Category: Mental health

Post-Traumatic Stress Disorder Pathophysiology

Post-traumatic stress disorder (PTSD) is a psychiatric disorder resulting from exposure to actual or threatened injury, death, or sexual assault and is associated with functional and cognitive impairment. Early interventions and diagnosis are essential for effective treatment and minimizing the long-term effects of PTSD (Mann & Marwaha, 2022). The pathophysiology can be described as interference with the neurotransmitter’s functionality and neurohormonal functioning. Patients with PTSD, despite their ongoing stress, portray lower levels of cortisol and higher levels of corticotropin-releasing factor (CRF). It tends to speed up the release of norepinephrine through the anterior cingulate cortex, which is responsible for the elevated sympathetic response, which leads to increased heart rate, blood pressure, and startle response (Mann & Marwaha, 2022). Furthermore, PTSD is linked with interfering with neurophysiology and anatomy of the brain. Moreover, the hippocampus’ size is reduced, and the amygdala, the process of emotions and modulation of fear response, is highly sensible amongst individuals with PTSD.

For the pharmacological treatment to control PTSD, the recent symptomatology experienced, comorbid conditions, and evidence of the efficiency of treatments before medication initiation are the factors that a clinician has to consider. Psychological therapies are the recommended primary treatment for PTSD (Lewis et al., 2020). In addition, medicines like paroxetine and sertraline are types of antidepressants called selective serotonin reuptake inhibitors and SSRIs (Ehret, 2019). Trauma-focused cognitive-behavioral therapy (TF-CBT) is effective at reducing symptoms of PTSD in adults, and self-help with support shows that it is an effective post-treatment (Lewis et al., 2020). The main symptoms of PTSD are avoidance, negative alterations in the mood, arousals, and reactivity that cause distress in social, occupational, and other essential areas of functioning. Therefore, PTSD co-occurs with other disorders like anxiety disorder and is associated with reduced quality of life and dangerous physical health outcomes.

Additional Analysis of the Case

In diagnosing any disease, there are specified guidelines to be followed. For PTSD, the procedures were followed step-by-step until the conclusion on the patient to be diagnosed with PTSD was attained. The criteria mainly apply to adults and involve the following steps; firstly, exposure to actual or threatened death through witnessing traumatic events considering the patient is a former servant in the military. Secondly, the availability of one or more intrusion symptoms linked to traumatic events like flashbacks when the individual feels the event reoccurs (Sanders & Hall, 2017). Thirdly, negative interference with mood and cognitions linked to traumatic events, like the inability to experience happiness, satisfaction, or love, sometimes makes it hard to sleep. The family history is reviewed to develop a better diagnosis of the patient’s condition.

Furthermore, the care was unique since the past medical history (PMHX), past surgical history (PSHX), the history of previous illness (HPI), current medications, and the demographics of the patient are highlighted and considered in the process of diagnosing the patient and give a general overview of what to look for when diagnosing the patient. The national criterion for diagnosing adults with PTSD is followed and applied adequately.

Follow-Up

Active monitoring for this scenario is recommended because the patient is experiencing moderate symptoms of PTSD. Active monitoring implies a close evaluation of the symptoms to see if they are getting worse or improving. Healing from PTSD occurs in a sequence that is not instant; hence, the symptoms can aggravate or ameliorate. In active monitoring when the symptoms persist in the next visit, talking therapies, TF-CBT, and eye movement desensitization and reprocessing (EMDR) should be conducted severally (Ehret, 2019). EMDR involves remembering traumatic events while focusing on specific eye movements as directed by the therapist. It focuses on ensuring the traumatic events are not intense since the brain processes and memorizes them, and becomes familiar to the brain.

Quality

In this scenario concerning a 35-year-old Caucasian male diagnosed with PTSD, a few changes can be learned from the scenario and help patients with similar symptoms and problems in future cases. Advising patients with similar conditions in the future to stay a healthy lifestyle includes ensuring enough time to sleep and less consumption of drugs. It would be important for institutions such as the military to include therapy sessions for retired military officers and after military combat to reduce cases of ex-military officers having PTSD caused by the traumatic events they encounter during their mission. Guidelines for diagnosing an adult patient with PTSD are essential for a clinical officer or therapist to follow the laid criterion. Furthermore, it is crucial to have a thorough background check about the patient, including the demographics, social history, current medication, family history, PSHX, PMHX, and HPI.

Coding and Billing

International Statistical Classification of Diseases and Related Health Problem version ten, ICD-10, is billable and is a code used in the healthcare diagnosis reimbursement of PTSD and other chronic diseases. ICD-10 replaces the ICD-9 developed by the World Health Organization (WHO) to help them code and identify health conditions (Sanders & Hall, 2017). Physicians and healthcare assistors require ICD-10 under the Health Insurance Portability and Accountability Act, HIPAA. Some codes can be identified in the case including F01-F09 for mental illness due to known physiological situations; F10-F19 for mental and behavioral illness due to psychoactive substance use; F30-F39 for mood disorders; F40-F48 for anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorder, and F60-F69 Disorders of adult personality and behavior, and F43.1 for PTSD.

References

Ehret, M. (2019). Treatment of posttraumatic stress disorder: Focus on pharmacotherapy.Mental Health Clinician, 9(6), 373-382. Web.

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for posttraumatic stress disorder in adults: Systematic review and meta-analysis.European journal of psychotraumatology, 11(1), 17-33. Web.

Mann, S. K., & Marwaha, R. (2020). Posttraumatic Stress Disorder (PTSD).

Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N., & Stockton, S. et al. (2020). Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychological Medicine, 50(4), 542-555. Web.

Sanders, M., & Hall, S. (2017). Trauma-informed care in the new-born intensive care unit: promoting safety, security and connectedness. Journal of Perinatology, 38(1), 3-10. Web.

The coronavirus pandemic has affected all people and spheres of society in many aspects. Restrictions and prohibitions caused by the spread of the disease have made an enormous contribution to the mental state of people who have become more likely to turn to specialists and search for information on dealing with stress on the Internet. In particular, COVID-19 affected the well-being of the younger generation, who increasingly began to experience negative emotions, which in some cases lead to suicidal thoughts. The study of the impact of the global pandemic on the mental state of adolescents and ways to combat them is of particular interest for this research paper. The impact of coronavirus on the younger generation of Canada was considered as the basis for the analysis of the problem.

Therefore, the central aspect that will be considered in this paper is the impact of coronavirus and related restrictions on the well-being of Canadian adolescents. People are worried about an impending emotional wellness crisis among children due to the declaration of COVID-19 as a pandemic. Canada came in 31st place among the 38 top-buying countries in terms of success and 30th in overall health. However, “Canada’s ranking in terms of the suicide rates among young adults was 28th out of 35 countries,” which is a dissatisfactory factor (Worlds Apart: Canadian Summary). Each adolescent and young person’s mental well-being strategy needs to include life advancement and implosion avoidance training. UNICEF’s report showed that while the number of youngsters reporting issues at home has increased in several countries, Canada has seen no change (Where Does Canada Stand?). Further, funding school-based close to home health groups helps level the playing field regarding access to health care. The recognition in local close-to-home wellness settings may benefit from the aid of schools. Some schools provide assistance that enables most children to enter and “facilitate a holistic, collaborative framework including educators and health care providers within a secondary school setting” (Kutcher and Wei 92). This aspect can have significant positive results on the state of well-being of young adults.

The lack of interaction, social events, and isolation play a crucial role in causing distress among adolescents. Furthermore, the suicide rate in “Canada for individuals aged 20 to 24 years old reached 11.7 per 100,000” people in 2020 (Suicide rate in Canada para. 1). Suicide was among the top ten leading causes of death in Canada in 2019. The rising distress captured in the survey, done before COVID-19, has likely only worsened during the pandemic. Tracey (para. 3) underlines that “teens may feel like their feelings are unbearable and will never end, so the only way to escape is suicide.” The pandemic has weakened teen and children’s support networks. It causes children to feel neglected because they try to find ways to cope with the situation, such as drinking, smoking, and suicide.

