Carmen Medina, aged 39, lives with her husband, Ral, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4- year-old son, Jos; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school after completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500. The family has health insurance through Mr. Medinas job. They live in a threebedroom apartment in a low-income Illinois community. Miguel works in a fast-food store a few hours a week. Because Rosa has responsibilities at home, the Medinas do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telling the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer. The family is having difficulty dealing with Rosas and Miguels developmental and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr. Medina is quiet and not actively involved in the discussion. He is more preoccupied with the familys financial situation. Mrs. Medinas parents are encouraging them to return to Puerto Rico. Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. Jos has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medinas last physical examination was after she had Jos. She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the familys finances. Mrs. Medina is Catholic and recently has been visiting her church more often. Study Questions 

1. Explain Mrs. Medinas attitude in her relationship with her adolescent daughter. 

2. Identify strategies to ensure that Rosa seeks prenatal care. 

3. Identify barriers to accessing health care for the Medina family. 

4. What are the high-risk behaviors exhibited by this family? 

5. What communication barriers exist in this family that affect care delivery? 

6. Discuss gender and family roles in the context of traditional Puerto Rican culture. 

7. Identify sociodemographic factors affecting the physical- and mentalhealth well-being for this family.

8. Identify Puerto Rican folk practices appropriate for this family.

9. If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why? 

10. If Mrs. Medinas parents visit a health-care provider, what might they expect? 

11. Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr. Medina.

12. Discuss the importance of respeto and familism in the Medina family. 

13. Identify culturally congruent interventions for Rosas pregnancy. 

14. Identify health-promotion and disease-prevention interventions needed for Jos. 

Edit question’s body

 

Respond to your colleagues by providing additional insights or alternative perspectives. 

POSITIVE COMMENT

                                              Main Post

 

How to Become a Social Change Agent for Psychiatric Mental Health

             Mental illness is a significant public health concern. Unfortunately,  society holds a negative attitude about mental illness (Casados, 2016).  The negative attitude impacts individuals on an interpersonal level,  through blaming and name-calling, and on an institutional level, through  employment discrimination (Casado, 2016). Shockingly, one study found  that 68% of Americans do not want mental illness being married into  their family, and 58% of Americans do not want people with mental  illness in the workplace (Dingfelder, 2009). Another study reported that  over 45% of people thought people with depression were unpredictable,  and 20% of people thought people with depression were dangerous  (Dingfelder, 2009).  The stigma associated with mental illness can make  psychological symptoms worse, and hinder treatment and recovery, which  can continue to compromise the individuals mental health (Casados,  2016).

             The statistics described above are astounding to me. I agree entirely  with one of the statements in the article by Bennett (2015), which  states, mental health is physical health; the two are inseparable  (para. 2). I believe a way to bridge that gap is through a new concept  in health care called patient-centered care. Patient-centered care is  providing care that focuses on physical comfort and emotional well-being  (NEJM Catalyst, 2017). It is providing care that is collaborative,  coordinated, and accessible at the right time and in the right place  (NEJM Catalyst, 2017). Patient-centered care allows the patient and  their family to be a part of the care team and play a role in decision  making (NEJM Catalyst, 2017).  If society understood patient-centered  care, then I think mental health would not be stigmatized the way it is.  

             Psychiatric mental health nurse practitioners (PMHNPs) can be a social  change agent by being a voice for our patients and utilizing  patient-centered care. Practicing care coordination and collaborating  with the patient, their family, and other healthcare providers is  essential. Society has a negative attitude about mental illness because  the majority of people do not understand it. Thus, providing education  to the community is also a key to breaking the stigma. 

How I Will Advocate for Change Within My Community

I  will advocate for change in my community by practicing patient-centered  care. I will do this by including the patient and their family when  discussing options and decisions. I will listen to the patient to  understand their preferences, cultural traditions, and socioeconomic  condition (NEJM Catalyst, 2016).  I will provide education within the  community to educate those who are unfamiliar with mental illness. I  will also work in rural areas to help those in underserved areas have  access to mental health care. 

 

        

                                                   References

Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health

Casados, A. T. (2016). What makes mental illness stigma so hard to change and to study? Clinical Psychology: Science and Practice. Retrieved from https://www.div12.org/what-makes-mental-illness-stigma-so-hard-to-change-and-also-to-study/

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from https://www.apa.org/monitor/2009/06/stigma

NEJM Catalyst. (2017). What is patient-centered care? Retrieved from https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559

Review Appendix A, Sections IV in Finkelman (2016).

