Students will: Assess clients presenting for psychotherapy Develop genograms for clients presenting for psychotherapyTo prepare: Select a client whom you have observed or counseled at your practicum

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Students will:

  • Assess clients presenting for psychotherapy
  • Develop genograms for clients presenting for psychotherapy

To prepare:

  • Select a client whom you have observed or counseled at your practicum site.
  • Review pages 137–142 of the Wheeler text and the Hernandez Family Genogram video in this week’s Learning Resources. Reflect on elements of writing a Comprehensive Client Assessment and creating a genogram for the client you selected.


The Assignment


Part 1: Comprehensive Client Family Assessment

With this client in mind, address the following in a Comprehensive ClientAssessment (without violating HIPAA regulations):

  • Demographic information
  • Presenting problem
  • History or present illness
  • Past psychiatric history
  • Medical history
  • Substance use history
  • Developmental history
  • Family psychiatric history
  • Psychosocial history
  • History of abuse/trauma
  • Review of systems
  • Physical assessment
  • Mental status exam
  • Differential diagnosis
  • Case formulation
  • Treatment plan


Part 2: Family Genogram

Prepare a genogram for the client you selected. The genogram should extend back by at least three generations (great grandparents, grandparents, and parents).

I send a sample..

Rubric:



uality of Work Submitted:


The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–


Excellent

27 (27%) – 30 (30%)

Good

24 (24%) – 26 (26%)

Fair

21 (21%) – 23 (23%)

Poor

0 (0%) – 20 (20%)



Quality of Work Submitted:


The purpose of the paper is clear.–


Excellent

5 (5%) – 5 (5%)

Good

4 (4%) – 4 (4%)

Fair

3.5 (3.5%) – 3.5 (3.5%)

Poor

0 (0%) – 3 (3%)



Assimilation and Synthesis of Ideas:


The extent to which the work reflects the student’s ability to:


Understand and interpret the assignment’s key concepts.–


Excellent

9 (9%) – 10 (10%)

Good

8 (8%) – 8 (8%)

Fair

7 (7%) – 7 (7%)

Poor

0 (0%) – 6 (6%)



Assimilation and Synthesis of Ideas:


The extent to which the work reflects the student’s ability to:


Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–


Excellent

18 (18%) – 20 (20%)

Good

16 (16%) – 17 (17%)

Fair

14 (14%) – 15 (15%)

Poor

0 (0%) – 13 (13%)



Assimilation and Synthesis of Ideas:


The extent to which the work reflects the student’s ability to:


Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–


Excellent

18 (18%) – 20 (20%)

Good

16 (16%) – 17 (17%)

Fair

14 (14%) – 15 (15%)

Poor

0 (0%) – 13 (13%)



Written Expression and Formatting


Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–


Excellent

5 (5%) – 5 (5%)

Good

4 (4%) – 4 (4%)

Fair

3.5 (3.5%) – 3.5 (3.5%)

Poor

0 (0%) – 3 (3%)



Written Expression and Formatting


English writing standards: Correct grammar, mechanics, and proper punctuation–


Excellent

5 (5%) – 5 (5%)

Good

4 (4%) – 4 (4%)

Fair

3.5 (3.5%) – 3.5 (3.5%)

Poor

0 (0%) – 3 (3%)



Written Expression and Formatting


The paper follows correct APA format for title page, headings, font, spacing,margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–


Excellent

5 (5%) – 5 (5%)

Good

4 (4%) – 4 (4%)

Fair

3.5 (3.5%) – 3.5 (3.5%)

Poor

0 (0%) – 3 (3%)