COVID-19 has resulted in many stressors for teens due to the limited interactions with their peers and teachers. When in school, educators could have been more attentive and close with some students that needed extra support. For some of them, this was a big part of their academic life, and due to the pandemic has been affected. Sources say that “children and youth struggling with their mental health may display signs that caregivers can notice” (Brown para. 9). In addition, “boys are four times more likely to die from suicide than girls, and girls are more likely to attempt suicide than boys” (Teen Suicide para. 3). Often, it is difficult to distinguish the difference in behavior between boys and girls, but low mood, lack of initiative and talkativeness, and isolation from everyone are common. Parents now have an even more significant role in assisting their children’s mental health. Therefore, “changes in eating, sleeping, and behaviors which last for many days or weeks may be a sign” (Brown para. 10). In addition, CBC reported that transformations in behavior could include “expressions of distress, disconnecting from loved ones, or acting out behaviors” (Brown para. 11). Parents, in turn, should turn to professionals to assist in working with children and providing recommendations.

In conclusion, this work aimed to study the impact of coronavirus and restrictions designed to prevent morbidity on the mental well-being of the adolescent population of Canada. Despite the fact that this country is characterized by good development in many areas, it is still faced with the problem of a reasonably large percentage of suicide cases. The studied sources also emphasized a decrease in psychological health indicators among the younger generation, which is expressed in an increased desire to isolate themselves from society and an increased level of stress. It is also noted that boys are more likely to commit suicidal acts than girls, which also raises concern not only for parents but also for the state as a whole. Therefore, it is necessary to develop programs to support adolescents and train parents and educators on how to recognize warning signs and help cope with them correctly.

Works Cited

Brown, Desmond. “Number of Youth in Hospital After Suicide Attempt Tripled Over 4-Month Period Under COVID-19.”CBC, 2021.

Kutcher, Stan, and Yifeng Wei. “Challenges and Solutions in the Implementation of the School-Based Pathway to Care Model: The Lessons from Nova Scotia and Beyond.” Canadian Journal of School Psychology, vol. 28, no. 1, 2013, 90-102.

”Suicide Rate in Canada by Age Group in 2020.”Statista, 2022.

“Teen Suicide.”John Hopkins Medicine, no date.

Tracy, Natasha. “Why Do Teens Commit Suicide? Causes of Teen Suicide.”Healthy Place, 2022.

“Where Does Canada Stand?” UNICEF Canada, 2019. Web.

“Worlds Apart: Canadian Summary of UNICEF Report Card 16.”UNICEF Canada, 2019.

Qualitative and mixed-method studies are valuable for nursing practitioners to retrieve sufficient evidence. The issue identified in the practicum site is that the number of impoverished patients who skip the follow-up appointments increases. Various studies that discuss the correlation between socio-economic, healthcare quality factors, and willingness to attend the additional visit exist, and the recent pandemic made the topic more urgent (Alshak et al., 2021). The article “Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties” by Aragona et al. discusses the follow-up visits. This paper aims to appraise the selected study and assess its potential application for future practice.

The number of skipped follow-ups increased due to the lockdowns; however, the cases where the repeated appointment is crucial, such as mental disorders treatment, still existed. The purpose of the study was to reveal the pandemic’s impact on outpatient services for migrants and patients in socio-economic difficulties and estimate how these factors influence follow-up attendance (Aragona et al., 2020). The research raised the critical question of the need for equal quality of healthcare for everyone and identified the challenges due to the COVID-19 lockdowns.

The research was designed as a retrospective cross-sectional study that allowed the scientists to retrieve the pre-pandemic data and compare it to the recent statistics. The mental health outpatient visits data were retrieved for each February and March between 2017 and 2020 to identify the one-month follow-up (Aragona et al., 2020). Patients’ records were studied to retrieve their socio-economic status and calculate the percentage of the most vulnerable populations. The cross-sectional design allowed the researchers to observe the prevalence of skipped follow-ups among the immigrants and patients with socio-economic difficulties, proving the existence of the attendance issue.

The sampling of the selected study is relatively narrow, yet it allowed the researchers to conduct a detailed data analysis and was sufficient to identify the tendencies for follow-up visits. The 286 patients were chosen because they attended the psychiatric interview in February and March of 2017-2020, and the February group was the baseline population (Aragona et al., 2020). During sampling, sociodemographic data and diagnoses were also considered to increase the scope of evidence retrieved from the research (Spector, 2019). As the study is retrospective, the primary data collection method was patient records’ analysis and categorization to retrieve the trends.

The findings submitted the growing challenge of skipped follow-up visits and revealed that socio-economic difficulties influence patients’ attendance aside from the pandemic-related complications. Aragona et al. (2020) state that “only 17.53% of patients accessing the mental health outpatient service in February 2020 came back for the scheduled follow-up appointment in March 2020, showing a significant decrease of 46.57%” (p. 54). The study’s strength is that it explored the novel and urgent topic of the COVID-19 impact on the healthcare industry, providing a foundation for further services’ improvement (Alshak et al., 2021). The main limitation of the selected research is that it was conducted retrospectively with narrow sampling, making its results difficult to generalize for other organizations. However, the study design and data analysis can be applied for future practice to retrieve insights about the specific patient characteristics and their perception of healthcare services (Bell et al., 2021). Indeed, similar retrospective research can be performed with patient records of a practicum site where the decreased attendance among the impoverished beneficiaries has already been noticed to prove the negative tendency.

Scholarly articles that discuss the pandemic help the healthcare industries to adjust their practices and maintain the services at the highest quality level possible. The selected study submitted the follow-up visit problem and provided evidence that socio-economic difficulties also influence the patients’ attendance. The research design and sampling are appropriate for organizations to retrieve trends in their beneficiaries’ behavior and calculate the results for further exploration.

References

Alshak, M. N., Li, H. A., & Wehmeyer, G. T. (2021). Medical students as essential frontline researchers during the COVID-19 pandemic. Academic Medicine, 96(7), 964-966. Web.

Aragona, M., Barbato, A., Cavani, A., Costanzo, G., & Mirisola, C. (2020). Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties. Public Health, 186, 52-56. Web.

Bell, L. C., Norris-Grey, C., Luintel, A., Bidwell, G., Lanham, D., Marks, M., Baruah, T., O’Shea, L., Heightman, M., & Logan, S. (2021). Implementation and evaluation of a COVID-19 rapid follow-up service for patients discharged from the emergency department. Clinical Medicine, 21(1), 57-62. Web.

Spector, P. E. (2019). Do not cross me: Optimizing the use of cross-sectional designs. Journal of Business and Psychology, 34(2), 125-137. Web.

Assessment

Maria is a 26-year-old patient who grew up in Honduras and is now going through immigration with her husband and daughter to become US citizens. Maria has a large family consisting of her mother, grandmother, and nine brothers and sisters, but the patient never knew her father, who left them when she was an infant. Maria’s mother was never married but had several long-term relationships. The patient’s family was not well-off, and Maria herself did not graduate from school, as she left after the fifth grade. At the age of 10, Maria was raped, and after that, the patient began to engage in prostitution to help her family financially since her mother and grandmother could not support everyone. At the age of 18, the patient met Jamie, from whom she quickly became pregnant and gave birth to a daughter named Sofia.

The young people illegally moved to the States and settled in Texas, where Jamie began to do part-time jobs since Maria was busy with their daughter and could not work. The family has a lot of difficulties in relationships since Jamie wants more children, as is customary for men of his culture, and Maria does not support this idea. She did not receive proper medical care and support from her partner when she was pregnant with Sofia. Jamie and Maria have used drugs in the past, and the man has some problems with alcohol. Due to such an irresponsible attitude to health and constant quarrels and stress, Sofia was born with a delay in speech and motor skills, which undoubtedly worsens the family’s emotional background. In addition, Jamie constantly cheats on Maria, raises his hand at her, and shouts insults. Fights and attempts to break up are not uncommon in the family, leading to nothing.

