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Derek Smith a 31 y o Caucasian Male Injection Drug User

Derek Smith a 31 y o Caucasian Male Injection Drug User

Derek Smith, a 31 y.o.,  Caucasian male injection drug user, who is homeless, presents to the ED with a chief complaint of shortness of breath. He describes a 1-month history of intermittent fevers and night sweats associated with a nonproductive cough. He has become progressively more short of breath, initially only with exertion, but now he feels dyspneic at rest.

He appears to be in moderate respiratory distress. His vital signs are abnormal, with fever to 39°C, heart rate of 112 bpm, respiratory rate of 20/min, and oxygen saturation of 88% on room air. Physical examination is otherwise unremarkable but notable for the absence of abnormal lung sounds. Chest x-ray film reveals a diffuse interstitial infiltrate characteristic of pneumocystis pneumonia, an opportunistic infection.

In this discussion:

1. Describe and discuss with your colleagues the underlying disease most likely responsible for this patient’s susceptibility to pneumocystis pneumonia.
2. Describe and discuss the immunosuppression caused by this underlying disease.
3. Describe and discuss the natural history of this disease and some of the common clinical manifestations seen during its progression.
4. Describe your plan of care for this patient following his hospitalization (he will likely be admitted to the “medical respite floor,” of a local homeless shelter, which has the services of a Nurse Practitioner three times per week—with on-call weekend consultation, and a registered nurse, Monday through Friday).

Include citations from the text or the external literature in your discussions.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Case Study for Derek Smith Example Approach

It is apparent from the description that Derek Smith is has the Human Immunodeficiency Virus (HIV). It is a condition that advances into the acquired immunodeficiency syndrome (AIDS) if not treated during the initial stages. Thus, it becomes chronic and thus potentially life threatening. It damages the immune system and makes it difficult for the body to fight any invasive conditions. As indicated by Wallace et al., (2012), the virus is mainly sexually transmitted and is spread via several body fluids.

It attacks the CD4 cells and mostly the T cells. With time, it causes destruction to many of these cells to the point that it cannot fight diseases. If it is not treated; it reduces the number of CD4 cells leading to the invasion by opportunistic infection and cancers. Pneumocystis pneumonia (PCP) is one of the serious infections that are caused Pneumocystis jirovecii fungus. Most of the people who suffer from it have weakened immune system as a result of HIV/AIDS or the use of drugs that lower the ability by the body to fight diseases (Skarbinski et al., 2015).

The advent of antiretroviral therapy has reduced the chances of infection with PCP. However, it is still a significant health problem that is accompanied by chest pains, fatigue, chills, fever and cough. Derek should be put on antiretroviral drugs as well as other antibiotics to help in the management of the chest conditions. There is also the need to put him under several analgesics to help in pain management. He should be placed under a medical respite floor where he can be safe from some of the too cod or dusty conditions. A follow up on the medication should be done to confirm adherence (Wallace et al., 2012).

Derek Smith a 31 y o Caucasian Male Injection Drug User References

• Skarbinski, J., Rosenberg, E., Paz-Bailey, G., Hall, H. I., Rose, C. E., Viall, A. H., … & Mermin, J. H. (2015). Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA internal medicine, 175(4), 588-596.
• Wallace, J. M., Rao, A. V., Glassroth, J., Hansen, N. I., Rosen, M. J., Arakaki, C., … & Pulmonary Complications of HIV Infection Study Group. (2012). Respiratory illness in persons with human immunodeficiency virus infection. American Review of Respiratory Disease

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Permalink

In reply to Samuel Jackson

Re: Week 8 Discussion 8

By Faye Felicilda-Reynaldo – Monday, September 14, 2020, 1:59 AM

Hi Samuel,

Thanks for your post. What types of antibiotics should we administer to our patients with PCP? What are the different first-line and second-line treatments for this condition?

Dr. Reynaldo

31 words

In reply to Faye Felicilda-Reynaldo

Re: Week 8 Discussion 8

by Samuel Jackson – Monday, September 14, 2020, 5:49 AMAntibiotics recommended for treatment of mild, moderate, or severe P jiroveci pneumonia (PJP). TMP-SMX has been shown to be as effective as intravenous pentamidine and more effective than other alternative treatment regimens. [2, 34] The parenteral route may be considered in patients who present with serious illness or in those with gastrointestinal side effects.(Medscape.com)PCP has to be treated with prescription medicine. No treatment, PCP can cause death. The most common form of drugs for treatment is trimethoprim/sulfamethoxazole (TMP/SMX), which is also known as co-trimoxazole and by several different brand names, including Bactrim, Septra, and Cotrim. This medicine is given by mouth or through a IV for 3 weeks. (CDC.gov)

Research papers and essays are two of the most common forms of writing assignments given to high school and college students. Both require presenting an informed argument, organizing main ideas into coherent content, and utilizing proper formatting rules. 

However, essays and research papers carry distinct purposes, structures, and methods that distinguish their approaches significantly.

Mastering what separates the essence and expectations between these academic writing forms helps writers prepare ideal papers that match instructor prompts and score maximum grades through proper execution.

What is an Essay?

An essay is a common form of academic or creative writing that requires presenting an argument, personal opinion, or observation about a specific topic. Typically ranging from three to ten pages long, academic essays are much shorter than a research paper or dissertations. 

The focus is usually narrow, allowing the essay writer to analyze a particular idea, experience, or text thoroughly.

Essays can take different forms, such as persuasive, descriptive, narrative, or expository, each with its own purpose. A strong essay contains a strong thesis statement supported in the body paragraphs with examples and evidence. 

Essays effectively convey the writer’s perspective through logic, personal insight, and rhetorical appeals. While research may be included, extensive citations and references are not required unless specifically assigned.

The language of an essay tends to be direct, concise, and compelling rather than purely fact-driven or technical. The structure is flexible but should have coherence and flow with smooth transitions connecting each part.

Overall, essays allow students to engage critically with ideas and strengthen their creative writing skills on a smaller scale than lengthier paper assignments.

What is a Research Paper?

A research paper is a complex academic writing that independently investigates a specific research problem or question. Significantly longer than an essay, research writing utilizes the scientific method to collect and analyze data, ultimately arriving at objective conclusions.

Before writing an academic research paper, the writer must conduct extensive research from credible sources and then evaluate and synthesize the information to inform and develop a thesis or argument. 

Writing a research paper requires one to adhere to the standard sections that include a title page, abstract, introduction, methodology, results, discussion, conclusion, and references. Strict formatting guidelines govern elements like subheadings, in-text citations, and data displays.

Researchers may submit their final papers to academic journals for peer review and possible publication. Overall, the research writing process demands that students demonstrate an advanced understanding of topics, critical assessment, evidence gathering, integrating credible sources, technical writing skills, and contribution of new findings to benefit wider knowledge about a specific research problem.

The Key Differences Between an Essay and a Research Paper

The table below summarizes core attribute separations helping classify essay and research paper writing:

DifferencesEssayResearch PaperLength<10 pages typically>15 pages commonlyPoint of ViewAnalyze personal opinions or experience related to focused topicsObjective investigative tone using third-person voiceNeed for ResearchOptional research inclusion in the writing processRequired comprehensive literature review inclusionAimAnalyze personal opinions or experiences related to focused topicsCritically assess scholarly knowledge states surrounding specific research problemsKnowledgeApply general background understandingDemonstrate expertise foundations on issues investigatedWriter’s LibertyHigh freedoms for customized presentationsStrict procedural format abidanceStructuring RuleThe thesis defense within the introduction and body paragraphs and ends with a conclusionTitle page, abstract, methodology, results, discussion, and recommendation sectionsTypesExpository, descriptive, narrative, and persuasive approachesAnalytical, expository, interpretive, and argumentative research paper modelsFormatTitle pages, outlines, and bibliographies optionally includedMandatory title pages, tables of contents, in-text citations, end references, and appendices

Final Thoughts On The Difference Between Research Paper and Essay

Writing an essay or research paper differs significantly in terms of the investigative scales, structural frameworks, evidentiary expectations, and analytical intents to compile written arguments about defined topics. However, both forms enable curiously minded students opportunities to demonstrate intellectual growth for professional students compose ideal models reflecting comprehensive understandings mirroring university-level competencies abyss. 