Students will: Assess clients presenting for psychotherapy Develop genograms for clients presenting for psychotherapyTo prepare: Select a client whom you have observed or counseled at your practicum
Week 3 Assignment 2: Practicum – Assessing Clients Name: Amina. H DOB; 1/10/1987 Age: 32 Gender : Female Race: Black or African American Facility: REH Crisis Stabilization Program City: Minneapolis State: MN Presenting problem- Excessive alcohol use, Homelessness History or present illness Amina is a Somali immigrant that left the war-torn country. She is experiencing an increase in mental health symptoms and stress, especially anxiety and other trauma-related stress. Having difficulty with connecting to other people due to several trauma-related symptoms and Currently homeless. Amina is required by CPS to remain sober and enter treatment in order to maintain custody of her six kids. Past psychiatric historyAmina has indicated that When under the influence of alcohol, Amina has gotten into fights at times. She is currently not using alcohol, and is requesting to be administered UA’s or breathalyzers to verify that she is not using alcohol. Amina has endorsed racing thoughts and rumination, paranoia/fear, dissociation, difficulty staying asleep, nightmares, negative cognitions of self, others, and the world; crying episodes, depressed mood, heightened startle response, shakiness, and irritability Medical history Client denies syncope, lightshades, fever, or numbness or tingling States that her generalized pain is 8/10. administered 400mg of Ibuprofen. Substance use history Amina reported that she has had more than 10 years history of over using alcohol, and she seeking to enter Substance use treatment for alcohol Developmental history No history available. Patient is an immigrant from Somalia Family psychiatric history No history available History of abuse/trauma Amina has endorsed persistent worrying that is difficult to control, experience of war, experience of childhood physical abuse, Review of Systems: General: Denies fever chills or malaise, Denies weakness or fatigue. Client is alert and oriented to person, place, and time as well as to situation. Client weighs 176 lbs. but client expresses her ideal weight to be 140lbs Skin, Hair Nails: No problems reported HEENT- denies a headache, dizziness, or syncope. Denies any hearing issues, denies tinnitus. Denies problems or changes in his vision; denies blurred vision; denies seeing spots. Cardiovascular: BP 124/104 on left arm sitting and 156/108 on right arm sitting. HR regular and at 97 beats per minute. Denies chest pain and palpitations Pulmonary: Oxygen saturation 98%. Denies asthma or any other pulmonary disorder. Denies shortness of breath; respirations 16. Gastrointestinal: Bowel is regular Genitourinary: Regular urinary pattern Neurologic: Client informs that she was diagnosed with polio when she was 7. Denies numbness and tingling; or paresthesia Musculoskeletal– Client informs that she was diagnosed with polio when she was 7. Patient states that she has generalized aches and pains. Hematology: Denies easy bruising or history of anemia Endocrine: Denies increase thirst or urination, Mental Health: Mental status exam Amina presented cooperative during the clinical interview. Her eye contact is poor. Speech is clear, coherent, but tangential at times. Speaks broken English. She makes no unusual motor movements and demonstrates no tic. Mood was dysphoric. Affect however is restricted. She denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. She is alert and oriented to person, place, and time. She reported that there were six children and she is estranged from them due to her excessive alcohol use. She reported depression and has a noticeable restrained affect, with an occasional smile. She denies visual or auditory hallucination, and her thought process is intact. The client’s awareness is age appropriate and associated with proper judgment and understanding. She denies current suicidal ideation. The diagnostic test of Patient Health   Questionnaire-9 (PHQ-9) was administered to the client. The score was 16, which indicates severe depression. Differential diagnosis Depression, Post Traumatic Stress Disorder (PTSD), Alcohol Use Disorder Case formulation Drawing up from psychiatric viewpoint, the premise of Amina issues may have result from been a witness and experience of war, and extensive childhood physical abuse, and overall the family is not supportive, and lost custody of her children. Her presentation is congruent with reported content. Treatment plan Goal #1 Amina will be able to reduce and manage her anxiety Objective Amina will develop her coping skills, and build on her current coping approaches of breathing, prayer, and self-soothing techniques such as taking a walk. Intervention Staff will check in with Amina 2-3 times to assess her practice of coping skills, and to offer information regarding additional coping skills including progressive muscle relaxation, visualization, assertive communication of her feelings. Goal #2 Amina will attend her therapy sessions Objective Amina will continue her sessions with the trauma-informed therapist, with an upcoming appointment next week. Intervention Staff will process current feeling about what to expect and how she is feeling about the appointment. Goal #3 Amina will complete a substance use disorder (SUD) treatment. Objective Amina will complete rule 25 assessment to be able to gain admission into treatment center at Park Ave Women’s center. Intervention Staff will encourage Amina to attend her assessment session and develop a relapse prevention plan. Genogram Amina’s children’s ages- 2,3,5, 7,8,9 Amina is estranged from her husband and children Amina does not have any extended family in the US