Maria became heavily dependent on Jamie due to various social and cultural aspects. Firstly, the patient comes from Honduras, where there is a system of relations according to which a woman is subordinate to her man, fulfills his requirements, and tolerates any behavior on his part. Secondly, the patient did not have a loving and caring father, but only a criminal who raped her at 10. That is why Maria had a perverted concept of relationships and a wrong idea of what a family should be. She subconsciously got used to being in a subordinate position since she never really controlled her life. Maria can be diagnosed with several psychological disorders, primarily associated with rape at an early age. It can include post-traumatic disorder and depression, which makes Maria go with the flow without thinking about the consequences of her actions.

When providing medical services to this family, there may be a lot of other ethical and legal considerations. It is possible to list the illegal status of patients, confidentiality, voluntary participation, the choice of therapeutic goals and procedures that will benefit the client, and the guarantee of the therapist’s qualifications and competence. Specialists are obliged to limit their practice to those areas and treatment methods in which they can be proven to have received sufficient and confirmed knowledge and experience.

Case Conceptualization

Maria meets the diagnostic criteria for prolonged depression and post-traumatic disorder caused by sexual abuse in childhood and moral and physical pressure from Jamie. To work with Maria, it is necessary to remember that she is part of the family, which, in turn, is a true ecosystem. Thus, it would be advisable to use the concept of a family system for psychotherapeutic intervention in this case. Proponents of this trend pay close attention to interactions and other manifestations of the activity of family members, which makes it possible to understand the organization or structure of the family (Finney & Tadros, 2019). How, when, and with whom family members interact is crucial for understanding and subsequent therapeutic changes in the family structure. Since the patient’s problems come from childhood, or rather from her family, close attention should be paid to the consideration of family values and relationships, but already in the present tense.

It would be advisable to use a structural model of family psychotherapy since family psychotherapy can change its structure and change the behavior of each of the members of the family system. Maria pointed out that she had never known her father, who was supposed to protect her family and Maria herself (Finney & Tadros, 2019). Thus, Maria has always felt defenseless, and probably, having not found a defender in Jamie, she still feels this way. Currently, there are severe problems in Maria’s family, which already have an extremely negative effect on the patient’s daughter, Sofia, who has early signs of a sexual disorder. Using a family approach to this problem will help develop some hidden rules that govern the interaction of family members.

For example, the rule “family members should always protect each other” will manifest itself in situations when someone from the family needs care or support. Such an approach will help Maria form her family as a whole and well-coordinated system and understand her and Jamie’s mistakes, which are already adversely affecting their daughter (Finney & Tadros, 2019). In addition, the support and love of Jamie, who also needs to feel like a part of the family, and not a separate independent element, will help Maria cope with depression and post-traumatic syndrome.

Treatment Plan

Based on contextual conceptualization, Maria’s treatment will aim to achieve two long-term goals: strengthening the sense of belonging to the family and increasing self-esteem and self-perception as a woman. To accomplish the first long-term goal, the following short-term goals will be set:

1. The patient needs to stop treating the family as a burden. It is recommended to maintain a relaxed and calm atmosphere at home, pay more attention to her daughter’s upbringing, and spend more time with Jamie.
2. The patient needs to establish a relationship with a partner and learn to see him as a defender and friend, not an enemy or an abuser.
3. The patient needs to take responsibility for her family members and not hide from it or shift it to others;

To achieve the second long-term goal, the following short-term goals will be set:

1. The patient needs to become more independent and independent from her partner. To do this, it is recommended to get a job to provide financial support to a partner and not be dependent on him financially.
2. The patient needs to set strict personal boundaries in communicating with Jamie, remember about self-esteem, and exclude any physical or moral humiliation attempts.
3. The patient needs to change her attitude towards herself, love herself and get rid of the guilt that often haunts victims of sexual violence.

Interventions

Adhering to the chosen approach of structural family therapy, it will be necessary to carry out the following types of interventions in Maria’s situation:

• actualization of family interaction models;
• setting or marking borders;
• escalation of stress;
• assignment of tasks;
• using symptoms;
• stimulation of a particular mood;
• support, training, or guidance (Varghese et al., 2020).

The intervention within the framework of the structural approach will focus not on the previous life experience and its reflection on the later behavior of the patient but the actual communicative conduct. The goal will be not so much to achieve insight as to identify the views of family members about the existing situation change communication stereotypes, which should be followed by restructuring the entire system of intra-family relations (Varghese et al., 2020). Imitation and prescription can be used as examples of psychotherapeutic techniques. In the first case, the therapist imitates, for example, the father and imitates his behavior, manners, and style of communication (Varghese et al., 2020). In the second case, the conflict is brought to classes, and family members demonstrate how everything is happening with them, after which the therapist determines ways to modify their interaction and patterns to create structural changes.

In this approach, the emphasis is on the family hierarchy: parents are deliberately placed in the position of seniority, which implies responsibility for children and excludes the idea of the family as a group of people equal in status. Structural family therapy focuses on the differentiation of subsystems, which can also be used in Maria’s situation (Finney & Tadros, 2019). For example, a psychotherapist encourages parents to talk to each other, preventing unwanted interference from children, or, on the contrary, recommends parents not to interfere in children’s communication with each other (Varghese et al., 2020). However, in cases where the family is separated, it stimulates oncoming traffic between subsystems, ensuring that family members feel more connected and provide more mutual support.

References

Finney, N., & Tadros, E. (2019). Integration of structural family therapy and dialectical behavior therapy with high-conflict couples.The Family Journal, 27(1), 31-36. Web.

Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian journal of psychiatry, 62(Suppl 2), S192.

Mental health nursing has undergone several changes in the post-modern era. Postmodernity is the state or condition that exists after modernity. Modernity on the other hand is the Enlightenment or Progressive era. Giddens (1990) says that modernity can be defined as a condition or rather a state in which most institutions undergo changes that have a direct impact on the social and political aspects of a community (p. 60). The phenomenon began in the 1950s. Postmodernity thus is the culmination of this process where constant change is the status quo and the progress notion is obsolete. The changes have influenced people’s perception of the major aspects of health care providers to mental health patients. This is due to the replacement of traditional cultural structures by the commoditization of social living, consumption, and failure to support the mental health needs that result in psychopathology. Some of the mental health needs include alienation, depression and anxiety, materialism and existential health. The desire for identity and personal growth as well as transcendence has proved to be generated when cultural frameworks become outdated. According to Kirmayer and Minas (2000), this modernity affects psychiatry in three ways; effects on identity, the impact of economic inequalities in mental health and dissemination of psychiatry knowledge itself (p. 67). Because of the human being’s nature as a social being, once that bond is destroyed and they live as individuals, many emotional and spiritual ills take place. Additionally, materialism and consumption in modern society are a way of life on emotional well-being. It promotes self-centeredness, lack of generosity to others later becoming less happy and less satisfied with life as a whole. When one gets to this stage in life, they become depressed which according to Murray and Lopez (1997) is the leading cause of disease burden (p. 1500).

The modern self has been alienated from society and consumables become the only way of self-identity. Schumaker states, “moderns have become distanced from the communal operations that historically have immunized members from a range of psychopathologies” (2001, p. 28). This in return evades the real meaning of existence leading to dissatisfaction. Additionally, competition is an example of the effects of modernity on mental health. The modern person has devalued co-operation and success is based on another person’s failure. This robs individuals of empathy, creating a more rugged individual leading to poor relationships. It eventually leads to isolation and socially alienated individual with no cooperation. World Bank’s statistics show that mental health problems cause a great loss of quality life-nearly 10% (1993, p. 45). Risks like terrorism as pointed out by Howson et al. are likely to have an immense impact on mental health in the world at large (1998, p. 589). Postmodernism has led to a more interactive relationship between the client and me as a mental health worker. This is so because before there was a boundary that dictated how to work and how far to go but with post-modernity, there is the feeling of belonging in the community that I work with. It makes it positive to offer services not as a servant to a master’s bidding but as an expert who knows what is expected. There is also the freedom to ask questions as well as resist practices contrary to the interests of the community and the profession.