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Diagnostic and statistical manual of mental disorders Dsm-5

Trauma- and Stressor-Related Disorders

Trauma- and stressor-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorders. Placement of this chapter reflects the close relationship between these diagnoses and disorders in the surrounding chapters on anxiety disorders, obsessive-compulsive and related disorders, and dissociative disorders.

Psychological distress following exposure to a traumatic or stressful event is quite variable. In some cases, symptoms can be well understood within an anxiety- or fear-based context. It is clear, however, that many individuals who have been exposed to a traumatic or stressful event exhibit a phenotype in which, rather than anxiety- or fear-based symptoms, the most prominent clinical characteristics are anhedonic and dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms. Because of these variable expressions of clinical distress following exposure to catastrophic or aversive events, the aforementioned disorders have been grouped under a separate category: trauma- and stressor-related disorders. Furthermore, it is not uncommon for the clinical picture to include some combination of the above symptoms (with or without anxiety- or fear-based symptoms).

Such a heterogeneous picture has long been recognized in adjustment disorders, as well. Social neglect—that is, the absence of adequate caregiving during childhood—is a diagnostic requirement of both reactive attachment disorder and disinhibited social engagement disorder. Although the two disorders share a common etiology, the former is expressed as an internalizing disorder with depressive symptoms and withdrawn behavior, while the latter is marked by disinhibition and externalizing behavior.

Reactive Attachment Disorder

Diagnostic Criteria 313.89 (F94.1)

A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

The child rarely or minimally seeks comfort when distressed.

The child rarely or minimally responds to comfort when distressed.

A persistent social and emotional disturbance characterized by at least two of the following:

Minimal social and emotional responsiveness to others.

Limited positive affect.

Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.

Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).

Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).

The criteria are not met for autism spectrum disorder.

The disturbance is evident before age 5 years.

The child has a developmental age of at least 9 months.

Specify if:

Persistent: The disorder has been present for more than 12 months.

Specify current severity:

Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.

Diagnostic Features

Reactive attachment disorder is characterized by a pattern of markedly disturbed and developmentally inappropriate attachment behaviors, in which a child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance. The essential feature is absent or grossly underdeveloped attachment between the child and putative caregiving adults.

Children with reactive attachment disorder are believed to have the capacity to form selective attachments. However, because of limited opportunities during early development, they fail to show the behavioral manifestations of selective attachments. That is, when distressed, they show no consistent effort to obtain comfort, support, nurturance, or protection from caregivers.

Furthermore, when distressed, children with this disorder do not respond more than minimally to comforting efforts of caregivers. Thus, the disorder is associated with the absence of expected comfort seeking and response to comforting behaviors. As such, children with reactive attachment disorder show diminished or absent expression of positive emotions during routine interactions with caregivers.

In addition, their emotion regulation capacity is compromised, and they display episodes of negative emotions of fear, sadness, or irritability that are not readily explained. A diagnosis of reactive attachment disorder should not be made in children who are developmentally unable to form selective attachments. For this reason, the child must have a developmental age of at least 9 months.

Associated Features Supporting Diagnosis

Because of the shared etiological association with social neglect, reactive attachment disorder often co-occurs with developmental delays, especially in delays in cognition and language. Other associated features include stereotypies and other signs of severe neglect (e.g., malnutrition or signs of poor care) Smyke et al. 2002; Zeanah et al. 2005.

Prevalence

The prevalence of reactive attachment disorder is unknown, but the disorder is seen relatively rarely in clinical settings. The disorder has been found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children Gleason et al. 2011.

Development and Course

Conditions of social neglect are often present in the first months of life in children diagnosed with reactive attachment disorder, even before the disorder is diagnosed. The clinical features of the disorder manifest in a similar fashion between the ages of 9 months and 5 years Gleason et al. 2011; Oosterman and Schuengel 2007; Tizard and Rees 1975; Zeanah et al. 2004.

That is, signs of absent-to-minimal attachment behaviors and associated emotionally aberrant behaviors are evident in children throughout this age range, although differing cognitive and motor abilities may affect how these behaviors are expressed. Without remediation and recovery through normative caregiving environments, it appears that signs of the disorder may persist, at least for several years Gleason et al. 2011.

It is unclear whether reactive attachment disorder occurs in older children and, if so, how it differs from its presentation in young children. Because of this, the diagnosis should be made with caution in children older than 5 years.

Risk and Prognostic Factors

Environmental. Serious social neglect is a diagnostic requirement for reactive attachment disorder and is also the only known risk factor for the disorder. However, the majority of severely neglected children do not develop the disorder. Prognosis appears to depend on the quality of the caregiving environment following serious neglect Gleason et al. 2011; Smyke et al. 2012.

Culture-Related Diagnostic Issues

Similar attachment behaviors have been described in young children in many different cultures around the world. However, caution should be exercised in making the diagnosis of reactive attachment disorder in cultures in which attachment has not been studied.

Functional Consequences of Reactive Attachment Disorder

Reactive attachment disorder significantly impairs young children’s abilities to relate interpersonally to adults or peers and is associated with functional impairment across many domains of early childhood Gleason et al. 2011.

Obsessive-compulsive Disorder Sample Paper

The patient, Ms. Shalin, is a 35-year-old female of African American descent who was referred to the clinic by her doctor for psychiatric evaluation. The patient presented with insecurities of leaving her doors unlocked and it was serious such that every time she would report for work, she had to go back home like twice to check whether her door was closed. She always reported to work late primarily because she kept checking repeatedly whether she had locked her door. Her work performance was poor and this resulted in most of her employers terminating her employment.

The patient has a history of diabetes type 2 which has been kept under control. She is currently on buspirone and occasionally uses alcohol. She has a positive family history of anxiety disorder and bipolar disease. The patient has agreed to and signed the informed consent. Assessment reveals a well-groomed 35-year-old lady, with no acute distress. She is talkative but loses concentration after some time. She maintains eye contact while communicating. Her thoughts are preoccupied and circumstantial with compulsion and obsession. The clinical impression is a diagnosis of Obsessive-Compulsive Disorder (OCD) (APA, 2013).

Psychopharmacology

OCD can present a significant management challenge. OCD can be treated using pharmacotherapy. The patient displays an impairment in function, both at home and occupational functionality. Pharmacotherapy is therefore recommended (Greenberg, 2018). The treatment starts with prescription of Selective serotonin reuptake inhibitors (SSRIs) which are the recommended first line intervention for OCDs.

SSRIs inhibit serotonin transporter (SERT) at the presynaptic axon terminal to prevent serotonin reuptake. Evidence has shown that SSRIs for OCD are more efficacious when used in high doses (Kayser, 2020). For Prozac, doses up to 80 mg are accepted. Starting dose of Prozac 20 mg PO once a day in the morning. This should be increased gradually by 20 mg to achieve a maintenance dose of 20-60 mg if the desired clinical outcomes are not met (Salehi et al., 2019).