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PICOT Course Project- Clinical Question Topic of interest: In A group of patients living in a long-term nursing home facility, (Patient population) how effective is repositioning every two hours (Inte

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PICOT Course Project- Clinical Question


Topic of interest:

In A group of patients living in a long-term nursing home facility, (Patient population) how effective is repositioning every two hours (Intervention) compared to not repositioning every two hours (Comparison) in reducing the risk for pressure ulcers (Outcome) during two months stay?


please see attached PowerPoint for further instructions on the assignment.


Peered Review Scholarly articles Please.



Rubric

1. Identifies in detail the reason for choosing the topic

2. Completely outlines the PICOT question.

3. Completely identifies and reviews the method for possible integration of evidence found in clinical practice.

4. Fully evaluates the effectiveness of implementation methods.

5. Paper is 2-3 pages in length (not including title page & reference page), written in APA format, spelling errors do not detract reader from the message

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Please find assigned below your patient case study for this week discussion. A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for

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Please find assigned below your patient case study for this week discussion.

A 16-year-old boy comes to clinic with chief complaint of sore throat for 3 days. Denies fever or chills. PMH negative for recurrent colds, influenza, ear infections or pneumonias.

NKDA or food allergies.

Physical exam reveals temp of 99.6 F, pulse 78 and regular with respirations of 18.

HEENT normal with exception of reddened posterior pharynx with white exudate on tonsils that are enlarged to 3 . Positive anterior and posterior cervical adenopathy.

Rapid strep test performed in office was positive.

His HCP wrote a prescription for amoxicillin 500 mg po q 12 hours x 10 days disp #20.

He took the first capsule when he got home and immediately complained of swelling of his tongue and lips, difficulty breathing with audible wheezing.

911 was called and he was taken to the hospital, where he received emergency treatment for his allergic reaction.

Post an explanation of the disease highlighted in the scenario above. Include the following in your explanation:

  • The role genetics plays in the disease.
  • Why the patient is presenting with the specific symptoms described.
  • The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
  • The cells that are involved in this process.
  • How another characteristic (e.g., gender, genetics) would change your response.

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Research and select an issue from one of the following categories that has or may have an influence on U.S. health care policies:Changing social norms at the state level Shifting health care prioriti

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Research

and

select

an issue from one of the following categories that has or may have an influence on U.S. health care policies:

  • Changing social norms at the state level
  • Shifting health care priorities in the United States
  • Impacts of global health care U.S. policy
  • Effects of health care on our environment


Write

a 525- to 700-word paper that discusses

the impact that the issue selected



can have


on changing health care policy.

  • Describe the issue selected.
  • Identify people or groups of people the issue impacts.
  • Describe the impact the issue has at the state and federal level.
  • Describe how likely it is the issue selected may change health care policy.


Cite

at least 2 reputable references. Reputable references include trade or industry publications, government or agency websites, scholarly works, a textbook, or other sources of similar quality.