Modernity and globalization have some deep-rooted consequences on mental health. The demand for psychiatrists is increasing day in day out. In addition, only the rich have access to proper treatment because of globalization. Unfortunately, the delivery of mental health services has not been equally provided irrespective of where the patients come from. Due to the increased ethnic and cultural diversity of service users, attitudes in relation to mental illnesses have broadened. Social-economic changes have also led to an increase in mental disorders. Globalization has already brought about crises of different forms including the social, economic, democratic and spiritual crises that make people view God as bread due to poverty. Finally, globalization will eventually increase the rates of depression with time.

References

Giddens, A. (1990). The Consequences of Modernity. Cambridge: Polity Press.

Howson, C. P., Fineberg, H.V. & Bloom, B. R. (1998). The pursuit of global health: the relevance of engagement for developing countries. Lancet, 351, 586– 590.

Kirmayer, L. J. & Minas, I.H. (2000). The future of cultural psychiatry: an international perspective. Canadian Journal of Psychiatry, 45, 438– 446.

Murray, C. J. L. & Lopez, A. D. (1997) Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet, 349, 1498– 1504.

Schumaker, J. (2001). The Age of Insanity. Modernity and mental health. Westport, CT: Praeger Publishers Inc.

World Bank (1993). World Development Report 1993: Investing In Health. New York: Oxford University Press.

It is important to note that psychopharmacology is a critical field of knowledge and expertise for any independent mental health practitioner. The main reason is the fact that psychopharmacology is a science-based study of medications and drugs on human psychology. It is becoming increasingly necessary for a mental health practitioner to be familiar and knowledgeable about pharmacological aspects of the treatment of mental issues.

As a future independent mental health practitioner, one must be fully equipped with skills and competencies in treating clients’ mental health problems, which is impossible without pharmacological interventions. It is stated that “even though psychiatrists represent the branch of medicine that specializes in psychopharmacology, they are directly responsible for providing only a fraction of professional services to the mentally ill” (Preston et al., 2021, p. 13). In other words, no treatment can be effective if the dedicated specialists are outsourcing the prescription of drugs to non-psychiatric professionals. In order to help clients to overcome stigma about mental disorders and medication, it is important “to bring up the topic in a preemptive way, at the time when the prescription is first written” (Preston et al., 2021, p. 66). In other words, a mental health practitioner needs to help patients weigh the pros and cons in an informed manner. Since non-adherence is a major problem when it comes to medications, one can help clients to comply with the prescriptions by giving “patients (and parents) time to really explore any concerns or worries that they might have about the psychiatric medication being recommended” (Preston et al., 2021, p. 67). Therefore, it is likely that patients will be cautious of drugs, which is why their concerns need to be heard, voiced and evaluated.

In conclusion, psychopharmacology is becoming critically important for an independent mental health practitioner. Medications play a major role in ensuring proper treatment measures. Thus, clients require assistance and informed education about their options.

Reference

Preston, J. D., O’Neal, J. H., Talaga, M. C., & Moore, B. A. (2021). Handbook of clinical psychopharmacology for therapists. (9th ed.). New Harbinger Publications.

Purpose

Given the challenges of their service paired with physical and psychological trauma, veterans are a vulnerable population in the USA. Suicide is one of the main concerns in relation to these patients due to the high risk of self-harm attempts. The prevalence of the problem is of significant concern because the healthcare system lacks adequate solutions that would meet veterans’ health needs (U.S. Department of Veteran Affairs, 2021). Currently, the hospital does not have sufficient mental health support for veterans with suicidal risks. Without such programs, the veteran population’s well-being and longevity are under-addressed. The management of the hospital should seriously consider the abundance of benefits the veteran population will obtain upon implementing a new group therapy program for veterans with suicide risks. Therefore, the purpose of this document is to present a comprehensive strategy for developing an improved community outreach program based on evidence-based therapy for veterans’ better mental health outcomes.

Problem

The issue at the center of this document is the high level of suicide risk in the veteran population and the urgent need to address this problem through therapy to prevent suicide in veterans. Statistical data show that:

• In the general population, suicide is ranked at the 10^th position in the leading causes of death in the United States (Johnson et al., 2019);
• On average, over 44,000 people in the USA die because of suicide annually (Johnson et al., 2019);
• Twenty percent of all the suicide deaths are the deaths of military veterans (Johnson et al., 2019).

These numbers vividly demonstrate why this issue needs addressing. Moreover, recent research findings in the field of suicide among veterans demonstrate the causes of the problem.

• Veterans are disproportionately exposed to multiple risk factors contributing to their likelihood to attempt suicide or self-harm:
• Post-traumatic stress disorder;
• Chronic pain;
• Veterans’ “early military separation and dishonorable discharge” (Johnson et al., 2019, p. 16);
• Frequently experienced depression, anxiety, and insomnia;
• Loneliness;
• Maladaptive psychological traits (Nichter et al., 2021);
• Exposure to trauma;
• Persistent thoughts of self-harm.
• The intersection of several of the above-mentioned factors increases the level of risk for a suicide attempt.
• Thus, it is essential to provide veterans with adequate professional and peer support to address most of these factors and prevent suicide.

Problem Analysis

The analysis of the problem at hand reveals that new evidence-based therapy is obligatory. The following are the specific challenges that should be addressed when implementing the solution:

• Individual sessions might be less effective in comparison to group therapy due to the loneliness issues and the need for peer support (Johnson et al., 2019);
• Under-diagnosis of mental health issues in veterans obstructs their treatment opportunities;
• Limited awareness and the lack of information on self-help and professional assistance contribute to the problem.
• In order to improve the situation, the management should allocate necessary resources to launch a group therapy program for suicide prevention in veterans:
• The hospital might cooperate with community services;
• Veterans’ awareness about the risks and causes of suicide attempts should be raised;
• Group sessions should be based on cognitive-behavioral therapy principles (Johnson et al., 2019);
• Self-help resources should be disseminated (U.S. Department of Veteran Affairs, 2021);
• Therapy attendance should be encouraged through informational means.

Results of Analysis

While researching the issue, it was found that

• Suicide prevention group therapy is effective when implemented for 1-3 months (Johnson et al., 2019);
• Therapy aimed at addressing multiple risk factors (including insomnia, thoughts of self-harm, depression, anxiety, chronic pain, and loneliness) is most effective (Nichter et al., 2021);
• The U.S. Department of Veteran Affairs (2021) prioritizes and supports suicide prevention programs, which might be used for the benefit of the hospital’s launching of group meetings.

The issue was researched using the methods of secondary data review in some recently published studies. The information presented by the official website of the U.S. Department of Veteran Affairs was examined to collect the necessary information. The findings are credible since they are based on reliable resources, such as peer-reviewed academic journals and official federal organizational statements.

Recommendations

The U.S. Department of Veteran Affairs supports and launches multiple programs to prevent suicide among American veterans. Given the scope of expertise, available resources, and experience of this organization, hospital management is encouraged to cooperate with the U.S. Department of Veteran Affairs to pursue the following goals:

• Find sponsors for program launching
• Train hospital therapists in the field of evidence-based cognitive-behavioral group sessions for suicide prevention;
• Initiate cooperation with community-based organizations to disseminate information about the group sessions;
• Initiate screening of hospital patients for suicide behavior;
• Enroll outpatients with a history of suicide problems;
• Conduct pre- and post-program evaluations to collect results for further program improvement.

It is vital not to leave the problem of suicide among veterans unaddressed. It is the responsibility of the hospital’s management to improve the quality of care for veterans to ensure that their health needs and concerns are properly met.

References

Johnson, L. L., O’Connor, S. S., Kaminer, B., Gutierrez, P. M., Carney, E., Groh, B., & Jobes, D. A. (2019). Evaluation of structured assessment and mediating factors of suicide-focused group therapy for veterans recently discharged from inpatient psychiatry. Archives of Suicide Research, 23(1), 15-33. Web.

