behavioral therapy session looks like) has a dysfunctional core thought of feeling unlovable.

Subsequently, the therapist focuses on reversing this kind of thinking through cognitive restructuring and self-guided expositions (MedCircle, 2019). Additionally, in this form of therapy, the therapist focuses on the individual well-being and perceptions. Consequently, it is imperative to establish a good therapist-patient relationship to encourage the exchange of ideas as well as revealing secrets and core dysfunctional thoughts. The bears the responsibility of the individual patient including issues correlated to privacy and confidentiality. Lastly, effective communication is necessary to facilitate interaction between the therapist and the patient.

On the other hand, family therapy is when cognitive behavioral therapy is carried out in the context of the family. Families form an elemental part of the social support and fabric system. According to Varghese et al. (2020), the mental illness of an individual is a mental illness of his or her family. For instance, the stigma associated with mental illness goes beyond the boundaries of the individual to affect the entire family. Cognitive-behavioral therapy in family settings seeks to family dynamics, conflicts, and distress by improving the systems of interaction among family members (Varghese et al., 2020). The therapist must consider the perceptions of all family members and make decisions that are in the best interest of the entire family (CBT for Couples, 2018).

The family therapist must create a good relationship between family members to unravel the family conflicts and struggles. It is not uncommon for some family members to blame others for the misery in the family which impairs the exchange of ideas during the therapy sessions (Wheeler, 2020). The therapist must maintain the privacy and confidentiality of the family at all costs despite lower levels of privacy and confidentiality compared to in an individual setting. It is the responsibility of the family therapist to assist the family pick out patterns of behaviors that will develop and maintain a functional and healthy family amid mental illness.

Cognitive-behavioral therapy in a group setting differs from individual and family settings. The prosperity of this type of therapy largely relies on the therapist as well as individual group members. The therapist must employ group techniques and strategies to carry out this form of psychotherapy. For instance, a clear sitting arrangement, introduction, agenda, rules, and assurance of confidentiality must be put in place from the onset (PsychExamReview, 2019). Effective communication and strategies to ensure the active participation of each group member are crucial for the success of this psychotherapy.

The levels of privacy are very low compared to the group and individual therapy (Neufeld et al., 2020). This therapy is similar to family therapy regarding issues of responsibility and sharing of information. It is the responsibility of the therapist to ensure that the decision made is in the best interest of the group and not an individual. Besides, some group members may not share their secrets for fear of being blamed or being laughed at. Lastly, it is not uncommon to encounter difficult members in group settings.

Challenges of Applying CBT Across Modalities

Implementation of cognitive-behavioral therapy across family, individual, and group settings is quite problematic. To begin, the therapist must consider the ethical issues related to the different modalities such as informed consent, confidentiality, responsibility, and privacy (Neufeld et al., 2020). The therapist must obtain consent before offering CBT. Besides, confidentiality and privacy across all settings of CBT must be observed. It is the responsibility of the therapist to ensure well being of all the patients without any favoritism.

Furthermore, the application of CBT in family and group settings faces the potential challenge of encountering a difficult member. A difficult family/group member is best removed from the therapy session if conservative methods fail and risks breakage of the group or family cohesion (Chand et al., 2021). Similarly, some members of group and family therapy may hold onto their secrets or rather blame other members of the group which breaks the collective trust and unity.

Effective Strategies

The challenges encountered during the execution of CBT can be handled by deploying a multitude of strategies. For instance, leveraging effective communication tends to encourage all members to actively participate. It further creates good interpersonal relationships that intensify sharing of secrets and ideas during therapy sessions. Aside from effective communication, the therapist should be well organized and utilize techniques for enhancing CBT (Chand et al., 2021). CBT is a well-structured form of psychotherapy that requires the therapist to take full charge of the sessions by vividly spelling out the agenda and the rules of every session.

Techniques of CBT to be utilized include reflection, summarizing, empathy, eye contact, rewarding comments, and comment rounds. Additionally, relaxation and stress reduction guided discovery techniques should also be executed. Lastly, the therapist should have sufficient knowledge background. This includes both self-awareness and recognition of others to understand the different group diversities and personalities and how to manage them. The articles referenced in this writing are scholarly distinguished by publication within the last five years, peer-reviewed, and from recommended sources such as Walden Library and Google Scholar.

Conclusion

The prosperity with which the implementation of CBT achieves its desired therapeutic value depends on the modality, the therapist, and the individual patients. Nurses should acquire the skills and techniques for carrying out an effective CBT.