OCD, however, takes long to respond to SSRI therapy. Clomipramine, a TCA can be added to SSRI to improve the symptoms of OCD. TCA have more serious side effects hence the preference for SSRIs. Clomipramine is therefore used in lower doses when given in combination with SSRIs so as to achieve the benefits of clomipramine while minimizing the side effects in patients (DiVall & Woolley, 2019). The expected outcome of the drugs is to reduce the obsessions and compulsions which interfere with the patient’s performance both at home and at work.

Psychotherapy

Cognitive Behavioral Therapy (CBT) and pharmacotherapy are the first line choice of treatment for OCD and are proven to reduce symptoms significantly (Greenberg, 2018). The effectiveness of cognitive-behavioral therapy is the same as that of pharmacotherapy in the treatment of OCD although behavioral therapy has beneficial effects which are long lasting. Behavioral therapy can be applied for both inpatient and outpatients and should be undertaken by a trained and experienced psychotherapist, preferably a behaviorally trained psychologist.

Noteworthy is that most of behavioral approaches require total commitment from the patients.  Further, for OCD patients, the primary goal of behavior therapy is exposure and response prevention (ERP). Often, the intervening behaviorist gradually exposes the patient to specific symptom triggers while at the same time training the patient on how to effectively suppress their response. While this is generally distressing to the patient, it tends to promote the cycle of learning and unlearning of the obsession and compulsion tendencies when correctly done.

Also, when tackling OCD, the therapist can identify and challenge cognitive distortions that relate to the patient’s OCD and make the patient aware of them. This would be a first step in helping the patient counter such thoughts. The therapy is aimed at changing the behavior, reducing dysfunction and improving the client’s life.

Medical Management

The patient should get her consultations from her Personal Care Physician (PCP). The patient has diabetes type 2 and needs continuous screening and monitoring by the primary care team. The PCP should be involved to ascertain if the patient develops any side effects to the medication. Prozac has been linked with hypoglycemia and poor glycemic control in diabetic patients. TCA have been associated with adverse effects such as orthostatic hypotension which may lead to dizziness and fall (Ulrich et al., 2020).

The patient should be aware of these side effects and should visit the PCP as soon as she notices any anomaly. Suicide risk is also increased in this patient and therefore the PCP who is the first contact for this patient plays a significant role in identifying and appropriately referring this patient.

Community resources

Patients with OCD experience impairment in occupational functioning and struggle to maintain employment. They can easily go into financial hardship because of this. Such patients can benefit from community resources referral. Organizations such as the National Alliance on Mental Illness (NAMI) provide free information about the disorder, medication and support groups.

Follow-up Plan and Collaboration

The patient should report back after one week for follow up and make sure she is compliant to her medications. A follow-up plan should be made every visit. The objective of the follow-up plan is to monitor for signs of self-harmful behaviors, any urges and the need to give in to such urges. These drugs come with certain adverse effects. The dose should be adjusted if the patient is not tolerating the drug well.

The patient should then be monitored every 4 weeks for medication management. Baseline lab tests should also be done monthly. These include the complete blood count, tests on kidney function, as well as liver function tests. The patient should make consultations with the therapist on a weekly basis for updates, questions, and concerns. SSRIs have been associated with the risk of patients being suicidal. The therapist and PCP should therefore be instructed on this possibility and collaborate to watch out for any unusual behaviors that may point towards suicidal tendencies.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC: Author.
• DiVall, M. V., & Woolley, A. B. (2019). CHAPTER Pharmacologic Agents. Acute Care Handbook for Physical Therapists E-Book, 431.
• Greenberg, W. M. (2018, May 17). Obsessive-Compulsive Disorder Treatment & Management: Approach Considerations, Pharmacotherapy, Behavior Therapy. Medscape. Retrieved from https://emedicine.medscape.com/article/1934139-treatment#d8.
• Kayser R. R. (2020). Pharmacotherapy for Treatment-Resistant Obsessive-Compulsive Disorder. The Journal of Clinical Psychiatry, 81(5), 19ac13182. https://doi.org/10.4088/JCP.19ac13182
• Salehi, M., Hadizadeh, H., Chang, A., & Grados, M. A. (2019). Recommendations for prescribing SSRIs. Contemporary Pediatrics, 36(11), 24-27.
• Ulrich, S., Ricken, R., Buspavanich, P., Schlattmann, Peter; Adli, Mazda (2020). Efficacy and Adverse Effects of Tranylcypromine and Tricyclic Antidepressants in the Treatment of Depression. Journal of Clinical Psychopharmacology, 40(1), 63–74. doi:10.1097/JCP.0000000000001153

Different Roles of the Nurse Practitioner Paper

Nurse practitioners (CRNP) and certified nurse-midwives (CNM) are advanced registered nurses with master’s degree-level education from a certified institution. They are trained under high standard institutions that impact them with knowledge and skills to offer patient-centered care that is of high quality, safe, and cost-effective care to patients (Poghosyan et al., 2017). Unlike CRNPS who offers care to people of all age groups from different institutions and centers, CNM offers pregnant women from the time of conception, through pregnancy, during delivery, and after delivery. They ensure normal delivery and neonatal safety.

However, other roles of CRNP and CNM are inseparable despite CNM roles being tailored towards reproductive women. Both offer a myriad of roles including history taking, physical assessment, ordering diagnostic tests, creating care plans, diagnosis acute and chronic conditions, offering treatment, education on preventive measures, providing health promotion, follow-up of patients, and advocating for patient rights (Zonneveld et al., 2018).

In addition, CNM offers contraception and birth control services, woman-centered care, conduct safe delivery, and gynecological services (Hastings-Tolsma et al., 2018). A family nurse practitioner (FNP) needs to understand the roles of both CRNP and CNM as this will influence their performance. FNP is entitled to provide primary care, perform a physical assessment, order diagnostic tests, develop care plans, and offer treatment just like CRNP and CNM.

On the other hand, physician assistants (PA) offer disease-centered care under the supervision of the physician. Their roles include taking patient history, performing a physical examination, ordering and interpreting laboratory tests, assisting in surgeries, making a diagnosis, prescribing medications, counseling patients, and offering preventive care (Halter et al., 2018). Likewise, an FNP provides care to different populations like PA. In addition, an FNP will be required to offer collaborative treatment, diagnose patients, and order tests while working with different health care providers (Zonneveld et al., 2018). Therefore, appreciating the roles of different care providers will help in the provision of coordinated high-quality patient care.

References

• Halter, M., Wheeler, C., Pelone, F., Gage, H., de Lusignan, S., Parle, J., Grant, R., Gabe, J., Nice, L., & Drennan, V. M. (2018). Contribution of physician assistants/associates to secondary care: a systematic review. BMJ Open, 8(6), e019573. https://doi.org/10.1136/bmjopen-2017-019573
• Hastings-Tolsma, M., Foster, S. W., Brucker, M. C., Nodine, P., Burpo, R., Camune, B., Griggs, J., & Callahan, T. J. (2018). Nature and scope of certified nurse-midwifery practice: A workforce study. Journal of Clinical Nursing, 27(21–22), 4000–4017. https://doi.org/10.1111/jocn.14489
• Poghosyan, L., Liu, J., & Norful, A. A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study. International Journal of Nursing Studies, 74, 1–7. https://doi.org/10.1016/j.ijnurstu.2017.05.004
• Zonneveld, N., Driessen, N., Stüssgen, R. A. J., & Minkman, M. M. N. (2018). Values of integrated care: A systematic review. International Journal of Integrated Care, 18(4), 9. https://doi.org/10.5334/ijic.4172

The Role of an NP Sample Paper

As an NP, an individual can diagnose and treat acute and chronic health problems, a role RNs cannot perform. The NPs also can prescribe medications for acute or chronic illnesses in their area of expertise. The NPs have advanced knowledge and experience in their area of expertise. Exploiting this knowledge and experience gives them a higher advantage of diagnosing and treating diseases, as well as managing patients effectively. According to Fraze et al. (2020), the presence of NPs in a hospital setting is associated with improved quality of care to the patients.