Nichter, B., Stein, M. B., Monteith, L. L., Herzog, S., Holliday, R., Hill, M. L., Norman, S. B., Krystal, J. H., & Pietrzak, R. H. (2021). Risk factors for suicide attempts among U.S. military veterans: A 7‐year population‐based, longitudinal cohort study.Suicide and Life‐Threatening Behavior. Web.

U.S. Department of Veteran Affairs. (2021). Suicide prevention. Web.

A proposed financial plan to support Mental Health Services for Healthcare Providers of Critical Patients:

The impact of a biblical stewardship perspective on the proposed financial plan

The biblical perspective on stewardship presumes that leaders are granted control over other people and resources by God (Carradus, Zozimo, & Discua Cruz, 2020). Thus, they should strive to ensure the well-being of every person in order to honor the Lord. In this regard, the current financial plan was designed in a manner that would benefit all the stakeholders involved, including healthcare providers of critical patients and consulting staff.

The potential holes and unknowns in the project’s financial plan

Although the financial plan seemingly addresses most of the expenses that may occur during the project realization, there are still some unknowns that should be considered. As such, O’Connell (2020) argues that managers should always think about the worst-case scenario and be prepared to respond adequately. In the case of the current project, first of all, it is hard to predict the real demand for mental health services among doctors. This, in turn, negatively affects the ability to predict the required number of mental health workers. Secondly, potential crises and resulting inflation rates may cause a price increase, which, in turn, would necessitate additional money to purchase equipment and medication. Moreover, the costs for the services, training, and maintenance may also surge.

Assumptions that can fill the potential holes in the project’s financial plan

As for the former hole in the financial plan, it can be assumed that there will be an average demand for mental services among healthcare professionals. This assumption would help to partly mitigate the risks of the unknown need for offered services. It is explained by the fact that when the expected demand is low but the actual necessity is high, then the patients are largely underserved. On the contrary, when expectations are high, but the actual demand is low, it leads to substantial financial losses. As for inflation, it is necessary to assume a certain amount of money for unforeseen expenditures. Therefore, if the prices rise, the organization will still be able to pay for the planned expenses.

References

Carradus, A., Zozimo, R., & Discua Cruz, A. (2020). Exploring a faith-led open-systems perspective of stewardship in family businesses. Journal of Business Ethics, 163(4), 701-714. Web.

O’Connell, S. (2020). 3 financial planning tips for an unknown future. Success. Web.

Introduction

The provision of high-quality healthcare services during the pandemic is a critical initiative for guaranteeing the wellbeing of citizens while the needs of hospital employees are frequently neglected. The events of this nature are particularly seen in the area of mental health issues which are typical for personnel due to increased stress levels (Chirico et al., 2021). Therefore, it is important to examine the ways to prevent adverse outcomes among them while ensuring the continuity of care for critical patients.

Background

The selection of the topic, mental health of healthcare providers working with critical patients, is conditional upon its applicability to the needs of both patients and medical specialists. Hence, it was formulated as a challenge of a multi-faceted nature which should be a priority of corresponding organizations. For the examination of the specified problem, the suitable setting is one of the local hospitals willing to participate in the project, and the contact there will be an administrator with access to the essential information. The perceived need for this initiative is the importance of establishing new guidelines for healthcare professionals to avoid burnout or post-traumatic stress disorders, which are emphasized as the main issues stemming from workplace conditions (Chirico et al., 2021). This necessity is supported by the previous research, according to which depression, anxiety, and insomnia, alongside the issues mentioned above, present a particular threat to female nurses (Soylu et al., 2021). Therefore, it is important to assess this category of workers in the first place and develop preventive measures applicable to them as well as other healthcare providers in the future.

Background of the Project

The project’s topic was selected due to raising concerns related to healthcare providers’ mental health, especially during the pandemic. Although new potential infections should be properly addressed with clinicians’ focus on patients’ physical well-being, the emotional well-being of nurses is extremely important for the provision of quality healthcare (Stuijfzand et al., 2020; Soylu et al., 2021). Thus, the project aims to evaluate the provision of mental health services for healthcare providers of critical patients in a primary care facility as its setting (facility) and with Jewell Snider as the mentor.

SMART Goals

In order to address the challenge identified in the previous section, it is crucial to set a specific goal. In this case, it will be formulated with regard to the evidence stating that some categories of workers are more susceptible to problems in this area, and stress levels are related to a number of circumstances (Chirico et al., 2021; Soylu et al., 2021). Therefore, I will use the data received from the hospital to conclude on the most vulnerable groups of employees in terms of mental health to develop precise recommendations for preventing adverse outcomes within one week. I will create a framework applicable to the selected setting with respect to differences in specialists’ conditions within the following week. Consequently, I will spend two days discussing the findings with the administrator and decide on practical measures to be implemented within a month.

Initial Project Design

The initial project design consists of the smart goals in the pre-determined order as per the hospital’s needs. The steps include examining the available data (sick leaves, reported problems), incorporating the findings into a comprehensive plan, and coordinating actions with the facility’s representative with the subsequent implementation of the elaborated framework (see Figure 1). In this situation, responsibility will be shared between the researcher and the administrator since the former is accountable for the precision of conclusions, whereas the latter is involved in the process of delivering information. The materials for the designed project include only the records of employees’ mental health issues and their type. Considering the stages determined for its implementation, it will take about two months.

Goals

First of all, the project aims to explore healthcare employees’ exhaustion, stress, burnout, compassion fatigue, and other mental health disorders that occur in the workplace. In addition, it will cover the scope of the provision of mental health assistance for them by the hospital’s services (Søvold, 2021; Cai et al., 2020). Finally, the project will evaluate mental healthcare amenities provided for critical patients by healthcare specialists during the pandemic.

Need Assessment

The project’s perceived needs include financial, stakeholder, patient, spiritual, facility, and funding needs. In general, the aim of the project is the evaluation of the efficacy and accessibility of mental health assistance provided for healthcare professionals and critical patients for its subsequent improvement (Chirico et al., 2021; Serrano-Ripoll et al., 2020; Greenberg et al., 2020). Thus, the improved mental health of these categories will decrease the health care system’s burden and costs, positively impact patient outcomes and interaction between the facility’s members, and contribute to individuals’ emotional, spiritual, and even physical health. In order to make decisions, allocate resources, and achieve programmatic objectives, needs will be assessed through direct observations and literature review.

Stakeholders

The project’s main stakeholders are psychologists, social workers, and nurses. Thus, psychologists want to support the project, social workers are not swayed either way but need to be informed, and nurses may resist due to the belief that the project may negatively impact what they do. In order to address all of them, the researcher should provide correct information concerning the research writing a letter to all stakeholders and explaining that their personal information and results will be secured. In this case, trust between stakeholders and the researcher will be established.

Project Requirements and Tools

In general, the project requires time, financial, and material resources, including tools and equipment, in order to accomplish its goals. First of all, the involved stakeholders’ emotional well-being will be examined by scholars before the project as a baseline to compare the project’s findings with the results. If the project’s needs are met, PERT and WBS techniques will be essential for measurements (Suryono & Hasbullah, 2020). At the same time, a Christian servant-leadership approach may be used to guide the researcher to design and implement interventions developing and optimizing performance. Leaders focus on day-to-day education, performance preparation, and the promotion of stakeholders’ personal achievements.

Literature Review

Available secondary data focuses on the mental health of healthcare practitioners who care for critical patients during the pandemic. Literature search strategies that include the use of keywords, phrases, and key terms will be applied. The central database for the researcher will be the online school library. The CRAAP test will be used to evaluate the reliability of resources (Esparrago-Kalidas, 2021). The inclusion criteria will be workers’ mental health – thus, articles that address it will be included, while articles with a lack of identified information will be excluded, respectively.

AlAteeq et al. (2020) address the mental health of Saudi Arabian healthcare providers during the pandemic. Using questionnaires for a cross-sectional study, authors aim to assess the levels of anxiety and depression among healthcare specialists in medical facilities. According to the results, more than half of the participants experience both anxiety and depressive disorder (AlAteeq et al., 2020). This study demonstrates the necessity of addressing healthcare specialists’ individual issues along with the promotion of altruism, solidarity, and social inclusion.