1. Select one of the sections and share how your chief nurse executive demonstrates expertise in these competencies.  Your comments should be about the highest nursing leader in your organization. Typically this is the leader who represents nurses and nursing to the governing board.
2. In your own words, explain the differences between a transactional nursing leader and a transformational nursing leader. What one is more like your Nurse Executive?
3. Describe how the Nurse Executive leads the charge for transformational leadership in an organization where you work or have done prelicensure clinical experiences.

3 paragraphs with reference and in text citation

 Respond to your colleagues by providing additional insights or alternative perspectives. 

Positive comment

                                Main Post

 

Mental  health disorders, even though suffered by many, remains stigmatized and  receives less attention than other health care issues (Swanton, 2016).   Many patients are not willing to disclose their mental health diagnosis  because of the fear of being looked down on or judged. There are also  limited mental health resources as well as some communities are not able  to gain some of these benefits due to insurance issues or the inability  to pay (Choi et al, n.d.).

             Two of the issues, that this writer believes need change are that of   the granting of FMLA leave to patients with diagnosed psychiatric  disorders and making treating options available to everyone. This writer  has worked with several clients who were having difficulties being  granted  FMLA or being denied. The FMLA is the Family and Medical Leave  Act. It works on behalf of those with medical and mental health  disorders who are unable to perform their job duties due to the  disability from the diagnoses (Wray et al., 2015).  Clients with  physical ailments may find it less difficult to be granted this paid  leave as their disorder is visible by the employer and those granting  the leave. When it comes on to mental health disorders, client tend to  run into several road blocks as their disorder is not readily visible. 

Many  clients explain that their request was denied or met several obstacles  as their diagnoses was not considered chronic or disabling. Many of the  clients argue that anxiety and depression make it difficult for them to  carry out their jobs that require them to come in contact with people.  The increased stress from interacting with others and trying to fit in  to the workplace can be debilitating but is rarely considered so by  employers. This is an area that needs attention and change. This writer  believes that Nurse Practitioners and other health care providers can be  an advocate for the client by providing thorough information on the  clients illness that support the need for a leave.  The Nurse  Practitioner should be readily available to answer questions and educate  the employers on mental health disorders. In addition, the Nurse  Practitioner could advocate for change on a federal or state level by  writing congress or their elected leaders.

             Another issue that this writer believes need special attention is that  of making special procedures available to everyone. When treating mental  health disorders there are many treatments that would be beneficial for  a client, but the client will end up not receiving the treatment due  their inability to pay or insurance coverage (Wang & Xie, 2019).  This writer has worked with several client suffering with depression who  have exhausted the use of antidepressants but were not qualified for  ECT due to monetary reasons. The client is simply placed back on the  antidepressants with limited hope to treat their disorder. This issue is  also another social change issue that we as Nurse Practitioners could  propose to our elected leaders. The mental health community on a whole  is stigmatized and separated and this only separates them more by  causing a separation amongst themselves.

                                              References

Choi, N. G., DiNitto, D. M., & Marti, C. N. (n.d.). Relationship Between the Types of Insurance 

Coverage and Outpatient Mental Health Treatment Use Among Older Adults. JOURNAL 

OF APPLIED GERONTOLOGY, 35(12), 13431362.

Swanton, M. (2016). Mental Distress. InsideCounsel, 16(181), 2628. Retrieved from 

ebscohost. com.ezp.waldenulibrary.org/login.aspx?direct=true&db=bth&AN=

23498644&site=eds-live&scope=site

Wang, N., & Xie, X. (2019). Associations of health insurance coverage, mental health problems, 

and drug use with mental health service use in US adults: An analysis of 2013 National 

Survey on Drug Use and Health. Aging & Mental Health, 23(4), 439446.

Wray, T. B., Dvorak, R. D., & Martin, S. L. (2015). Demographic and economic predictors of 

mental health problems and contact with treatment resources among adults in a low-

income primary care setting. Psychology, Health & Medicine, 18(2), 213222.

There are three approaches that can be used to study personality in a cultural context, the cultural-comparative approach; the indigenous approach; and the combined approach, which incorporates elements of both views. Answer the following questions:

• Which approach do you support?
• Why do you most support this particular approach?
• Give an example of how you envision this approach being used in a real-world context.

Secondly, go to your group discussion forum and introduce yourself to your group members.

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

Estimated time to complete: 2-3 hours

Respond to your colleagues’ posts by sharing your thoughts on their specialty, supporting their choice or offering suggestions if they have yet to choose. 

At least 2 references in each peer responses!

  

           Growing up, I played nurse with my pets, wrapping them in bandages while they patiently accepted their fate of being practice patients. This trend of care taking animals developed into having that same love of care taking for people. As long as I could remember, I knew I would be in a profession where I would dedicate my life to the wellbeing of humans and alleviation human suffering. In nursing school, I was torn between psych and pediatrics, and conveniently I was hired as a youth behavioral health nurse, combining my passions. Working as a nurse in psych has solidified my choice of nursing specialty in that I am focused on becoming a Psychiatric Mental Health Nurse Practitioner (PMHNP).