Learning never ends, and the training at the master’s level is not enough. Ensuring proficiency requires personal effort. I will embark on nursing research in my area of expertise to discover new knowledge and enhance existing knowledge. I will also participate in seminar training organized by the hospital, professional organizations, and the government. I will also ensure that I use the available website in the area of expertise to keep myself updated with information on current practice because nursing practice is very dynamic (Winter et al., 2020)

References

• Fraze, T. K., Briggs, A. D., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of nurse practitioners in caring for patients with complex health needs. Medical Care, 58(10), 853-860. https://dx.doi.org/10.1097%2FMLR.0000000000001364
• Winter, S., Chapman, S. A., Chan, G. K., Duderstadt, K., & Spetz, J. (2020). Nurse Practitioner Role and Practice Environment in Primary and in Nonprimary Care in California. Medical Care Research and Review, 1077558720942706. https://doi.org/10.1177%2F1077558720942706

Differential Diagnosis and Plan for Treatment Sample Paper

The differential diagnosis I selected is schizoaffective disorder. This decision is owing to the fact that schizoaffective disorder is a mental health disorder presenting with a combination of schizophrenia symptoms, such as delusions or hallucinations, and mood disorder symptoms, such as mania or depression (Wy & Saadabadi, 2019). A.A has symptoms of auditory hallucinations since he complains of hearing voices even while at work, which distract him from his occupation. He also complains that he feels hopeless in some situations, driving him to be anti-social. A feeling of hopelessness is evident in major depression.

The primary aim of this diagnosis is to improve the quality of life of the patient by first establishing the pathology. Moreover, it is imperative to rule out other conditions that manifest with the same symptoms in order to arrive at the appropriate management strategy (Parker, 2019). Majority of persons with schizophrenia or schizoaffective disorder are at first misdiagnosed with major depression or bipolar disorder. Thus, my intention is to rule out other closely resembling conditions in order to zero down to the primary disorder affecting patient A.A.

The initial diagnosis for patient A.A is schizophrenia. Also, he has been on treatment for the same condition, with the medication olanzapine, 15 mg per oral daily and sequel 200 mg at night. Nonetheless, she complains of auditory hallucinations distracting her from work and feeling of hopelessness driving her to be anti-social.  Since she is on medication, she is not expected to experience auditory hallucinations, particularly if she is compliant. On the other hand, since the symptoms persist, the clinician is prompted to query the cause. Misdiagnosis is a probable cause why she is experiencing the symptoms even while on medication (Parker, 2019). Moreover, since in addition to the schizophrenic symptoms she has a feeling of hopelessness and anti-social drive, she is more likely to have schizoaffective disorder.

Treatment Plan for Psychotherapy

The first part of the psychotherapy comprised of individual counseling. The need for individual counseling cannot be overemphasized since it enabled the patient to better comprehend his condition. In addition, through individual counseling I was more able to offer support and guidance to patient A.A, particularly regarding his concerns (Potik, Moghrabi & Schreiber, 2020). He was concerned that the symptoms were driving him to leading an anti-social life. The counseling sessions allowed me to assist A.A on how to solve the difficulties facing his relationships or work.

Psychotherapy would be incomplete without cognitive behavioral therapy. Cognitive behavioral therapy aimed to guide A.A to develop positive thought patterns that would culminate in improved mental health. CBT is based on the principle that thought patterns affect the emotions that in turn affect behaviors (Potik et al., 2020). CBT assisted A.A to nurture positive thoughts, leading to more positive feelings and eventually positive behaviors. CBT involved the patient identifying specific problems/issues in his life. Under my guidance, A.A became aware of unproductive thought patterns and how they impacted his life. I then probed him to identify negative thinking in order to ultimately reshape it in a way changing his emotions. Finally, A.A. learnt new behaviors and how to put them into practice.

No differences were noted between my expectations and the actual achievement in patient A.A’s mental health. Individual counseling enabled him to embrace the condition without prejudice and without fear of discrimination or stigmatization. Accepting the condition was key to his prognosis since it foreshadowed his readiness to comply with the appropriate therapy (Green et al., 2019). Worth noting, after the cognitive behavioral therapy, A.A was in a better mood and gradually became sociable, engaging actively in social interactions and activities. His encouraging prognosis was directly attributable to the individual counseling and the cognitive behavioral therapy.

Treatment Plan for Psychopharmacology

The medication I prescribed for A.A. was paliperidone. Paliperidone is the only antipsychotic drug that the Food and Drug Administration specifically approves to manage schizoaffective disorder (Arndtzen & Sandlund, 2020). Nonetheless, other antipsychotic drugs such as olanzapine may manage the psychotic symptoms. Patient A.A was on paliperidone, intramuscular injection for sustained release, 234 mg in deltoid on the treatment day, then 156 mg 1 week later, followed by a maintenance dose of 234 mg in the gluteal muscle once monthly. Mood stabilizing medications were avoided in A.A since his schizoaffective disorder was not the bipolar type. Nonetheless, since he had a feeling of hopelessness and loneliness that are consistent with depression, sertraline was also prescribed, at a dose of 25 mg per oral four times in a day, which was gradually increased by 25 mg every 3 days until the dose was 200 mg four times in a day.

Paliperidone enabled patient A.A to calm down and effectively stopped the auditory hallucinations. My intention for prescribing paliperidone was primarily to relieve the symptoms associated with schizoaffective disorder (Huhn et al., 2021).  Sertraline relieved the feeling of hopelessness and loneliness and gradually A.A became engaging actively in social interactions. The primary goal of prescribing sertraline was to relieve the depressive symptoms, which proved to be successful.

Worth noting, the results achieved in patient A.A and my expectations were not different. A. A responded remarkably to the pharmacotherapeutic intervention. The ethical considerations involved in the treatment plan are diverse, owing to the debilitating nature of the condition. Since schizoaffective disorder affects the mental status of the patient, it was challenging for A.A to practice autonomy, which is an ethical principle in medical practice (Saya et al., 2019). Where the patient is unable to directly make decisions pertaining to his/her healthcare, a family member, often the next of kin is called upon to make the decision. However, A.A has never been in a relationship and had no kin to make the decision regarding his mental condition. Thus, the clinician had to intervene to improve the patient’s quality of life (Saya et al., 2019). Moreover, the clients’ families ought to know of the conditions affecting their kin, especially in mental illness. The families should also be notified of the treatment, which is done in family therapy.