De Pablo et al. (2020) aim to systematize both physical and mental health issues of healthcare providers that have occurred predominantly during the pandemic. Their meta-analysis and systematic review identified the most common mental health burden of clinicians, including general health concerns, fear, psychological distress, insomnia, anxiety, burnout, PTSD, and stigmatization feelings. In general, this study describes the scope of the problem that requires an immediate solution.

Di Tella et al. (2020) investigate the impact of the pandemic on Italian healthcare workers’ mental health. Using responses of 145 participants, authors find out that working with COVID-19 patients is strongly associated with healthcare providers’ high levels of PTSS and depression (Di Tella et al., 2020). In addition, women without relationships demonstrate the highest levels of mental health disorders. Thus, this study provides an insight into targeted solutions on the basis of workers’ gender, age, or marital status.

A systematic review by Vizheh et al. (2020) aims to review all available materials related to healthcare workers’ mental health. Included cross-sectional studies reveal that front-line healthcare providers, nurses, younger medical staff, and female workers suffer from high levels of anxiety, stress, and depression. On the basis of this research, it is recommended for managers and policymakers to adopt encouragement, supportive, and motivational training and intervention to improve workers’ mental health.

Finally, following the example of other countries, Tsamakis et al. (2020) investigate how the pandemic impacts the mental well-being of healthcare providers in Greece. In this descriptive research, the authors state that clinicians have faced unprecedented psychological pressure that led to high levels of anxiety, stress, emotional burnout, and even fear-triggered panic attacks. At the same time, researchers mention that raising concerns related to the importance of healthcare specialists’ mental well-being will lead to the development of appropriate solutions.

Biblical Reflection

As a healthcare worker, I realize that I am responsible for others, serve them, and put their physical and mental health as my top priority. Thus, the verses (Matthew 5:3–7) play an important role in recognizing the urge for God and my spiritual poverty. I understand that my duty is to satisfy patients’ needs according to God’s will addressing their emotional suffering (Kilbourne et al., 2018). In addition, I believe that my devoutness will help others to establish healthy relationships with God and serve Him.

Project Budget

Fixed Costs

The first line of the financial plan is devoted to the description of fixed costs. The latter concept represents the expenditures that are constant throughout the analyzed period of time (Datar & Rajan, 2018). Firstly, telephone services include the mobile phone fees for two managers, which equal $200 each month. As such, it seeks to cover the phone calls that administrators would need to make to communicate with suppliers, clients, staff, and other people. Secondly, it is assumed that internet service fees will be paid by the building or facility administration where the mental health service will operate. In this regard, it is planned to pay $25 as a proportion of overall internet expenses. The internet is crucial for the project’s operations as it is assumed that part of the consultations with clients will be conducted online.

Next, the offices rental is also assumed to be constant throughout the year. In total, it is planned to rent five offices for managers and personal consultants and two group consultation rooms for group mental health service providers. It may seem first that the rental space does not fit the necessity of all workers, especially considering that private consultants should occupy one office. However, calculations were made based on the assumption that employees will work in shifts and, thus, use the same office during different days. Moreover, the corporate plan of the TherapyNotes program will be purchased every month for $59 (TherapyNotes, n.d.). Finally, office and equipment maintenance is also regarded as a fixed cost, but it is less predictable than other expenses in this category (Zhang et al., 2017). It is assumed that equipment and space sustenance would require around 10% of the total investments in laptops and mobile phones and rental expenditures accordingly.

Personnel Costs

Personnel expenditures can be both variable and fixed costs depending on the form of payment for labor. In the case of the current project, all the expenditures are predefined, and employees will receive fixed salaries. The latter was determined as an average wage in the region, but small corrections will be made during the process of employment as the experience and qualification of the workers will be considered. As for the number of professionals, the number of six personal consultants and four group consultants was determined to effectively satisfy the yearly demand for mental health services which approximately assumed to be 1800 patients. Additionally, certain amount of money was budgeted to conduct initial personnel training. In particular, the two managers will be taught about specifics concerning the work in the sphere of mental health service and some techniques on how to manage employees and relations with clients and suppliers effectively. Furthermore, both administrators and common workers will have the training concerning the usage of the TherapyNotes program.

Supplies and Investments

Medical and administrative supplies are variable costs as they depend on the demand. However, for the former, the budget assumes the approximate cost of $125 every month, whereas, for the latter, the biggest expenditures will incur during the first month and be equal to $210. Moreover, every three months, $100 would be spent to ensure that there are sufficient supplies, including pencils, papers, and notebooks, all the time. During the other months, supply costs are budgeted to be $10, considering some unforeseen expenses may occur.

Assessment of Proposed Solutions

The proposed project evaluates clinicians’ level of stress, burnout, exhaustion, compassion fatigue, and other mental disorders during the COVID-19 pandemic. The project’s feasibility needs to be assessed to attain reliable results and make the overall process effective. Indeed, effectiveness is one of the primary criteria in project evaluation (Glodzinski, 2018). The two methods that will be used to assess this research’s feasibility are horizontal and vertical approaches.

The horizontal technique focuses on evaluating methodology, while the vertical method incorporates the influence of the stakeholders. Specifically, the horizontal approach assesses project performance in terms of social and environmental aspects, resources, responsibilities, investments, budgeting, and risk assessment (Glodzinski, 2018). The vertical technique concentrates on project maturity, governance, benefits, and inputs from stakeholders (Glodzinski, 2018). The proposal can be appraised for its effectiveness using these two approaches because the goals, resources, methods, and stakeholders are known. Thus, the pilot testing can be conducted with fewer participants through video calls. The questionnaire will be sent to all pilot study participants to receive their feedback and implement their suggestions for improvement.

If the project is started and something is not working the way I envisioned, I will make specific changes to adapt to these challenges. For example, if the participants cannot come to offices, the therapy sessions may be conducted through calls or video conferences to ensure that the sample size is maintained as initially planned and everyone receives consultation. Feedback is considered an objective way to demonstrate whether the proposed solutions are helpful (Martin et al., 2019). The participants’ feedback after each session will be the primary strategy to see if the project goals are met.

If the original strategy is not working, I plan to change and adapt the project according to the stakeholders’ needs. Specifically, I will ask nurses, physicians, and therapists to provide their suggestions for altering the study design. Lastly, at this point, the objectives of this research should remain the same, but if significant issues with the completion of tasks appear, the goals should be revised.

Plan B

Healthcare professionals have always been under increased stress, but the COVID-19 pandemic elevated this pressure. Therefore, this project strives to identify the exact number of healthcare workers with mental health issues and the quality of help. However, if the original plan for this study does not work, an alternative solution should be implemented that will require performing the entire project in an online mode using digital platforms.

The new approach will allow to save budget and conduct the study even if the participants do not have the opportunity to visit consultation offices. Plan B is to perform all interviews, data collection, and help sessions using video calls, social media, and telemedicine platforms (Vizheh et al., 2020). In fact, the hospital where the study will be conducted utilizes online consultation; hence, the new approach aligns with organizational strategies. Furthermore, various mobile health applications can be introduced to remind clinicians to engage in self-care practices like mindfulness, meditation, and yoga (Vizheh et al., 2020). Notably, this plan should only be implemented in case of financial restrains and the unwillingness of many participants to go to consultation offices.

Risk Assessment

Since this project is focused on collecting sensitive data from healthcare workers, legal and regulatory matters should be considered to prevent the violation of the study participants’ privacy. This information is delicate because individuals with depression and anxiety may feel stressed to reveal their problems due to the fear of being stigmatized and discriminated against at a workplace (Taylor & Blackford, 2020). Legislative aspects should be revised since the law’s primary goal is to define and enforce citizens’ rights, and it is critical not to violate them in this study (Wing & Gilbert, 2007). Moreover, this project requires adequate risk assessment and strategies to make the study more effective. Thus, the confidentiality of participants’ personal information will be ensured through number coding, and the three-step risk evaluation will be performed.