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Assignment file attached

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Assignment file attached

Assignment file attached
In present times nursing continues to echo sentiments of nursing shortages and projections on the need for nurses continues to rise. In a paper reviewing the US nursing shortage, “The American Epidemic: the U.S. Nursing Shortage and Turnover Problem”, Cox & Willis examine the nursing shortage and the influence of turnover. The Bureau of Labor and Statistics projected employment growth between 2010 and 2020 reporting that the expected need for registered nurses would rise from 2,737,400 to 3,449, 300 which is an increase of 26% (Cox & Willis, 2014). Cox & Willis continue to share statistics from the American Health Care Association who released its results from a study completed in 2007 that a 110000 direct care staff positions were vacant which was at the time 1 in 6 registered nursing positions that were unable to be filled due to a lack of qualified applicants (Cox, Willis, 2014). The AHCA when on to state that the empty positions will continue to rise, and the amount of vacant positions will continue to increase by 2025; which would leave the shortage of nurses to rise well over 260,000. This deficit that will be twice as many as the US has experienced since the 1960’s (Cox &Willis, 2014). Cox & Willis go on to elaborate on what they feel is a key factor influencing the nursing shortage- turnover. Cox & Willis define Turnover as the movement of employees from being hired to leaving the current position voluntarily and not staying within the organization. There is great expense that is incurred due to having high turnover. It is estimated that 10,000 to $60,000 is the cost per vacancy depending on the specific nursing discipline and specialty. A lack of nursing educators can also be identified as a core cause to the lack of available nurses. In 2009 only 21% of people would consider becoming an RN as their career profession. In 2006 nursing schools denied 41,683 applications into BSN in nursing programs with a major reason cited as a lack of faculty being an issue (Fox & Abragamson, 2009). Cox & Willis research this topic with the purpose to identify the root problems of nursing turnover and what factors are driving the nursing shortage issue in the United States. Cox & Willis surmised that there were economic factors, employee factors and external factors that influence the nursing shortage all of which are influenced by job satisfaction retention and turnover. References Cox, P., & Willis, W. K. (2014, March). The American Epidemic: The U.S. Nursing Shortage and Retrieved from http://mds.marshall.edu/cgi/viewcontent.cgi?article=1125&context=mgmt_faculty
Assignment file attached
This week you will be completing a Power Point. Don’t be afraid to experiment with color! What I am looking for is a clean, easy to read, and follow presentation. With Power Points, it is better to write in full sentences to help balance your turnitin score and you still need to cite your references. You need to give credit to the author for the ideas in your PowerPoint. In other words, each slide will probably have at least 1 reference cited. It is ok to use pictures, just make sure to reference where you found the pictures. You can go to YouTube to help you understand how to put together a Power Point. Make sure you have a title slide and the second slide should be an intro slide with your objectives. Part one: Peplau was the first nursing theorist to identify the nurse–patient relationship as being central to all nursing care. Peplau valued knowledge, believing that the nurse must possess extensive knowledge about the potential problems that emerge during a nurse–patient interaction. Peplau’s theoretical work on the nurse–patient relationship continues to be essential to nursing practice. Describe the phases of the Nurse-Patient relationship as defined by Peplau. Align your presentation regarding the use of Peplau’s theory with a current practice example.  You should have one slide per phase with an explanation of each phase (at least 4 slides). Please make sure you have at least 1-2 slide for the current practice example.   Part two: Provide a discussion of Orem’s Self-Care Deficit Theory.  Identify and explain the three related parts. Identify a current nursing practice example where Orem’s theory would be relevant. Use at least one evidenced-based research article to support your practice example.  For this section you will need one slide that gives an overview of Orem’s theory and at least one slide each for the three related parts.  You will have at least one slide for the practice example. Power Point should include at least 3 outside references and the textbook. It should include title and reference slides and be 14-20 slides.  APA tips of the week Make sure your hyper link is turned off on the reference page. Make sure you introduce acronyms properly Type Registered Nurse (RN) when first introducing and then just use RN throughout the remainder of the paper. Required Textbook: Smith, M. C., &  Parker, M. E. (2015). Nursing Theories and Nursing Practice (4th ed.).  Philadelphia, PA: F.A. Davis. ISBN  978-0-8036-3312-4

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Discussion Question 1 Post a detailed description of your experience of working with a nurse leader. Include the following aspects in your description. · Of the leadership theories discussed this week

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Discussion Question 1

Post a detailed description of your experience of working with a nurse leader. Include the following aspects in your description.

· Of the leadership theories discussed this week, which one did this nurse leader subscribe to? Why?

· How has your experience been with the nurse leader? Provide a description of your interactions with him or her?


Discussion Question 2

Using the South University Online Library or the Internet, choose a professional nursing organization and review the organization’s website. Based on your understanding of the organization, answer the following questions:

· What was the organization’s response to the COVID-19 pandemic?

· Do you think the response was adequate? Why or why not?

As you develop your initial post in answering the discussion question be sure to completely answer all aspects of the question and sub-questions. When preparing your initial post incorporate what you have learned from the weekly lecture and assigned readings first and then add outside websites and/or journals to supplement your response. Citations should be included throughout the paragraphs to support your comments and references should be listed at the end. Reply posts should be substantive meaning your comments are supported with citations and references from your readings and/or other resources to demonstrate your understanding of the content. Be sure to check grammar and spelling before posting. Do not cut and paste from websites. Use APA resources when doing citations and references using the rules for punctuation, capitalization, and italics.

