This chapter explains how the administrator fits into the financial aspect of nursing facility operation and the need for strategic business planning. The administrator’s primary role as financial manager is to use the financial information to make informed decisions about the facility. The chapter explores two systems of accounting: cash and accrual, and discusses two main steps in the accounting process: keeping the books and preparing the financial statement. A common approach to analyzing financial statements is to perform a ratio analysis. Capital assets are those used to provide services during more than one time period. Knowledge of costs and the ability to control and reduce them permit liquidity of limited funds, making them available for other uses. Knowledge of the facility’s past financial performance and insight into the reason for earlier budget shortfalls or successes are essential for preparing a realistic and useful budget.
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This chapter provides an overview of the nonprofit organization in the United States, the main characteristics of nonprofit organizations, and the reality of the nonprofit sector today. It describes the differences between a nonprofit and a for-profit corporation. Nonprofit organizations have existed for many centuries, especially through religious groups or religious-based activities. The nongovernmental sector is growing throughout the world. Increasingly, these organizations are playing key roles in the economic and social contexts of their countries. Unlike private-sector organizations concerned primarily with making a profit, nonprofit organizations are focused on carrying out a specific public-service mission. Successful nonprofit organizations require substantial capability in key areas of management: developing strong boards of directors, recruiting and motivating talented staff and volunteers, creating plans to focus resources on relevant goals and innovative programs, winning the support of diverse stakeholders, raising funds, and wisely managing fiscal and human resources.
This chapter discusses the term “service delivery” and describes a service delivery system in the context of a nonprofit organization. Servitization is the process whereby an organization develops creative and innovative ways to create a product-service system that integrates value-based products and service offerings. The chapter discusses the roles of client-centeredness, decision making, scheduling, priority setting, effective and efficient flow of services or activities, quality assurance, and continuing quality improvement, and how these factors contribute in their own context to influence positively or negatively the financial sustainability of a nonprofit organization. A customer-centric service design is a service delivery system that focuses on providing the best quality service possible to customers or clients or the service target, based on a service concept, a service decision path, service sustainability, and service quality. The chapter explains the relationship between service delivery and financial sustainability.
This chapter defines the concept of social marketing and provides some of the common areas for the use of social marketing by nonprofit organizations. The term “social marketing” has been used for several decades to refer to a systematic process of using marketing strategy to influence current behaviors of a target population into a desired behavior in order to positively change a social or community issue. The chapter describes the contents of a social marketing plan. A social marketing plan is a document that justifies the needs for a social marketing campaign, as well as the process of implementation by outlining a SWOT (strength, weakness, opportunity, threat) analysis, a description of the target population, the goals and objectives, an impact statement, the marketing mix strategies, an implementation plan, an evaluation plan, and a budget. The chapter establishes the relationship between social marketing and financial sustainability.
When working in a healthcare organization, one may learn that they “practice Lean”, or they follow principles of “Design Thinking”, or they mention some other model of how they approach and solve problems as an organization. This chapter describes how the problem-solving method compares to these two methods. Regardless of the organizational problem-solving method used in the organization, the knowledge of using the problem-solving method as a thought process will be complementary to, and not competing with, these other methods. The two aspects of the problem-solving method that will be most useful to the reader regardless of the problem-solving method used in the organization are how to define the problem and engaging with stakeholders. Of the three methods, the problem-solving method is agnostic as to the type of problem being faced, and can be thought of as a “logic processor” to apply in any situation when engaging in organizational problem-solving.
This chapter focuses on women, who are HIV positive, from a global perspective. It illustrates more easily what makes groups of people, and in this case women, vulnerable and then consider vulnerability from a global health (GH) perspective using the chronic illness, HIV. The chapter presents some examples of situations that make women vulnerable to HIV and, once infected, vulnerable for life, and use a case-based approach to highlight women as a vulnerable population. It also focuses on the real ethical issues that occurred with each case, which one anticipate will help prepare the new GH nurse for practice in the global environment. The chapter demonstrates by using an exemplar of HIV-positive women, vulnerable populations exist both within and outside the United States. Reasons for vulnerability may include stigma, victimization, mental illness, migration, limited access to needed health care or food, or substance use.