2.6 million youth between 12 and 17 have had a major depressive episode, with 3.3 million receiving treatment for behavioral disturbances (Ramirez, 2016). This statistic only represents a fraction of individuals of all ages suffering from mental illness. I have first-hand seen on numerous occasions, patients having to reside in the emergency department waiting for a bed. I did not struggle with the decision to pursue the PMHNP path because seeing the lack of providers has been a motivating factor, as well as my passion for psych nursing. A significant concern for individuals with mental health diagnosis is accessing mental health care providers that have the skills and knowledge to primarily address mental health, including medication management and psychotherapy (Ramirez, 2016). This lack of adequate services is where PMHNP is poised to fill this gap for these individuals obtaining sufficient care as well as making a significant difference in behavioral health care delivery (Chapman, Phoenix, Hahn, & Strod, 2018, p. S243).

To support my efforts in becoming a PMHNP, the American Psychiatric Nurses Association promotes personal enrichment as a psychiatric nurse practitioner who, in turn, elevates the quality of care provided to individuals (American Psychiatric Nurses Association, 2019a). Becoming a member involves paying a membership fee, but the membership includes networking, continuing education, and personal growth opportunities (American Psychiatric Nurses Association, 2019b).

The decision to become a nurse was instinct, but the decision to pursue the specialty of PMHNP is motivated by the undue suffering I see as a psych nurse with individuals not receiving adequate services due to stigma and lack of providers.

Imagine you have been asked by your local church, synagogue, scouting group, sports team or some other community organization, to give a 15-20 minute talk about addiction. Imagine there has been some concern in the community about how to deal with the problem. Youve been asked to talk about what happens to the brain when people become addicted.

Your presentation may be in any of the following forms:

• Powerpoint presentation with notes (10 slides minimum, APA format)
• 3-5 page paper (APA format)
• Other presentation formats (must be approved by the instructor by the middle of the week)

Your paper should:

• Be three to four pages long. 
• Double spaced. 
• One inch margins. 
• 12 point font, Times New Roman. 
• You should add citations in the body of the paper and include a reference page at the end of the paper.
• Your paper should reflect not only your opinion but also your familiarity with the material from the course.
• Your PowerPoint presentation must include citations and references in each slide (as appropriate) and a references slide at the end of the presentation.
• Your presentation should reflect not only your opinion but also your familiarity with the material from the course.
• Pay attention to your formatting and professionalism of the presentation.
• Alternative presentations must include citations and a reference page and should be professional in appearance.