Confidentiality is one of the essential ethical obligations of researchers and clinical workers; hence, specific measures will be taken to ensure that the study participants’ privacy is not violated. Specifically, the names of the participants will receive the corresponding identification number that will be used in the analysis of results. This measure should be taken to prevent medical identity theft, resulting in the participants’ information being used by third parties (Showalter, 2017). Moreover, potential dangers to the project should be determined using systematic risk management that consists of three elements: risk assessment and classification, analysis, and mitigation (Barghi & Sikari, 2020). Firstly, the potential risks in case of using plan A include assaults, terrorist attacks, environmental disasters, and civil disturbances (Colling, 2001). Secondly, each threat should be assessed and ranked in the order of probability. Thirdly, the possible action plan in each situation should be proposed to ensure the study participants’ safety. Overall, adherence to law and risk assessment is critical to achieving the study goals legally and safely.

Research Databases

The main databases that will be used for this literature review are the online school library and Google Scholar. The search strategy that will be used is searching with keywords. The following key terms will be used: “project assessment,” “clinicians’ mental health,” “healthcare legislation,” and “risk assessment.” The sources that included these terms and were related to psychological health and project management were considered, while irrelevant papers were excluded. Furthermore, the CRAAP test, which stands for currency, relevance, authority, accuracy, and purpose, will be used to evaluate the research literature quality.

Badahdah et al. (2021) focus on assessing the mind of the healthcare workers in Oman during the COVID-19 pandemic. The article was written by researchers from Oman and the United States. The study included 500 nurses and physicians from several hospitals in Oman to determine the prevalence of psychological problems (Badahdah et al., 2021). They utilized the Generalized Anxiety Disorder Scale, Perceived Stress Scale, and WHO Well-Being Index (Badahdah et al., 2021). The results showed 75% of healthcare workers experienced mild anxiety, and 25% had moderate to severe stress (Badahdah et al., 2021). The authors recommend helping clinicians through mindfulness practices and cognitive behavioral therapy. This paper is reliable because it was published recently in a peer-reviewed journal.

Barghi & Sikari (2020) discuss qualitative and quantitative methods for project evaluation. Specifically, they developed a hybrid risk assessment tool that was tested by 15 participants (Barghi & Sikari, 2020). The results showed that this technique was effective in risk identification (Barghi & Sikari, 2020). This paper was published by qualified researchers in the international peer-reviewed journal less than two years ago; thus, it can be considered credible.

The book by Colling (2001) focuses on security in healthcare organizations. It discusses the basics of hospital safety, methods of clinics’ protection, and workplace violence management. Moreover, the author provides a review of particular security concerns and emergency planning. Even though this book was written two decades ago, it is still credible and relevant because the fundamental principles of security in healthcare institutions have not changed.

Glodzinski (2018) presents the study results related to the project assessment framework. This research observes 13 financial, IT, and development projects in Poland. The results showed that the multidimensional approach used to evaluate these projects allowed obtaining qualitative and quantitative data about their effectiveness. Since the paper was published in a peer-reviewed journal by a credible author within the last five years, it can be viewed as reliable.

Although the paper by Martin et al. (2019) was not related to healthcare workers, it was still included because it contained essential information about project assessment. This study focused on developing the online course using advice from award-winning teachers (Martin et al., 2019). The most relevant information in this article for my project is the use of feedback to check if the intended goals are met. This paper can also be considered credible because it was published within the past five years in a peer-reviewed journal by reputable authors.

The book by Showalter (2017) provides an extensive review of the legislation related to healthcare administration. Indeed, this source is an objective representation of the United States’ laws and regulations about hospitals, patients, and healthcare workers. Specifically, the information about the rights and responsibilities in public healthcare, private and federal medical insurance programs, and regulations passed from the 1970s to the most recent times. The CRAPP test showed that this source is credible because it is recent, relevant, accurate, published by a reliable author, and coincides with the purpose of the project.

The paper by Sultana et al. (2020) discusses the problems of burnout among clinicians during the ongoing pandemic. It identifies such stressors as workplace-related stress, long shifts, and working in quarantined areas that are responsible for sleep disturbances, anxiety, and depression among healthcare workers (Sultana et al., 2020). The authors suggest promoting mental health awareness and mindfulness practices in hospitals to reduce the prevalence of burnout and stress. This article is reliable since it was published recently by qualified researchers in a peer-reviewed journal.

Taylor et al. (2020) present their ideas about mental health problems in front-line healthcare workers during the pandemic. This paper highlights that the fear of stigmatization and discrimination prevents many clinicians who are stressed from seeking help (Taylor et al., 2020). Thus, the authors recommend spreading the message that healthcare workers who struggle with mental disorders can receive proper support. This article is credible since it was published in a peer-reviewed journal less than two years ago.

The systematic review by Vizheh et al. (2020) presents a broad representation of the prevalence of various psychological issues among healthcare workers during the coronavirus crisis. The authors included 100 articles related to mental health problems among doctors and nurses. The results showed that the prevalence of anxiety ranged from 24% to 45% in different studies, and 12%-50% of healthcare workers had depression (Vizheh et al., 2020). The paper recommends governments and hospital administrations provide emotional support to clinicians to reduce stress. This article is credible since it was published by reputable researchers in a peer-reviewed journal, it is recent.

Lastly, the book by Wing & Gilbert (2007) provides an extensive review of public health laws. The information presented ranged from the structure of the legal system and citizens’ rights to abuse of rules and malpractice. Furthermore, the authors provide reading suggestions at the end of the chapter to understand some regulations deeper. Although this book was published about 15 years ago, it still can be considered credible because many healthcare system regulations passed in the United States previously are still relevant today. Lastly, the authors are reputable, and the source is relevant to the project’s goals.

Recommendations For Practice

The acquired information helps to formulate specific recommendations linked to the issue under research. First of all, statistics show that healthcare workers acquired numerous health issues during the pandemic (Sultana et al., 2020). It means that their resilience declined, and they became highly vulnerable to various stressors. Under these conditions, it becomes critical to monitor the mental health of this group and introduce specific interventions to support it at the desired level. For this reason, it can be recommended to integrate mental health assessment tools and activities into the work of health units. It will help to monitor the current state of all specialists and determine the critical problems they face. Furthermore, timely intervention might help to reduce burnout and stress levels, which is also vital during the pandemic. For this reason, this recommendation seems relevant regarding the collected information.

The second possible step to improve the situation in the healthcare sector is linked to the stereotypes associated with stress and mental health issues. Thus, the literature review shows that clinicians have a fear of stigmatization and discrimination related to revealing their mental health problems (Taylor et al., 2020). It prevents them from working with specialists and resolving managing stress. For this reason, it becomes vital to alter these attitudes and create the basis for cooperation between psychologists and health workers. Under these conditions, it can be recommended to introduce activities aimed at cultivating increased awareness levels among clinicians related to stress and mental health issues. It is critical to explain that stress is not normal, and it is vital to address the problem. Otherwise, the high levels of burnout and numerous psychological problems will reduce effectiveness and deteriorate outcomes.

Assumptions

The given paper was made making several critical assumptions:

• The mental health of health workers will suffer during the pandemic (Vizheh et al., 2020)
• Reporting stress and burnout will be linked to stigmatization and existing stereotypes (Taylor et al., 2020)
• Organizations will focus on the improved quality of care because of the recommended interventions
• The project will prove the relevance and importance of the issue
• The literature review will justify the choice of the topic
• The Biblical worldview will remain applicable to the project
• The offered intervention will have a high practical value

These assumptions were vital for formulating the research paradigm and conducting the study. They also helped to formulate the goals and major expectations linked to the research. In such a way, the outlined assumptions are vital for understanding the researcher’s logic and the choice of methods to analyze the problem and discuss it.