Healthy body image is critical to adolescent development, and teens often diet and worry about their weight and appearance. However, for some youth these concerns become fixed and distorted, resulting in psychopathology. Eating disorders, particularly binge-eating disorder, anorexia nervosa, and bulimia nervosa, are serious, complex chronic disorders, which can be life-threatening. Differential diagnoses for eating disorders include: cardiac valvular disease, malabsorption syndromes; inflammatory bowel disease; chronic infections; thyroid disease; hypopituitarism, Addison disease; central nervous system lesions; cancer; and other psychiatric disorders including depression, obsessive-compulsive disorder, anxiety, and substance abuse. Eating disorders are difficult to treat, especially when presenting with comorbid diagnoses, and treatment depends on the severity of the illness. Primary health care providers play a critical role in assessment, monitoring of treatment progress, screening for and managing medical complications, and coordinating care with psychiatric and nutritional professionals.
This chapter discusses comprehensive school crisis interventions, identifies the characteristics that define a crisis, finds ways to assess for the level of traumatic impact, and determines what interventions can be provided to help with response and recovery. It highlights the PREPaRE Model of crisis prevention and intervention. There are six general categories of crises: acts of war and/or terrorism; violent and/or unexpected deaths; threatened death and/or injury; human-caused disasters; natural disasters; and severe illness or injury. Children are a vulnerable population and in the absence of quality crisis interventions, there can be negative short- and long-term implications on learning, cognitive development, and mental health. Evidence-based interventions focusing on physical and psychological safety may be implemented to prevent a crisis from occurring or mitigate the traumatic impact of a crisis event by building resiliency in students. Crisis risk factors are variables that predict whether a person becomes a psychological trauma victim.
- Go to chapter: Evidence-Based Interventions for Major Depressive Disorder in Children and Adolescents
Depression is a chronic, recurring disorder that impacts children’s academic, interpersonal, and family functioning. The heritability of major depressive disorder (MDD) is likely to be in the range of 31% to 42%. This chapter begins with a brief overview of the etiology of depression. It presents a description of a cognitive behavioral therapy (CBT) intervention designed to be delivered in a group format, an individual interpersonal intervention, and an individual behavioral activation (BA) intervention that includes a great deal of parental involvement. The ACTION program is a manualized program that is based on a cognitive behavioral model of depression. There are four primary treatment components to ACTION: affective education, coping skills training (BA), problem-solving training, and cognitive restructuring. The chapter concludes with a brief discussion of universal therapeutic techniques to be incorporated into work with depressed youth regardless of the therapeutic orientation or treatment strategy.
Divorce is a lengthy developmental process and, in the case of children and adolescents, one that can encompass most of their young lives. This chapter explores the experience of divorce from the perspective of the children, reviews the evidence base and empirical support for interventions. It provides examples of three evidence-based intervention programs, namely, Children in Between, Children of Divorce Intervention Program (CODIP), and New Beginnings, appropriate for use with children, adolescents, and their parents. Promoting protective factors and limiting risk factors during childhood and adolescence can prevent many mental, emotional, and behavioral problems and disorders during those years and into adulthood. The Children in Between program is listed on the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-Based Programs and Practices. The CODIP and the New Beginnings program are also listed on the SAMHSA National Registry of Evidence-Based Programs and Practices.
Children and youth with serious emotional, behavioral, and social difficulties present challenges for teachers, parents, and peers. Youth who are at risk for emotional and behavioral disorders (EBD) are particularly vulnerable in the areas of peer and adult social relationships. The emphasis on meeting academic standards and outcomes for children and youth in schools has unfortunately pushed the topic of social-emotional development to the proverbial back burner. This chapter emphasizes that social skills might be considered academic enablers because these positive social behaviors predict short-term and long-term academic achievement. Evidence-based practices are employed with the goal of preventing or ameliorating the effects of disruptive behavior disorders (DBD) in children and youth. An important distinction in designing and delivering social skills interventions (SSI) is differentiating between different types of social skills deficits. Social skills deficits may be either acquisition deficits or performance deficits.