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Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particul

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Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

  1. Evidence-based solution
  2. Nursing intervention
  3. Patient care
  4. Health care agency
  5. Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particul
Capstone Project: Developing a Question Recall the components of PICOT from your research course: (P) Population of Focus (I) Intervention (C) Comparison (O) Outcome (T) Time Identify each of the components in relation to your approved Capstone Project topic. P: I: C: O: T: Then, develop a PICOT question/statement. Examples of PICOT questions/statements: In adult cardiac surgery patients experiencing post-operative pain (P) immediately following surgery (P), is morphine (I) or fentanyl (C), administered intravenously, more effective in reducing postoperative (T) pain (O)? For immune-compromised patients, 50 years and older (P), does the use of pneumonia vaccine (I) reduce the future risk (T) of pneumonia (O) compared with patients who have not received the vaccine (C)? © 2015. Grand Canyon University. All Rights Reserved.
Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particul
PICOT STATEMENT PAPER 4 Student Name: Course: NRS 490V: Professional Capstone and Practicum Due Date: Instructor: Ellen Pavela, DNP, RN PICOT Statement Paper Start your introduction here with the focus of the assignment, the topic for discussion and the pertinent concepts to be brought forth as a lead into the body of the paper. This section should be about the nursing issue that you have chosen, why it is important and the implications for nursing care. PICOT Statement PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project In this paper of 500-750 words, clearly identify the clinical nursing problem and how it can result in a positive patient outcome. {Remove anything that is highlighted in yellow before you submit your assignment as these are instructions for you. They are NOT part of the assignment.} Evidence-Based Solution How will the PICOT question be solved? In a brief statement, explain how this situation will be improved for future nursing practice. Nursing Intervention What is the intervention that will be used to correct the nursing situation and briefly explain the comparison nursing intervention? Patient Care How will this intervention improve patient care for those patients who are affected by this nursing issue? Describe this briefly Health Care Agency Briefly describe the setting for your practicum immersion site in a few sentences. Nursing Practice Briefly explain how the improvement of this nursing issue will impact the daily nursing practice of those nurses who provide care for the patients affected by this nursing issue. Conclusion This paragraph is 4 or 5 sentences that make up the main points of the paper without minor statements or criteria. It is the wrap-up for the reader. Use spell check and grammar check always. Speak in the active voice and not a passive voice. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. References Nun, N. (2015). How to get through a busy shift without going crazy. Journal of Mental Health for Nursing, 5(1), 218-222. (Journal article example) Dewey,K, Cheetum, L, & Howe, J. (2014). The legal aspects of nursing mistakes. New York, NY: Law University Publishers. (Book example) McBain, L. (2012). The way in which we learn to nurse patients. American Nurse Today 24(4), 233-245. Retrieved from https://www.american_nurse_today/methodsinnursing/3456html. (Web site example) Centers for Disease Control and Prevention. (2019). Influenza Vaccination Information for Health Care Worker. U.S. Department of Health & Human Services https://www.cdc.gov/flu/professionals/healthcareworkers.htm (Government site) (Center for Disease Control and Prevention [CDC], 2019) Citation example)
Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particul
PICOT Question Work Sheet 1-2020 Question type Definition Template Intervention or therapy To determine which treatment leads to the best outcome In _____________________ (P), how does ______________ (I) compared with _________ (C) affect __________________ (O) within _________________ (T)? Etiology To determine the greatest risk factors or causes of a condition Are ______________________________ (P) who have ________________________ (I), compared with those without ______(C), at ____ risk for ____________________ (O) over _____________________________ (T)? Diagnosis or diagnostic test To determine which test is more accurate and precise in diagnosing a condition In __________________________________(P), are/is (I) compared with ___________(C) increase more accurate diagnosing _________(O) over_______________________________ (T)? Prognosis or prediction To determine the clinical course over time and likely complications of a condition In ________________________________ (P), how does ________________________(I) compared with_______________________ (C), increase / decrease ___________________(O) over_______________________________ (T)? Meaning To understand the meaning of an experience for a particular individual, group, or community Do __________________ ____ (P) with _____________________ (I) compared with ______________________(C), perceive ____________________ (O) during ___________________________(T)? OR- To understand the meaning of an experience for a particular individual, group, or community Does (a/ an individual, group, or community)_______ (P) with ______(new intervention that corrects the problem) _____________________ (I) compared with (current nursing dilemma or problem cause/ intervention) ____________(C), improve / deteriorate (intended outcome of your project/project change) __________________ (O) over (duration of research project) 10-week time frame_(T)? When caring for ___________(adult, middle-aged, senior or elderly; medical-surgical, orthopedic, cardiac, respiratory, etc) patients, does __________  (nursing practice that is the new change so the patient outcome is improved) compared to _________________(current nursing practice that needs to change ) decrease or increase________________(intended outcome from the nursing practice change) over a 10-week time frame? Please choose from the identifiers in the parentheses, based upon your research topic. This will help you get on the right track from the beginning. The PICOT question that you write should give a clear picture of what result you intend to find in your research project as well as how you intend to find those results.