References

• Arndtzén, M., & Sandlund, M. (2020). To live with a Schizoaffective disorder. Journal of Psychiatric and Mental Health Nursing, (). https://doi.org/10.1111/jpm.12708
• Saya, A., Brugnoli, C., Piazzi, G., Liberato, D., Di Ciaccia, G., Niolu, C. & Siracusano, A. (2019). Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review. Frontiers in Psychiatry, 10(), 271–. doi:10.3389/fpsyt.2019.00271
• Huhn, M., Leucht, C., Rothe, P., Dold, M., Heres, S., Bornschein, S., Schneider-Axmann, T., Hasan, A. & Leucht, S. (2020). Reducing antipsychotic drugs in stable patients with chronic schizophrenia or schizoaffective disorder: a randomized controlled pilot trial. European Archives of Psychiatry and Clinical Neuroscience, 271(2), 293-302. doi:10.1007/s00406-020-01109-y
• Green, A., Stephenson, T., Whiskey, E., & Shergill, S. (2019). Closure beyond clozapine: Successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis. BJPsych Open, 5(3), E43. doi:10.1192/bjo.2019.31
• Parker, G. (2019). How well does the DSM-5 capture schizoaffective disorder? The Canadian Journal of Psychiatry, 64(9), 607610. https://doi.org/10.1177%2F0706743719856845
• Potik, D., Moghrabi, F., & Schreiber, S. (2020). Case Report: Pharmacotherapy and EMDR Psychotherapy as an Effective Treatment for OCD Imagery in a Patient with a Psychotic Disorder. Israel Journal of Psychiatry, 57(1).
• Wy, T. J. P., & Saadabadi, A. (2019). Schizoaffective Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541012/

 

then

Discussion 2: Your Leadership Profile Week 5 NURS 6053

Please follow the instructions below to complete this work . I will attach the assignment instructions, the course reading and a copy of my strength finder as files.

Discussion 2: Your Leadership Profile

Do you believe you have the traits to be an effective leader? Perhaps you are already in a supervisory role, but as has been discussed previously, appointment does not guarantee leadership skills.

How can you evaluate your own leadership skills and behaviors? You can start by analyzing your performance in specific areas of leadership. In this Discussion, you will complete Gallup’s StrengthsFinder assessment.

This assessment will identify your personal strengths, which have been shown to improve motivation, engagement, and academic self-conference. Through this assessment, you will discover your top five themes—which you can reflect upon and use to leverage your talents for optimal success and examine how the results relate to your leadership traits.

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To Prepare for Discussion 2: Your Leadership Profile Week 5 NURS 6053:

Complete the StrengthsFinder assessment instrument, per the instructions found in this Module’s Learning Resources.

Please Note: This Assessment will take roughly 30 minutes to complete.

NOTE: Please keep your report. You will need your results for future courses.

Leadership Profile Sample Discussion

Numerous studies have identified holistic nurse leader’s characteristics and examine the ways through which nurse leaders can cultivate these characteristics (Christensen, Wilson & Edelman, 2018). As a leader, I could continue to develop my leadership qualities if I was able to recognize and strengthen my abilities. This week’s StrengthsFinder assessment revealed five themes that potentially define my leadership qualities as a leader. From the assessment, the five themes that emerge include individualization, responsibility, developer, arranger, and connectedness. In the facility’s emergency department, I carry the role of a clinical educator, and although the job may not be considered a leadership position, it is essential to recognize my abilities as an informal departmental leader.

From the five themes, I would like to develop two leadership traits, namely connectedness and responsibility. Connectedness is vital because it provides the basis of faith that there is a link to everything and every situation. A leader with this strength believes there are only a few coincidences and that every event has a meaning (Gallup, 2019). By nurturing this strength, I could help individuals realize that teamwork and group efforts are essential in accomplishing tasks, a significant goal in a busy emergency department. On the other hand, responsibility is a personal leadership trait that makes me liable to take psychological ownership, whether small or large, or emergent situations. This builds a sense of commitment to serving other nurses and the patient’s body without having any excuses or rationalizations.

Nursing requires core values that form the standard components in all clinical and educational nursing settings. The core values guide and motivate professional behaviors of nurses in their respective work areas. Pidgeon (2017), for instance, has enumerated various leadership core values and two that I would like to strengthen, namely the capacity to accept discrepancies in opinions and a commitment towards a caring-based leadership approach. The two core values will strongly influence the developer and arranger themes identified in the strength assessment report discussed.

I believe that leaders are made and not born. Leadership is a learning process that a person acquires over time. I can be a leader by personal experience or simply by borrowing, through emulation, of leadership qualities and skills from other leaders. Ideally, one can achieve this when operating within an organizational culture that supports learning and orientation (Duggan et al., 2015).

A good leader promotes the productivity of their team. On the same note, I would like to develop a leadership philosophy based on individualization and adaptability. Individualization as a theme and a personal leadership philosophy allows a leader to be intrigued by each person’s unique qualities. As an educator, I tend to see learners as a group of individuals with distinct traits. Consequently, I must pay more attention to their individual skills, attitudes, and interests to draw out their uniqueness and bring out their highest potential.

On the other hand, adaptability is not viewing the future as a fixed destination but creating choices. In the emergency department, nurses must adapt to the department’s stressful situations. Showing my clinical staff that I can be adaptable to our unit’s various stressors as a role model could help them feel that they have a supportive leader. Adaptive leadership, as a component of transformational leadership, is a trait that one needs to cultivate because even stable situations can become unstable when challenges emerge (Broome & Marshall, 2021).

That said, I believe that leadership is a mindset that a person develops as they grow in their career or line of work. Good leaders always try to strengthen their leadership qualities while working on the weak points. Nurse leaders should create an image that is easy to understand by the other nurses and be ready to inspire others to continue developing within their respective areas of service or levels pf leadership. Having taken the StrengthsFinder test, I now understand the importance of such assessments as through it I was able to understand my leadership strengths and weaknesses, and how I can better improve on the identified weaknesses.

Discussion 2: Your Leadership Profile Week 5 NURS 6053 Reference

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Christensen, S. S., Wilson, B. L., & Edelman, L. S. (2018). Can I relate? A review and guide for nurse managers in leading generations. Journal of Nursing Management, 26(6), 689–695.

Duggan, K., Aisaka, K., Tabak, R. G., Smith, C., Erwin, P., & Brownson, R. C. (2015). Implementing administrative evidence-based practices: lessons from the field in six local health departments across the United States. BMC Health Services Research, 15(1), 1-9.

Gallup. (2019). Clifton StrengthsFinder 2.0. Retrieved from https://walden.gallup.com

Pidgeon, K. (2017). The Keys for Success: Leadership Core Competencies. Journal of Trauma Nursing, 25(6), 338-341.

Technical Issues with Gallup:

If you have technical issues after registering, please contact the Gallup Education Support group by phone at +1.866-346-4408. Support is available 24 hours/day from 6:00 p.m. Sunday U.S. Central Time through 5:00 p.m. Friday U.S. Central Time.

• Reflect on the results of your Assessment, and consider how the results relate to your leadership traits.

Post a brief description of your results from the StrengthsFinder assessment. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your StrengthsFinder assessment. Be specific. Discussion 2: Your Leadership Profile Week 5 Nursings 6053

By Day 3 of Week 5 of Discussion 2: Your Leadership Profile Week 5 Nursings 6053

Post a brief description of your results from the StrengthsFinder assessment. Then, briefly describe two core values, two strengths, and two characteristics that you would like to strengthen based on the results of your StrengthsFinder assessment. Be specific.

By Day 6 of Week 5

Respond to at least two of your colleagues on two different days by making recommendations for how they might strengthen the leadership behaviors profiled in their StrengthsFinder assessment, or by commenting on lessons to be learned from the results that can be applied to personal leadership philosophies and behaviors.