Cognitive Behavioral Therapy Sample Paper References

• CBT for Couples. (2018, June 7). Youtube. https://www.youtube.com/watch?v=JZH196rOGsc
• Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2021). Cognitive Behavior Therapy. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470241/
• Fordham, B., Sugavanam, T., Hopewell, S., Hemming, K., Howick, J., Kirtley, S., das Nair, R., Hamer-Hunt, J., & Lamb, S. E. (2018). Effectiveness of cognitive-behavioral therapy: a protocol for an overview of systematic reviews and meta-analyses. BMJ Open, 8(12), e025761. https://doi.org/10.1136/bmjopen-2018-025761
• MedCircle. (2019, December 13). What does a cognitive behavioral therapy (CBT) session looks like. Youtube. https://www.youtube.com/watch?v=8-2WQF3SWwo
• Neufeld, C. B., Palma, P. C., Caetano, K. A. S., Brust-Renck, P. G., Curtiss, J., & Hofmann, S. G. (2020). A randomized clinical trial of the group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder. International Journal of Clinical and Health Psychology: IJCHP, 20(1), 29–37. https://doi.org/10.1016/j.ijchp.2019.11.004
• PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241). Youtube. https://www.youtube.com/watch?v=A2_NN1Q7Rfg
• Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian Journal of Psychiatry, 62(Suppl 2), S192–S200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19
• Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company. https://doi.org/10.1891/9780826193896

Also Read: NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Case

Cognitive Behavioral Therapy and Alcohol Abuse and Substance Addiction

Alcohol and substance abuse is a critical health concern in the USA. The statistics by the National Survey on Drug Use and Health shows that about 19.7 million people in America were victims of substance use disorder in the year 2017. The statistics shows that 74% of this population suffered from alcohol use disorder. Alcohol and drug use disorder is associated with adverse health effects that include addiction, low quality of life and loss of productivity. Therapeutic interventions have been developed for use in the treatment of alcohol and drug abuse. Therefore, the purpose of this paper is to examine the use of cognitive behavioral therapy in the treatment of alcohol and drug addiction.

Background

Cognitive behavioral therapy is a psychotherapeutic intervention that is used in treatment of substance abuse disorder, including alcohol and drug addiction. The therapy works by helping patients to address their problematic feelings as well as thoughts attributed to addiction. Therapists help patients to identify their negative feelings and thoughts and their management using meaningful and positive interventions. The use of the therapy enables patients to develop effective coping skills for managing addiction. The history of cognitive behavioral therapy dates back to the 1960s when it was developed by Dr. Aaron Beck while working at the University of Pennsylvania. Dr. Beck found that depressed patients demonstrated consistent negative thoughts that were spontaneous in nature. Dr. Beck further found that the negative thoughts could be eliminated or managed by helping patients to re-evaluate them and thoughts about themselves, hence, the development of the resilience that patients needed in managing their daily functions and minimizing the harms associated with negative feelings and thoughts (Sadock & Sadock, 2020). Since then, the use of cognitive behavioral therapy for the treatment of different mental health problems such as depression, anxiety and addiction among others have been explored in studies.

Theoretical Underpinnings

Cognitive behavioral therapy has its basis on operant and classical conditioning, social learning as well as research on human cognitive processes. The therapy operates on the beliefs that negative stimulus develops from repeated exposure and pairing of the stimulus with relevant stimulus that produces unlearned biological response. The theory also is based on the belief that environmental stimuli may increase or decrease the risk of behavior development, which has an effect on the mental, psychological and emotional wellbeing of an individual (Ash et al., 2021). The interaction between different stimuli therefore influences individual behavior and response to their environmental needs.

A number of principles guide cognitive behavioral therapy. One of them is the belief that problematic behaviors arise from learned interactions with the environment. The behaviors can be unlearned for individual’s optimal functioning. The therapy also operates on the principle that least complex problems should be prioritized in psychological treatments. The complex issues should be considered if the adopted interventions are ineffective. In addition, cognitive behavioral therapy is based on scientific knowledge that influences the accuracy and safety of the adopted interventions (Barry et al., 2019). For example, therapists develop hypotheses that guide the interventions and assessment of their effectiveness in the management of psychological problems.

Cognitive behavioral theory in its use in alcohol and substance abuse addiction therefore believes that substance abuse is a learned behavior. The onset as well as continuation of substance abuse largely depends on the positive expectancies that are associated with the substance abuse and by social influence of significant others such as family members and friends. The therapy further acknowledges the fact that aspects such as behaviors, norms, and stress coping may impel individuals to abuse alcohol and substances in their settings. Cognitive behavioral therapy can therefore be administered individually or in a group to achieve its desired therapeutic effectiveness. Its use in either individual or group therapy aims at reducing the positive expectancies of the patients about substance abuse and improving the self-confidence and self-efficacy of the patients towards resisting substance misuses and enhancing their coping skills (Ibemere, 2020). Consequently, cognitive behavioral therapy focuses on social learning, stress and coping, behavioral economics, and social control for the victims of alcohol and substance abuse.