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Kately Sylvia Week 2 Main Discussion Post COLLAPSE Week 2: Main Discussion Post Selected Topic The topic selected is the use of physical restraints on children/adolescents and adults with psychiatric

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Kately Sylvia Week 2 Main Discussion Post COLLAPSE

Week 2: Main Discussion Post

Selected Topic

The topic selected is the use of physical restraints on children/adolescents and adults with psychiatric health disorders. Hospital settings still frequently use physical restraints on patients, for example, who are agitated and at risk for self harm or harm to others. Physical restraints do not allow patients to freely move their body by often restraining arms, legs or both. There are other restraints as well such as raising all 4 bedside rails and covering a patient with tightly tucked sheets to prevent movement. There has been a decrease in the use of physical restraints because of the adverse effects. The benefits of using physical restraints should outweigh the adverse effects.

Ethical Issues Related to Physical Restraints

The ethical issues of applying physical restraints to children and adolescents with mental health conditions are the physical consequences are understood, but the psychological consequences of the restraints are poorly understood (Nielson et al., 2020, p. 342). The systematic review by Nielson et al. (2020) found that “little is known about children and adolescents’ first-hand experiences of physical restraints,” and more research is needed to address the first-hand experiences of physical restraints (p. 342). According to Ridley and Leitch (2019), health care providers need to understand children/adolescent consequences of physical restraints on their mental and physical well-being (as cited in Nielson et al., 2020, p. 343). Further research needs to be done on the psychological adverse effects of physical restraints on this population.

In the article by Ye et al. (2020), the ethical issues of applying restraints to adults with mental health disorders are the principles of autonomy, justice, beneficence and non-maleficence. First, the lack of autonomy violates the patient’s freedom to make decisions about their care. The least restrictive means should be used for patients who pose harm to themselves or others. If patients cannot speak for themselves about having physical restraints applied, the patient’s next of kin should give permission to do so because the patient’s autonomy will not be breached (Ye et al., 2017, p. 69). Second, justice is for providers to always treat patient’s as humans and not as “insane” humans, and physical restraints should always be used as a last resort while their basic needs are being met (Ye et al., 2017, p. 69). Third, beneficence is the best course of action for patients. If a patient does require restraints a provider has to assess the patient every 4 hours and nurses every 2 hours for skin assessment and circulation where the restraints are applied (Ye et al., 2017, p. 69). Four, non-maleficence means to do no harm to patients. Physical restraints often have adverse side effects, and “therefore, the author of this article asserts that the therapeutic goal of physical restraints should outweigh their adverse effects in nursing practices” (Ye et al, 2017, p. 70).