 

Discussion 2: Your Leadership Profile Week 5 NURS 6053 Rubric Detail

 ExcellentGoodFairPoorMain Posting45 (45%) – 50 (50%)Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

40 (40%) – 44 (44%)Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

35 (35%) – 39 (39%)Responds to some of the discussion question(s).One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 34 (34%)Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness10 (10%) – 10 (10%)Posts main post by day 3.0 (0%) – 0 (0%)0 (0%) – 0 (0%)0 (0%) – 0 (0%)Does not post by day 3.First Response17 (17%) – 18 (18%)Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

15 (15%) – 16 (16%)Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

13 (13%) – 14 (14%)Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 (0%) – 12 (12%)Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.0 (0%) – 0 (0%)0 (0%) – 0 (0%)0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.Total Points: 100       

Results of my strength finder assessments

Strengths Insight Guide

SURVEY COMPLETION DATE: 09-22-2020

DON C.

Father of Strengths Psychology and Inventor of CliftonStrengths

SURVEY COMPLETION DATE: 09-22-2020Depending on the order of your themes and how you responded to the assessment, some of your themes may share identical insight statements. If this occurs, the lower ranked theme will not display insight statements to avoid duplication on your report.Your Top 5 Themes1. Activator
2. Achiever
3. Discipline
4. Consistency 5. Focus

2 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

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Activator

SHARED THEME DESCRIPTION

People who are especially talented in the Activator theme can make things happen by turning thoughts into action. They are often impatient.

YOUR PERSONALIZED STRENGTHS INSIGHTS

What makes you stand out?

Because of your strengths, you urge people to attain their goals by pressing ahead without stopping. Some people feel threatened by your forceful messages. You probably use this technique with individuals who are slow to start or who are inclined to quit before the work is finished. Instinctively, you may find that you easily energize people.

You might be determined to generate enthusiasm about projects, events, or activities. Chances are good that you want to be in charge. As soon as you have made up your mind, you are eager to get started. People who interfere with your progress probably irritate you. Driven by your talents, you notice that people heed your demands. What you say and how you say it can even frighten and threaten people. You probably have used this effect to influence individuals to do what you want.

It’s very likely that you are naturally open and honest about who you are, what you have done, what you can do, and what you cannot do. Your straightforward explanations and stories help listeners see you as you see yourself. You reveal your strengths and limitations. You are forthright and plainspoken. People generally seek your company and want to work with you. Many are impelled to move into action by your words and examples.

Questions

1. As you read your personalized strengths insights, what words, phrases, or lines stand out to you?
2. Out of all the talents in this insight, what would you like for others to see most in you?

3 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

 

Achiever

SHARED THEME DESCRIPTION

People who are especially talented in the Achiever theme have a great deal of stamina and work hard. They take great satisfaction from being busy and productive.

YOUR PERSONALIZED STRENGTHS INSIGHTS

What makes you stand out?

It’s very likely that you may prefer to enroll in demanding classes. Perhaps you thrive in situations where you can test your talents or your endurance to discover how much you can accomplish. You may need to “prove yourself to yourself” every now and then.

Because of your strengths, you might toil for hours, days, weeks, or months to produce desired outcomes. Perhaps you impose demanding standards for excellence or productivity on yourself. You might not rest until each requirement is met. By nature, you might argue that success is the product of hard work.

Perhaps your no-nonsense approach impels you to compare your most recent progress to your past performance. You sometimes strive to excel by imposing measurable goals for personal or professional growth on yourself. Instinctively, you might wonder why an unexpected series of events or personal encounters occurred. Sometimes you can simply accept what happened and you go on with your life.

You sense that good fortune, good timing, or good connections may influence outcomes as much as your hard work does. Chances are good that you might win over individuals when they notice you are intense, diligent, and earnest. Perhaps you are attracted to people whose work ethic matches your own. This may partially explain why they enjoy your company.

Questions

1. As you read your personalized strengths insights, what words, phrases, or lines stand out to you?
2. Out of all the talents in this insight, what would you like for others to see most in you?

4 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

 

Discipline

SHARED THEME DESCRIPTION

People who are especially talented in the Discipline theme enjoy routine and structure. Their world is best described by the order they create.

YOUR PERSONALIZED STRENGTHS INSIGHTS

What makes you stand out?

Because of your strengths, you rely on your own exacting standards and methodical routines to ensure things are done with careful attention to all aspects and details. This is especially true when you encounter obstacles. You often decide it is easier to deal with these difficulties on your own. This way you know for sure everything is done right. Instinctively, you are the type of person who maps out trips, projects or agendas well ahead of time.

our detailed preparation usually involves a lot of reading. Fortunately, you devour the written word with the same passion as someone who loves food savors a delicious meal. Chances are good that you genuinely appreciate forward-looking thinkers who help you envision the future. They usually inspire you to outline the tasks and list the deadlines for reaching each of your goals.

Having a plan to follow improves your chances of accomplishing what you desire in the coming months, years, or decades. Driven by your talents, you track progress toward your major goals by evaluating your income. Your financial well-being contributes greatly to your outlook on life.

Money buys you many things that give you joy. You are apt to work even harder when you lack the funds to do what you want to do. By nature, you naturally are drawn to start-up activities. Why? They give you an opportunity to accomplish something no one else has done. You are likely to push yourself to reach goals. You are hardwired to double check your work to verify that everything is going as planned. You are equally concerned that every person and piece of equipment is in its assigned location.

Questions

1. As you read your personalized strengths insights, what words, phrases, or lines stand out to you?
2. Out of all the talents in this insight, what would you like for others to see most in you?

5 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

 

Consistency

SHARED THEME DESCRIPTION

People who are especially talented in the Consistency theme are keenly aware of the need to treat people the same. They try to treat everyone in the world with consistency by setting up clear rules and adhering to them.

YOUR PERSONALIZED STRENGTHS INSIGHTS

What makes you stand out?

It’s very likely that you probably are one of those people who reads the regulations first, especially when they apply to everyone in a group. Your need to commit these rules to memory is apt to be the way you prepare to play a game, assemble a device, use a computer program, or adhere to a standard process. Driven by your talents, you routinely search for ways to do a better job of making sure all individuals know and abide by established rules, procedures, or guidelines.

Chances are good that you might be the team member who streamlines processes, rules, or procedures. Periodically you outline steps so all group members perform the same task the same way every time they do it. Because of your strengths, you may prefer to set goals in an environment where most people agree to follow the procedures or rules. Perhaps knowing beforehand what to expect of others and what they expect of you makes the task a bit more enjoyable. When you are given the choice between order and chaos, you sometimes choose order. This partially explains why you become irritated with individuals who try to change procedures or make exceptions to the rules in the middle of meetings.

Instinctively, you might not want any one thing to consume every minute of your day. For practical purposes, you may choose to handle some personal or professional problems matter-of-factly or deal with information unemotionally. Perhaps you minimize conflict between people by not taking sides. Instead, you try to make certain individuals aware of things as they actually are. Maybe you emphasize what they have in common. Sometimes you manage to move adversaries toward peaceable solutions or general agreements.

Questions

1. As you read your personalized strengths insights, what words, phrases, or lines stand out to you?
2. Out of all the talents in this insight, what would you like for others to see most in you?

6 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

 

Focus

SHARED THEME DESCRIPTION

People who are especially talented in the Focus theme can take a direction, follow through, and make the corrections necessary to stay on track. They prioritize, then act.

YOUR PERSONALIZED STRENGTHS INSIGHTS

What makes you stand out?

Chances are good that you might want to distribute your time more evenly among the priorities in your life. This is a challenge, however. Why? You tend to express yourself through your work. One part of you is completely devoted to your job or studies. Another part of you demands equal time for family, friends, solitude, or recreation. You typically block out everything but your work when you must give your undivided attention to an assignment, project, experiment, or special event.