Biblical Worldview

The project rests on the Biblical ideas, which are used as the core for determining possible interventions. Thus, In Matthew 5:3-7, it is stated that the compassionate will be sanctified as God will be kind to them. Moreover, it is said that those who thirst and hunger for justice will find it and be content. It means that healthcare professionals should respond to the needs of the people they serve and help them in different situations. The verses also help to realize the researcher’s role and focus on giving hope to individuals in need. Applying these ideas to the research project, it is possible to say that healthcare specialist who has mental issues should also be assisted as this idea follows the Biblical worldview. For this reason, the project’s outcomes can be interpreted in terms of religious philosophy and are vital for society.

Conclusion

Altogether, the project proves the critical importance of mental health issues during the pandemic. Literature review shows that clinicians face a higher risk of burnout and stress accumulation because of the complexity of working conditions and high pressure. It means that the emotional well-being of health nurses acquires the top priority as the critical factor influencing the quality of care. Under these conditions, the project’s goal can be viewed as relevant and practical. Determination of the most vulnerable groups and provision of care to them is critical regarding the pandemic and numerous adverse effects associated with it. The high level of stigmatization and fear linked to the problem also proves the significance of the selected issue and the necessity to select the most powerful tools to address it.

The project offers the suggestion to improve the mental health of healthcare providers working with critical patients by studying their actual problems in this area based on a single facility. These findings will be translated into practical measures with the help of its representative, and the continuation of work in this respect will, consequently, allow learning more about the possibility to prevent adverse outcomes. Thus, the developed project is based on theoretical information at the initial stage and will lead to concrete solutions.

At the same time, the project contributed to the enhanced understanding of the healthcare employees’ exhaustion, stress, burnout, compassion, and other mental disorder rates in the workplace. It is critical for the enhanced understanding of how to address the problem and what measures can be used to assist in resolving the problem and guaranteeing the best possible outcomes. In general, using information from the literature review and other credible sources, the project managed to achieve the established goals. First, the major mental health problems were investigated. Second, the scope of the mental health assistance was determined. Finally, the possibility of various interventions is discussed. Regarding the collected information, it can be recommended to continue investigating the given question as it remains relevant. It is vital to outline the major causes of growing stress and introduce practical tools to address the problem and alter health workers’ attitudes.

References

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Cai, W., Lian, B., Song, X., Hou, T., Deng, G., & Li, H. (2020). A cross-sectional study on mental health among health care workers during the outbreak of Corona Virus Disease 2019. Asian Journal of Psychiatry, 51, 102111. Web.

Chirico, F., Nucera, G., &Magnavita, N. (2021). Protecting the mental health of healthcare workers during the COVID-19 emergency.BJPsych International, 18(1), 1-2. web.

Datar, S. M., & Rajan, M. V. (2018). Horngren’s cost accounting: A managerial emphasis. Pearson.

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Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021). Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority.Frontiers in Public Health, 9. Web.

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Introduction

Nursing theory, or the structuring of ideas pertaining to the philosophy and practice of care, fulfills a variety of tasks. Its roles range from the provision of guidance to explaining nursing as a phenomenon. This paper addresses the topic of nursing theory by reviewing current research pertaining to hypothetico-deductive reasoning, suggesting the model’s potential value in the research of nurse education techniques and barriers to decision-making, and discussing the uses of Peplau’s middle-range theory in mental health nursing.

Article Summary and Theory Identification

In her scholarly article on the pitfalls of managing clients that may have life-threatening conditions, Watkins (2020) delves into the real-life applications of decision-making theories and provides a substantial analysis of the scenario of an elderly female client with chest pain. In the analysis section, the researcher reviews the nurse student’s use of the ABCDE assessment and the cardiology team’s efforts to make the diagnosis of ST-elevated myocardial infarction (Watkins, 2020). In general, using the case scenario, the researcher provides insight into the uses of decision-making theories, including the hypothetico-deductive reasoning model, inpatient evaluation, and care escalation decisions.

The hypothetico-deductive model of reasoning refers to a series of thinking interventions that support effective clinical decision-making in emergency situations. Being among the most popular and rational approaches to decision-making, the model can be described as prescriptive in nature since it prescribes the desired sequence of actions based on descriptive observations of real-life approaches to clinical decisions and the normative principles of logic and rational thinking. As the model suggests, the process of making a decision is comprised of a series of stages, including the acquisition of pre-counter cues, for instance, the information regarding warning signs, and hypothesis generation, during which one applies previous knowledge to new situations and creates at least one hypothesis, sometimes demonstrating the principle of pattern recognition (Watkins, 2020). Finally, in the hypothesis evaluation stage, one determines and implements the most relevant diagnostic tools to gain further clinical evidence and conclude on the validity of the initial proposition.

The Value of Theory for Nursing Research

Theoretical assumptions and models support research by generating the phenomena of interest and allowing for comparisons between several approaches to care and decision-making. Nursing theory can promote the expansion of the knowledge base on the most promising approaches to nurse education. For instance, the abovementioned theory, the hypothetico-deductive model of reasoning, may find application in experimental scholarly research focusing on approaches to teaching clinical reasoning skills to future healthcare professionals. In particular, the hypothetico-deductive model can be used as an experimental condition and compared to alternative reasoning models, such as intuitive or non-analytical reasoning, in terms of how these approaches to managing patient cases affect care outcomes and diagnostic accuracy. Experimental studies that test the model against some alternatives, such as dual-process diagnostic reasoning models, integrative models, and pattern recognition, are not extremely common, but they could shed light on the effective approaches to the development of diagnostic competence in healthcare students.

The hypothetico-deductive reasoning model might be useful in researching novice nurses’ barriers to effective decision-making and producing recommendations on the uses of approaches to reasoning depending on the experience level. The model in question suggests the use of cues for the generation of hypotheses. However, modern researchers agree that novice and student nurses’ understanding of health conditions and their symptoms is not always profound enough to lead to the creation of one or more hypotheses and consider differential diagnoses, which is a barrier to be studied (Watkins, 2020). Additionally, as per critical assertions, the hypothetico-deductive model wrongly implies a “simple rational approach to decision-making” without considering other factors, such as the context and decision-makers’ emotions (Krishnan, 2018, p. 75). Thus, the scholarly discussions of this model might suggest the need for studies that would explore the merits of the various decision-making models for diverse nurse populations and cause improvements in practical recommendations.

Personal Practice and Nursing Theory

As a nurse in an inpatient mental health setting that serves adult and geriatric populations, I make use of Peplau’s theory of interpersonal relations to guide my collaboration with patients. This mid-range theory introduces the benefits of interpersonal techniques and describes effective nurse-patient collaboration as the sequence of four phases, such as orientation, problem identification, exploitation, and resolution (Pehlivan & Güner, 2016). Establishing personal rapport with patients to promote effective care is among my core responsibilities, and my interactions with new and actual patients basically follow the four-stage approach introduced above. Thus, my interaction with new patients starts with problem definition and needs assessments, during which I apply nursing ethical principles to avoid overly personal and irrelevant questions, and then proceeds to the identification phase that involves personalized care plan development. Next, the exploitation and resolution stages involve plan implementation, the use of interviews and teaching techniques to ensure patients’ proper understanding of treatment goals, and communication to review the patient’s progress. Leading mental health patients through these stages of therapeutic relationships is often challenging and may require family involvement, but the theory is still valuable to my practice.

Conclusion

To sum up, nursing theory plays a critical part in the promotion of effective care, positive and trust-based nurse-patient communication, and nurse education. The hypothetico-deductive model supports decision-making and might shed light on the effectiveness of strategies used to teach clinical reasoning skills. Theories of interpersonal relationships enable mental health nurses to promote the best possible patient outcomes by taking a structured approach to therapeutic interpersonal relationships.

Refrerences

Krishnan, P. (2018). A philosophical analysis of clinical decision making in nursing. Journal of Nursing Education, 57(2), 73-78. Web.

Pehlivan, T., & Güner, P. (2016). The use of theories in psychiatric nursing-II. Journal of Psychiatric Nursing, 7(2), 100-104.

Watkins, S. (2020). Effective decision-making: Applying the theories to nursing practice. British Journal of Nursing, 29(2), 98-101.