Treatment Approach and Guidelines

Several cognitive behavioral treatment approaches exist for use in the management of alcohol abuse and drug addiction. The treatment approaches are largely classified into those that focus on cognitive development and those focusing on behavioral aspects of managing alcohol and drug addiction. The cognitive techniques aim at the beliefs and thoughts that predispose patients to engaging in addictive behaviors. The fundamental skill in cognitive techniques entail identifying and differentiating the core thoughts, beliefs, emotions and behaviors of the addicts. Patients are assisted in identifying their negative thoughts and emotions to enable the utilization of complex cognitive techniques such as exposure-based strategies arousal reduction, and assertive training (Magill et al., 2019). Part of the cognitive techniques include teaching patients the skills related to rational decision making where patients are guided to understand the benefits and risks of making specific choices related to addictive behaviors.

Cognitive behavioral techniques in substance abuse and addiction aim at modifying the unhealthy behaviors that predispose the patients to alcohol and substance abuse. Therapists largely rely on methods such as physical exercises, relaxation training, assertiveness training as well as activity scheduling to help patients modify their unhealthy behaviors. Contingency management therapies have also proven effective where patients are given incentives for achieving specific behavioral goals. Contingency management therapies utilize principles of operant condition where the aim is to achieve sustained utilization of the prescribed interventions for addiction management (Kapadia, 2020). Skills training therapies are effective in helping patients identify the high-risk situations that predispose them to drug abuse and strategies that they can utilize to cope with them. Motivational interviewing is also used where patients are assisted to develop the intrinsic motivation to change. The additional cognitive behavioral techniques utilized in alcohol and substance addiction include couple and family treatments and drug counseling. A specific guideline for cognitive behavioral therapy for use in patients with alcohol abuse and addiction does not exist. Cognitive behavioral therapy is indicated for use in a wide range of mental health problems that include anxiety, depression, obsessive compulsive disorders, addiction, post-traumatic stress disorder, eating disorder, psychosis, and panic disorders (López et al., 2021).

Basic Training and Certification

Evidence has shown that APRNs are uniquely positioning to provide cognitive behavioral therapy that exceeds the care needs of patients with alcohol and substance abuse problems. However, their ability to provide cognitive behavioral therapy for alcohol and substance abuse disorders is currently restricted due to the lack of clear pathway on issues such as training opportunities as well as credentialing. Therefore, it is not mandatory for APRNs to be trained on cognitive behavioral therapy (Ibemere, 2020). However, they can enroll in training programs to enhance their knowledge and skills in the use of cognitive behavioral therapy in the management of different mental health problems.

Cultural/Genetic Issues

Cognitive behavioral therapy has been shown to be highly effective for a wide range of disorders, including alcohol and substance abuse and addiction. However, the majority of the existing research on cognitive behavioral therapy has largely utilized western populations. The emerging evidence has begun to focus on the use of cognitive behavioral therapy for ethnic minority groups in the USA and other global states. Cognitive behavioral therapy may be effective in addressing the need of patients from ethnic and diverse backgrounds (Hinton & Patel, 2017). However, there is an increasing need to ensure that the cognitive behavioral therapy that patients receive is culturally adaptive. Accordingly, individuals from different ethnic backgrounds have unique cultural values, beliefs and practices. The diversity in beliefs, values and practices imply that the existing cognitive behavioral interventions should be culturally sensitive (Naeem, 2019). Culturally sensitive or adaptive cognitive behavioral therapy has been shown to be highly effective when compare to unadapted cognitive behavioral therapy.

Cognitive behavioral therapy should be modified to account for culture, language and contexts of the diverse populations affected by alcohol and substance abuse. Accordingly, standard techniques should be framed in a way that they are more tolerable to individuals from diverse ethnicities and psychopathologies. The need for the modification of cognitive behavioral therapy should also be targeted at eliminating local stigma associated with mental health problems. Healthcare providers should also be prepared to provide culturally adaptive cognitive behavioral therapy to patients with alcohol and substance abuse. They should be provided with training opportunities that increase their competencies in the delivery of culturally appropriate cognitive behavioral therapy (Naeem, 2019). Through such interventions, healthcare organizations and providers will create positive expectancy as well as treatment credibility in the delivery of culturally appropriate cognitive behavioral therapy.

Recent Research

Several studies have been conducted over the recent past to determine the effectiveness of cognitive behavioral therapy in substance abuse disorders. One of these studies is the research by Magill et al. (2019). Magill et al. (2019) conducted a research that aimed at determining the effectiveness of cognitive behavioral therapy in alcohol and other drug use disorders. The investigation was a meta-analysis of 30 randomized controlled trials. The analysis of the data in this study showed that cognitive behavioral therapy was associated with moderate to significant effect size in all the selected randomized controlled studies. The authors therefore recommended that cognitive behavioral therapy should be used in the treatment of alcohol and substance abuse disorders to enhance coping and recovery process.