Driven by your talents, you usually consider what you need to do better as a person or as a professional. You are surprised when you realize how much time you have spent thinking about an important problem, issue, or question. By nature, you channel your energy toward what you can accomplish in the coming months, years, or decades. Your mind churns out new and inventive ways of reaching your goals. You risk becoming bored and delivering a lackluster performance when you are constantly forced to adhere to a predetermined process, a tried-and- tested procedure, or a traditional method.

You can hear yourself pleading, “But, if we only did it this way, it would be so much better.” It’s very likely that you are baffled — that is, confused or puzzled — by people who have few, if any, clear goals. These individuals serve as constant reminders that poorly defined objectives frequently lead to failure. You are aware of this risk. You concentrate your mental, emotional, and physical energy on reaching your most important goal.

Simply put: You become single-minded — that is, you dedicate yourself to one purpose. Because of your strengths, you can mentally zero in on tasks for hours at a time when you have a goal to reach. When the assignment demands extra time, you would be wise to honor your body’s natural rhythms. In other words, if you are a “morning person,” work in the morning. Work in the afternoon if that is when you hit your stride. Work in the evening if that is when you think better. Work around midnight after everyone has gone to bed if you are someone who usually stays up very late.

Questions

1. As you read your personalized strengths insights, what words, phrases, or lines stand out to you?
2. Out of all the talents in this insight, what would you like for others to see most in you?

#7 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

Your Signature Theme Report

SURVEY COMPLETION DATE: 09-22-2020

DON CLIFTON

Father of Strengths Psychology and Inventor of CliftonStrengths

1 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

SURVEY COMPLETION DATE: 09-22-2020Many years of research conducted by The Gallup Organization suggest that the most effective people are those who understand their strengths and behaviors. These people are best able to develop strategies to meet and exceed the demands of their daily lives, their careers, and their families.

A review of the knowledge and skills you have acquired can provide a basic sense of your abilities, but an awareness and understanding of your natural talents will provide true insight into the core reasons behind your consistent successes.

Your Signature Themes report presents your five most dominant themes of talent, in the rank order revealed by your responses to StrengthsFinder. Of the 34 themes measured, these are your “top five.”

Your Signature Themes are very important in maximizing the talents that lead to your successes. By focusing on your Signature Themes, separately and in combination, you can identify your talents, build them into strengths, and enjoy personal and career success through consistent, near-perfect performance.

Activator

“When can we start?” This is a recurring question in your life. You are impatient for action. You may concede that analysis has its uses or that debate and discussion can occasionally yield some valuable insights, but deep down you know that only action is real. Only action can make things happen. Only action leads to performance. Once a decision is made, you cannot not act. Others may worry that “there are still some things we don’t know,” but this doesn’t seem to slow you.

If the decision has been made to go across town, you know that the fastest way to get there is to go stoplight to stoplight. You are not going to sit around waiting until all the lights have turned green. Besides, in your view, action and thinking are not opposites. In fact, guided by your Activator theme, you believe that action is the best device for learning. You make a decision, you take action, you look at the result, and you learn. This learning informs your next action and your next.

How can you grow if you have nothing to react to? Well, you believe you can’t. You must put yourself out there. You must take the next step. It is the only way to keep your thinking fresh and informed. The bottom line is this: You know you will be judged not by what you say, not by what you think, but by what you get done. This does not frighten you. It pleases you.

2 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

 

Achiever

Your Achiever theme helps explain your drive. Achiever describes a constant need for achievement. You feel as if every day starts at zero. By the end of the day you must achieve something tangible in order to feel good about yourself. And by “every day” you mean every single day—workdays, weekends, vacations. No matter how much you may feel you deserve a day of rest, if the day passes without some form of achievement, no matter how small, you will feel dissatisfied. You have an internal fire burning inside you. It pushes you to do more, to achieve more.

After each accomplishment is reached, the fire dwindles for a moment, but very soon it rekindles itself, forcing you toward the next accomplishment. Your relentless need for achievement might not be logical. It might not even be focused. But it will always be with you. As an Achiever you must learn to live with this whisper of discontent.

It does have its benefits. It brings you the energy you need to work long hours without burning out. It is the jolt you can always count on to get you started on new tasks, new challenges. It is the power supply that causes you to set the pace and define the levels of productivity for your work group. It is the theme that keeps you moving.

Discipline

Your world needs to be predictable. It needs to be ordered and planned. So you instinctively impose structure on your world. You set up routines. You focus on timelines and deadlines. You break long-term projects into a series of specific short-term plans, and you work through each plan diligently. You are not necessarily neat and clean, but you do need precision. Faced with the inherent messiness of life, you want to feel in control. The routines, the timelines, the structure, all of these help create this feeling of control.

Lacking this theme of Discipline, others may sometimes resent your need for order, but there need not be conflict. You must understand that not everyone feels your urge for predictability; they have other ways of getting things done. Likewise, you can help them understand and even appreciate your need for structure.

Your dislike of surprises, your impatience with errors, your routines, and your detail orientation don’t need to be misinterpreted as controlling behaviors that box people in. Rather, these behaviors can be understood as your instinctive method for maintaining your progress and your productivity in the face of life’s many distractions.

Consistency

Balance is important to you. You are keenly aware of the need to treat people the same, no matter what their station in life, so you do not want to see the scales tipped too far in any one person’s favor. In your view this leads to selfishness and individualism. It leads to a world where some people gain an unfair advantage because of their connections or their background or their greasing of the wheels. This is truly

3 Copyright © 2000, 2006-2012 Gallup, Inc. All rights reserved.

offensive to you. You see yourself as a guardian against it. In direct contrast to this world of special favors, you believe that people function best in a consistent environment where the rules are clear and are applied to everyone equally. This is an environment where people know what is expected. It is predictable and evenhanded. It is fair. Here each person has an even chance to show his or her worth.

Focus

“Where am I headed?” you ask yourself. You ask this question every day. Guided by this theme of Focus,

The travel nursing career has exploded in popularity over the last few years, offering adventurous nurses the chance to explore the country while enjoying attractive benefits like higher pay, stipends, and flexibility in choosing placements. The nationwide nursing shortage, coupled with the demands of the COVID-19 pandemic, has created high demand and abundant openings for travel nurses across the U.S.

However, travel nursing comes with considerable downsides as well that should be carefully evaluated before signing any contracts. This article will dive deep into the numerous pros and cons of travel nurse positions. 

What’s It Like Being a Travel Nurse? 

Being a travel nurse offers a unique career filled with adventure and opportunity—but it also has some significant downsides. Travel nurses work temporary contracts at hospitals and facilities nationwide, usually 13 weeks long. This mobile lifestyle allows nurses to explore new places, meet new people, and expand their skills.

However, the nature of travel nursing means that nurses must adapt to constantly changing policies, procedures, colleagues, patient populations, and locations. Travel nurses need a thick skin, resourcefulness, and extreme adaptability to thrive.

How Does Travel Nursing Work? 

Travel nursing agencies connect registered nurses to medical facilities nationwide. When a hospital has a staffing shortage or seasonal influx of patients, they inform agencies of their need for temporary nurses. Agencies then match open contracts to nurses registered in their talent pools.

An experienced recruiter helps travel nurses choose contracts that align with their skills, specialties, financial needs, geographic preferences, and lifestyle. Once matched, travel nurses relocate nationwide to work their 13-week contracts before accepting their subsequent assignments. Agencies also provide stipends to reimburse travel expenses like transportation, housing, meals, and licenses.

How to Become a Travel Nurse

Becoming a travel nurse requires some essential skills and experience:

Licensing, Credentials, and Certifications: Travel nurses must hold an active RN license in every state where they want to work. Some contracts require additional certifications like ACLS, PALS, or NRP.