Legal Issues Related to Physical Restraints

According to the article by A. Preisz and P. Preisz (2019), the legal issues of applying unnecessary restraints to children and adolescents with health and mental health conditions done by force is assault and can have legal ramifications (p. 1116). On occasion, it may be necessary to restrain a child or adolescent to do a procedure or because of self harm or potential harm to others. “At other times, the least restrictive form of restraint, whether by chemical or physical means, should be adopted to allow for effective assessment, management and monitoring” (A. Preisz & P. Preisz, 2019, p. 1116). For young people and adults, restraints should never be used for such things as discipline or convenience (Disability Rights Maryland, 2020). Furthermore, another legal issue related to children/adolescents being physically restrained is that it can have both physical and psychological harm (Nielson et al. 2021, p. 363).

According to the article by Ye et al. (2017), legal issues related to the use of physical restraints in adults and possibly children are adverse effects such as skin injury, nervous system damage, deep vein thrombosis and death (pp. 69-70). Other adverse effects such as malnutrition, contractures, worsening behavior and bed sores can occur while the patient is in physical restraints (van Gemert et al., 2015; V & VN, 2013; Heinze et al., 2012 as cited in de Bruijn, 2020, p. 2). Checking patients while in restraints to prevent physical and psychological harm is mandatory to have best patient health outcomes.

Application of Physical Restraints in Clinical Practice

Restraints are ordered by a licensed health care provider for emergency situations, and a patient’s personal representative may sign informed consent before application of physical restraints, if available (Altunkeser & Korhan, 2019, p. 1). Studies examined reasons why physical restraints have adverse effects. First, the physical restraint was not necessary to use at that time; second, the appropriate physical restraint was not chosen; third, the restraint was applied “too tight or too loose, and the patient is not watched regularly sufficiently and the required interventions are not carried out” (Altunkeser & Korhan, 2019, pp.1-2). The purpose of the study by Altunkeser & Korhan (2019), was to develop a “Physical Restraint Application and Evaluation Scale” to help providers and nurses to manage a better outcome for the application of physical restraints (p. 2). The scale was found to have acceptable levels of reliability and validity for nurses and providers to use in managing the care of patients in physical restraints (Altunkeser & Korhan, 2019, p. 7). The scale consists of 55 items using a Likert Scale with 1 meaning “I totally disagree” and 5 meaning “I totally agree” (Altunkeser & Korhan, 2019, p. 3). The scales highest score is 275, and the lowest score is 55; the higher the score using the scale means that applying physical restraints are necessary ((Altunkeser & Korhan, 2019, p. 3).

Specific Implications for Restraints in Maryland

Physical restraints must be ordered by a licensed practitioner, and must be used appropriately for emergency safety precautions. In the state of Maryland the use of restraints is in compliance with 42 CFR 483.352–483.376 for children under age 21 years old (Disability Rights Maryland, 2020, pp 1-2).

In compliance with 42 CFR 483.356 include the following: one, physical restraints may not be used for “coercion, discipline, convenience, or retaliation” (Disability Rights Maryland, 2020, p. 2). Two, restraints may not result in harm to the patient, and restraints and seclusion may not be used at the same time. Three, the restraint may no longer be used if a patient is not a harm to themselves or to others even if the order has not expired (Disability Rights Maryland, 2020, p. 2).

In compliance with 42 CFR 483.358, the order for restraints may not be used longer than needed. Also, restraints under no circumstances should not be used longer than the following duration: first, young adults 18-21 year olds must not have physical restraints applied longer than 4 hours; second, children/adolescents 9 to 17 years old may not have physical restraints applied longer than 2 hours; and, children under 9 years may not have restraints applied longer than 1 hour (Disability Rights Maryland, 2020, p. 2). Also, the name of the ordering provider, the date and time the restraint was ordered, the expiration of the restraint, and the restraint used should be documented. Furthermore, a provider should assess the patient in person 1 hour after the restraint has been applied to assess the patient’s physical, psychological status, behavior, appropriate intervention and complications of the restraint (Disability Rights Maryland, pp. 2-3).

In compliance with 42 C.F.R. 483.362, restraint monitoring and assessing during an emergency situation should be continuous to ensure the patient’s physical and psychological well-being. (Disability Rights Maryland, 2020, p. 3). Moreover, when the restraint is immediately removed a provider must assess the patient and the effects of the intervention (Disability Rights Maryland, 2020, p. 3).