Roos et al. (2017) conducted a study that aimed at examining whether the baseline dependence severity was attributed to mediating effect of cognitive behavioral therapy in alcohol abuse disorders. The study used 1063 patients with alcohol abuse disorder. The analysis of data cognitive behavioral therapy enhanced the coping skills of participants who had history of alcohol abuse disorder. Cognitive behavioral therapy also lessened the severity of symptoms by enhancing the coping skills that the participants developed in the study.

The feasibility and efficacy of cognitive behavioral therapy has been subject of discussion in most of the studies. In this regard, Barry et al. (2019) conducted a study that aimed at evaluating the acceptability, feasibility, and efficacy of cognitive behavioral therapy use in opioid use disorder as well as chronic pain. The researchers used 21 patients who were assigned to cognitive behavioral therapy and 18 assigned to the methadone drug counseling. The results of the investigation showed that cognitive behavioral therapy was associated with a high rate of abstinence, satisfaction, and sustained effectiveness when compared to those assigned to the methadone counseling group. The feasibility, efficacy, and acceptability of cognitive behavioral therapy was also supported.

Views/Perspectives/Controversies

The use of cognitive behavioral therapy in alcohol abuse and drug addiction is effective in practice. Most of the studies conducted on the topic show that it improves withdrawal and dependence symptoms among the affected populations. According to López et al. (2021), cognitive behavioral therapy interventions such as contingency management is effective in reducing the use of drugs such as cocaine and methamphetamine. The authors also note that cognitive behavioral therapy interventions such as motivational interviewing, prevention support groups, and social support groups are effective in reducing the use and abuse of marijuana. Optimum benefits are reported in cases where cognitive behavioral therapy is used alongside pharmacotherapy. According to Ray et al. (2020), cognitive behavioral therapy with pharmacotherapy is highly effective when compared to pharmacology and usual care. The enhanced benefits can be seen from reduced risk for relapse and sustained effectiveness. Kiluk et al. (2018) reported similar findings in their research where innovative interventions that include computerized and clinician delivered cognitive behavioral therapy were found to be highly effective in substance use disorders when compared to the usual care. The researchers found that the intervention reduced the frequency of drug use with continuous benefits post-implementation of the study. Therefore, healthcare providers should consider incorporating cognitive behavioral therapy plus pharmacotherapy in the treatment plan for patients with alcohol and substance abuse disorders.

Issues of APRN Practice

APRNs can play a proactive role in the delivery of cognitive behavioral therapy to patients with alcohol and substance abuse disorders. However, a number of issues impede their ability to undertake this role. Firstly, issues such as the need for additional training and lack of credentialing for APRNs on cognitive behavioral therapy impede their role in patient care. Effective frameworks are needed in nursing practice to provide insights into the training and licensure requirements for APRNs interested in cognitive behavioral therapy. The other issue that impede the delivery of cognitive behavioral therapy by APRNs in clinical settings is the inadequacy of resources. Healthcare institutions often face the challenge of inadequate resources to train its mental healthcare providers to offer cognitive behavioral therapy. There is also the lack of a formally recognized reimbursement scheme for nurse practitioners involved in the provision of cognitive behavioral therapy for patients’ alcohol and substance abuse disorders (Yohannes, 2018). Therefore, the above issues should be addressed to increase the roles of APRNs in the use of psychotherapy in substance abuse disorders.

Future Development and Research

Cognitive behavioral therapy has been largely explored in Western nations to examine its effectiveness in different mental health problems including alcohol and substance abuse disorders. Its use in ethnic minorities and refugees however remain unexplored. Therefore, future studies should aim at exploring its effectiveness in this populations. There is also a need for future studies to examine the effectiveness, efficacy, and safety of culturally-adaptive cognitive behavioral therapy in alcohol and substance abuse disorders.

Conclusion

Alcohol and substance use addiction is a critical health problem affecting the American populations. The disorder is associated with low quality of life as well as loss of social and occupational productivity. Cognitive behavioral therapy is a psychological intervention that is recommended for use in the management of alcohol and substance abuse disorders. Cognitive behavioral therapy helps patients develop effective coping knowledge and skills for managing substance abuse disorders. The existing evidence shows that optimum benefits are seen in the use of pharmacotherapy and cognitive behavioral therapy. Culturally appropriate cognitive behavioral therapy is needed in the current practice of mental health. Therefore, future studies should explore the effectiveness of culturally-adaptive cognitive behavioral therapy in ethnic minority groups.

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