Communication Skills: As travel nurses change facilities constantly, communication and listening skills help them connect with new colleagues, policies, and patient populations. Cultural sensitivity is critical.

Adaptability: Travel nurses must acclimate quickly to new environments. Comfort with uncertainty and change makes this lifestyle more accessible.

Know What You Want: Understanding your skills, interests, priorities, and deal-breakers helps recruiters match you to ideal contracts. Financial literacy also allows you to evaluate compensation packages accurately.

Financial Expertise: Travel nurses must understand taxes, reimbursements, deductions, budgets, and retirement planning to manage inconsistent income streams. Organization and literacy protecting earnings are vital.

Pros of Travel Nursing

Travel nursing offers many advantages over staff nursing positions. The following are the top advantages of being a travel nurse:

Compensation: Travel nurses earn significantly higher pay than staff nurses. Experienced travel nurses report average salaries between $60,000-$100,000 annually. Pay packages also include stipends and reimbursements for travel costs.

Stipends and Other Perks: Most agencies provide generous stipends for meals/incidentals, lodging, travel, and licenses. Some offer retention bonuses, referral programs, and mileage reimbursements as well.

Choice of Contracts: Travel nurses select contracts matching their needs and preferences instead of standard work directives. This freedom and flexibility is nearly impossible for staff nurses.

Avoiding Workplace Conflicts: The temporary nature of contracts allows nurses to leave unpleasant managers, colleagues, or practices behind quickly.

Travel to New Places: For nurses who relish travel, contracts across the country enable them to explore new cities and hometowns while getting paid.

Expand Marketable Skills: Exposure to cutting-edge technology, unique patient populations, and specialty units expands nursing skills and resumes.

Try Out New Hospitals: Travel nursing allows assessing new workplaces and cities while employed instead of relocating blindly. Long contracts help thoroughly evaluate potential sites.

Disadvantages of Being a Travel Nurse

 While travel nurse jobs offer some advantages, nurses should weigh the disadvantages. Cons of being a travel nurse include: 

Financial Literacy: Inconsistent incomes and complicated reimbursement policies require extreme organization, literacy, and discipline to prevent mismanagement.

Healthcare and Retirement Benefits: Most travel nurses must secure health insurance and retirement plans since agencies do not provide benefits. This represents significant additional expenses.

Lack of a Support System: Frequent moves and job changes can isolate travel nurses from family, friends, and community support emotionally and physically.

Loneliness: The isolating nature of short-term contracts in unfamiliar cities leaves many travel nurses emotionally lonely despite busy schedules. Building connections quickly helps overcome this challenge.

Lack of Rapport With Colleagues: The quick contracts of travel nursing limit opportunities to establish camaraderie, rapport, and relationships with facility staff.

Career Development Challenges: Since travel nurses change facilities quickly, obtaining advanced certifications, training, and leadership development opportunities proves challenging. Promotions and accountability also become limited.

Pushback Over High Wages: Some staff nurses resent the higher incomes of travel nurses. Tension or bullying sometimes results in units.

Travel Nurses Lack Job Security: When contracts end (or funding runs out), travel nurse positions immediately terminate. Beginning the job search process again brings anxiety and instability.

You Can’t Choose Your Hours: Since travel nurses fill staffing gaps, they work complex and inconsistent schedules without much control. Twelve-hour shifts often extend to 16.

The Pay Varies: While travel nurses generally earn excellent pay, actual incomes depend on facility budgets. Lucrative contracts exist, but lower-paying rural or seasonal contracts do as well.

You Won’t Have Paid Time Off: Rarely do travel nurse contracts include PTO, sick days, or vacation accruals. Nurses must budget carefully when taking unpaid leave.

You Will Always Be the New One: Adapting to new environments and colleagues every 13 weeks means frequently feeling out of step. Building connections with reserved or skeptical staff brings added emotional work.

Licensing Can Be a Struggle: Navigating license transfers between multiple state boards causes headaches for many travel nurses and delays assignments.

The Housing Situation is Complicated: Figuring out short-term housing stipends logistically and financially in expensive cities across the country greatly stresses some nurses.

You Will Dread Tax Season: Since travel nurses work taxable contracts in multiple states annually, filing taxes becomes complicated, confusing, and expensive.

You Will Miss Home: Despite adventures, many travel nurses experience profound homesickness and displacements from loved ones back home. The lifestyle simply doesn’t suit everyone emotionally.

Disadvantages of Travel Nursing

The advantages and disadvantages of travel nursing positions vary from nurse to nurse. While the travel lifestyle offers adventure, autonomy over schedules and workplaces, and excellent compensation, the downsides cannot be ignored. Before becoming a travel nurse, candidates must reflect carefully and realistically on their career motivations, preferences, financial literacy skill levels, adaptability, and emotional needs.

Travel nursing is no different than travel itself—the rewards prove worth it for some but not for others. Nurses considering the leap from staff positions would benefit profoundly from conversing with veteran travel nurses about their experiences to decide whether travel nursing aligns with their life and career aspirations.

Discussion 3: Jewish Orthodox faith

Discussion 3: Jewish Orthodox faith

Answer the Discussion Board board questions in paragraph form.

1.

A premature infant was delivered at Woman’s Hospital by the plaintiff. The child died shortly after birth, and the plaintiff was assured by the floor nurse that the hospital would take care of the infant’s burial. When the mother went to the obstetrician for an examination six weeks later, she was given her folder to hold while waiting for the physician.

She found in it a note from the pathologist about disposal of the baby’s body. When the plaintiff asked the physician about the disposal of the body, he instructed his nurse to take her to the hospital across the street to see someone who would tell her what had been done with the baby. When the woman and the nurse found the person, the plaintiff was handed a large jar with the baby’s body inside.

As a result, the plaintiff suffered nightmares, could not sleep, was depressed when she was around children, had surgery for a pseudopregnancy, and required psychiatric treatment. Should a patient–physician relationship include the contract to dispose of a dead body?

2.

The plaintiff’s 18-year-old son died suddenly at home. His body was taken to the hospital, where the cause of death could not be found without an autopsy. The deputy medical examiner ordered a postmortem examination.

The plaintiff was a member of the Jewish Orthodox faith and refused the postmortem examination of his son on the basis that religious conviction prohibited any molestation of the body after death. Is freedom of religion curtailed by a law that has a compelling state interest?

Also Read:

• Discussion 4: Safety concerns for APRN providers
• BSN-FP4012 Assessment 4
• NUR 513 Week 6 Quiz Assignment
• Topic 3 DQ2 Patophysiology Week 2
• NUR 550 Topic 2: Epidemiology, Biostatistics, Genetics, and Genomics
• NUR 550 Topic 3 Translational Research Framework and Legal and Ethical Considerations

Discussion 4: Safety concerns for APRN providers

Discussion 4: Safety concerns for APRN providers

1

a) Using the National Center for Complimentary and Integrated Health (NCCIH) at https://nccih.nih.gov/, provide research about a complementary therapy.

• Provide a summary overview of the therapy.
• What evidence is there about providing care for patients of all cultures.
• Discuss how you would work with a patient to integrate the therapy into his/her care plan.

b)Using transcultural care concepts, provide evidence-based practice guidelines that illustrate how linguistic challenges interfere with culturally competent care.

• What are the safety concerns for APRN providers?

Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with citations and references in APA format.

ORDER THROUGH BOUTESSAY

Discussion 4: Safety concerns for APRN providers Instructions

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.

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).
• Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

• 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).
• Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
• I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

• 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.
• It is best to paraphrase content and cite your source.

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.
• Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
• Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
• Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

• 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.
• As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

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.