Last, in compliance with 42 CFR 483.372 is the medical staff is obligated to document in the patient’s record all injuries sustained during emergency applied physical restraints to patients and any injuries to staff members. In addition, the “staff must meet with supervisory staff and evaluate the circumstances that caused the injury and develop a plan to prevent further injuries” (Disability Rights Maryland, 2020, p. 5).

References

Altunkeser, E. B., & Korhan, E. A. (2019). Application of physical restraints and developing a rating scale. International Archives of Addiction Research and Medicine, 5(1), p. 1-7. doi: 10.23937/2474-3631/1510030

de Bruijn, W., Daams, J. G., van Hunnik, F. J. G., Arends, A. J., Boelens, A. M., Bosnak, E. M., Meerveld, J., Roelands, B., van Munster, B. C., Verwey, B., Figee, M., de Rooij, S. E. & Mocking, R. J. T. (2020). Physical and pharmacological restraints in hospital care: Protocol for systematic review. Frontiers in Psychology, 10(921), pp. 1-10. doi: 10.3389/fpsyt.2019.00921

Disability Rights Maryland. (2020). Restraint & seclusion legal requirements. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://disabilityrightsmd.org/wp-content/uploads/Restraint-Seclusion-Legal-Requirements-Handout-1.pdf

Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care, 25(3), 342–367. https://doi.org/10.1177/1367493520937152

Preisz, A. & Preisz, P. (2019). Restraint in paediatrics: A delicate balance. Journal of Paediatrics and Child Health, 55(10), pp. 1165-1169. doi.org/10.1111/jpc.14607

Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2017). Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 5(1), 68–71. https://doi.org/10.1016/j.ijnss.2017.12.001

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Signature Assignment Title: Theory Overview   This week, you will develop a PowerPoint presentation reviewing the theories from each module. Please select one theory from each module (1-8) and answer the following questions. You should have two slides per theory: Describe the theory Provide 3 examples of how the theory applies to current practice Provide 3 positive patient outcomes resulting from utilizing the theory Explain 3 benefits to nursing satisfaction when utilizing the theory Describe two barriers to using the theory in practice and at least one method for overcoming each barrier (support methods with sources) Support from literature clearly noted throughout The PowerPoint presentation should include at least two outside references & the textbook. The presentation should contain 2 to 4 slides per theory, for a total of 16 to 32 slides. Don’t forget graphics Total Point Value of Assignment: 500 points Theories: Module 1: Nightingale Module 2: Peplau, Henderson, and Orem Module 3: Johnson, Orlando, and the 1950-60’s Module 4: King & Rogers Module 5: Roy, Neuman, and the 1970’s Module 6: Leininger, Newman, and Watson Module 7: Parse, Erickson, and Tomlin & Swain Module 8: Theories of the 1980’s and 1990’s Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F.A. Davis.

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Topic: Childhood Obesity You will identify a topic area and develop a problem- or issue-related topic within that area of interest. As you develop this specific topic, keep in mind that your eventual

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Topic: Childhood Obesity

You will identify a topic area and develop a problem- or issue-related topic within that area of interest. As you develop this specific topic, keep in mind that your eventual goal is to formulate and present a solution to the healthcare issue or problem you identify.

Your topic proposal should include the following items and address the following:


Describe the topic you wish to pursue.

  • It may be somewhat broad at this point and it may imply a problem. Use the resources in your course materials to help you search for ideas.


Identify your purpose: Why are you interested in this topic? (Narrow your topic.)

  • Specifically explain what it is that fascinates you or draws you to this topic.
  • Clearly describe the topic’s relevance in the field today.
  • Identify a purpose for a paper on this topic:

    • What might you accomplish in exploring this problem?
    • What is your intended goal?

      • To evoke change
      • To make new connections (new cause and effect)
      • To introduce a new theory, solution, or idea
    • Is this goal realistic?


Identify a problem within the topic and draft a problem statement. (It will likely evolve and be revised as you progress through your research.)

  • Identify a problem related to your topic and state it.
  • The problem statement should be specific and indicate the focus of your final paper.

    • Not too narrow, not too broad
    • Intellectually challenging (a simple solution is not apparent)
  • Who would benefit from a solution to this problem (who is the target population)?

Your paper should be 2 pages. Adhere to APA Style throughout.

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