Estimated time to complete: 4 hours

Rubric

PS101 Unit 4 Assessment – Midterm ProjectPS101 Unit 4 Assessment – Midterm ProjectCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeContentPS101-CO1; PS101-CO327.0 ptsLevel 5Expresses content knowledge with the assignment purpose in a complete, organized, clear, professional, and culturally respectful manner.24.0 ptsLevel 4Expresses content knowledge with the assignment purpose in a complete, organized, clear, professional, and culturally respectful manner with minor weaknesses in one or more of the areas.22.0 ptsLevel 3Partially expresses content knowledge with the assignment purpose. Expresses ideas in a complete, organized, clear, professional, and culturally respectful manner with weaknesses in this area.19.0 ptsLevel 2Partially expresses content knowledge with the assignment purpose. Ideas are partially expressed in an organized, professional, and culturally respectful manner with major weaknesses in these areas.16.0 ptsLevel 1Expresses limited content knowledge with the assignment purpose. Ideas are not expressed in a complete, organized, clear, professional, and/or culturally respectful manner.0.0 ptsLevel 0The assignment was not completed or there are no constructed concepts that demonstrate analytically skills and no evidences to support the content does not align to the assignment instructions27.0 pts
This criterion is linked to a Learning OutcomeAnalysisPRICE-P27.0 ptsLevel 5Constructs concepts related to course content, demonstrating strong analytical skills with strong evidence to support professional and personal subject knowledge through details, supporting evidence, and idea differentiation.24.0 ptsLevel 4Constructs concepts related to course content, demonstrating strong analytical skills with evidence to support professional and personal subject knowledge through details, supporting evidence, and idea differentiation.22.0 ptsLevel 3Constructs concepts related to course content, demonstrating analytical skills with some evidence to support professional and personal subject knowledge through details, supporting evidence, and idea differentiation.19.0 ptsLevel 2Constructs concepts related to course content, demonstrating weak analytical skills with minimal evidence to support professional and personal subject knowledge through details, supporting evidence, and idea differentiation.16.0 ptsLevel 1Constructs concepts related to course content, demonstrating inadequate evidence of analytical skills. There is minimal or no evidence to support professional and personal subject knowledge through details, supporting evidence, and idea differentiation.0.0 ptsLevel 0The assignment was not completed or there was no evidence of constructed concepts that are supported by professional and personal subject knowledge through details, supporting evidence, and idea differentiation.27.0 pts
This criterion is linked to a Learning OutcomeTechnology18.0 ptsLevel 5Manipulates multiple technological resources to effectively implement all assignment requirements.16.0 ptsLevel 4Manipulates multiple technological resources to effectively implement most assignment requirements.14.0 ptsLevel 3Manipulates multiple technological resources to effectively implement some assignment requirements.13.0 ptsLevel 2Manipulates multiple technological resources for some assignment requirements.11.0 ptsLevel 1Manipulates technological resources to minimally meet some assignment requirements.0.0 ptsLevel 0The assignment was not completed or difficulties with technological manipulation were evident. The assignment submitted does not meet requirements.18.0 pts
This criterion is linked to a Learning OutcomeWriting13.5 ptsLevel 5The assignment exhibits an excellent command of written English language conventions. The assignment has no errors in mechanics, grammar, or spelling.12.0 ptsLevel 4The assignment exhibits a good command of written English language conventions. The assignment has no errors in mechanics or spelling  with minor grammatical errors that impair the flow of communication.10.0 ptsLevel 3The assignment exhibits a basic command of written English language conventions. The assignment has minor errors in mechanics, grammar, or spelling that impact the flow of communication9.0 ptsLevel 2The assignment exhibits a  limited command of written English language conventions. The assignment has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.7.0 ptsLevel 1The assignment exhibits little command of written English language conventions. The assignment has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.0.0 ptsLevel 0The assignment does not demonstrate command of written English language conventions. The assignment has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning.13.5 pts
This criterion is linked to a Learning OutcomeAPAPRICE-I4.5 ptsLevel 5In-text citations of sources and references in proper APA style are included with no errors.4.0 ptsLevel 4In-text citations of sources and references in proper APA style are included but have 1-2 minor APA errors.3.0 ptsLevel 3In-text citations of sources and references in proper APA style are included but have 3 – 4 minor APA errors.2.0 ptsLevel 2In-text citations of sources and references in proper APA style are included but have more than 4 errors.1.0 ptsLevel 1The errors demonstrate a limited understanding of in-text citation and reference requirements0.0 ptsLevel 0There are no in-text citations AND/OR references.4.5 pts

Make a table : for the two Mental health Condition  1.depression 2. Anxiety  – fill in Medication – Side effects 

2. Make a care plan for Depression and Anxiety 

Care plan should include: Diagnosis, Risk, Intervention and Evaluation   in a table fomart

  

Describe one of the safety committees your organization uses and how it reduces risk within your organization. Who are the general members of the group, how often do they meet, and is there a regulatory requirement that they report or publish notes? Is this a good use of the staff’s time or would another method that still addresses the safety goal of this group be more efficient? (2 paragraphs).

The Occupational Safety and Health Administration (OSHA), the Centers for Medicaid and Medicare Services (CMS), and the Joint Commission (JC) require that health care organizations maintain risk management programs to address infection control. Detail three measures that your health care organization (or any health care organization) could implement, beyond what is currently in practice, to support the delivery of safe health care services and avoid the spread of infection (e.g., placing hand washing devices at all of the public entrances of the health care facility). Support your response with a minimum of two peer-reviewed references (2 paragraphs)

  

Assignment: Off-Label Drug Use in Pediatrics

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a childs weight. However, children are not just smaller adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.  

Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To Prepare

Review the interactive media piece in this weeks Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders( option drugs below)

Reflect on situations in which children should be prescribed drugs for off-label use.

Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

Write a 1-page narrative in APA format that addresses the following:

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Therapy for Pediatric Clients with Mood Disorder

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

 Client complained of feeling sad

 Mother reports that teacher said child is withdrawn from peers in class

 Mother notes decreased appetite and occasional periods of irritation

 Client reached all developmental landmarks at appropriate ages

 Physical exam unremarkable

 Laboratory studies WNL

 Child referred to psychiatry for evaluation

 
 

MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is sad. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

 
 

RESOURCES

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.

Treatment options

1)Zoloft 25 mg orally daily, 2) Paxil 25 mg orally daily, 3) Wellbutrin 75 mg orally BID 

Resources for reference ( 3 + references)

Rosenthal, L. D., & Burchum, J. R. (2018). Lehnes pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Chapter 8, Drug Therapy in Pediatric Patients (pp. 6567)

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.