Eating disorders (EDs) are a complex and comparatively dangerous set of mental disorders that deeply affect the quality of life and well-being of the child or adolescent who is struggling with this problem as well as those who love and care for him or her. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for the diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or ED. Treatment of eating disordered behavior typically involves a three-facet approach: medical assessment and monitoring, nutritional counseling, and psychological and behavioral treatment. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are also evidence-based approaches to treatment for AN. The treatment of EDs should be viewed as a team effort that integrates medical, nutritional, and mental health service providers.
Asthma, a pulmonary condition, is a chronic respiratory disorder typified by persistent underlying inflammation of tissues, airway obstruction, congestion, hyperresponsive airways, and the narrowing of smooth airway muscle. Asthma is one of the most common chronic medical conditions in children and is the leading cause of school absenteeism. This chapter describes childhood asthma, including its causes and triggers. It elucidates the extant research supporting treatment of the disorder and provides step-by-step empirically based interventions to ameliorate asthmatic symptomatology in children. The psychological underpinnings of asthma have been investigated in the field of psycho-neuroimmunology (PNI), which examines the interplay of the central nervous system, neuroendocrine, and immune system with psychological variables and their relation to physical health. Researchers have shown that relaxation and guided imagery (RGI), written emotional expression, yoga, and mindfulness therapy improve pulmonary lung functioning, decrease rates of absenteeism, and improve overall quality of life.
This chapter reviews the empirical support for such a multifaceted approach by considering selected neurodevelopmental concerns and medical variables that present as obstacles to healthy neurodevelopment. It discusses select neuro-developmental prenatal complications that can be prevented or ameliorated through behavioral interventions with the pregnant mother. The chapter addresses the deleterious effects of legal substances on the developing fetus, but professionals should be vigilant about preventing or reducing intrauterine exposure to illicit substances as well. Tobacco is a legal substance that, when used during pregnancy, has the potential to harm both the mother and fetus. Of particular concern with tobacco use are the detrimental health risks, such as hypertension and diabetes, which adversely affect the cerebrovascular functioning of pregnant women. The process of neurodevelopment is complex and represents a dynamic interplay among genetics, behavior, demographics, the environment, psychosocial factors, and myriad physiological factors.
This chapter reviews prevention, including genetic counseling. It discusses genetic testing for diagnosis as opposed to screening and the treatment for genetic disease. Methods of prevention begin with education of the public and health care professionals and identification of those at risk. Genetic counseling is the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. The malignant cells often exhibit aneuploidy as well as translocations that are found only within the tumor cells. Genetic errors that arise from specific cell lines are somatic mutations. It is suggested that there is a thorough collection of family, genetic, and medical history for children entering the adoption process. Nurses may play a variety of roles in genetic counseling that reflect their preparation, area of practice, primary functions, and setting. The chapter explains the incidence of chromosome abnormalities.
The initial recognition of the need for a genetics referral may arise when a nurse suspects a genetic contribution to disease because of personal or family medical history and/or findings from a physical assessment. Family history is a valuable and cost-effective tool that is often underutilized in clinical practice. Many common genetic conditions result from complex interactions between genetic and environmental factors. It is critical to collect information about potential environmental exposures to help inform a patient’s risk assessment. Health care professionals should become familiar about toxic environmental agents that are common in their specific geographic location. A growing number of Food and Drug Administration (FDA) approved drugs have labeling that includes pharmacogenomic information, which can be used to optimize drug dosage and prevent adverse and life-threatening drug reactions in a patient or family member.
Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.
An individual’s identity development, including his or her preferred gender identity, is a lifelong process, which starts with the earliest interactions with the world. The concepts of gender identity have been explored, studied, debated, and discussed for decades and are currently going through a resurgence of examination, especially in Western cultures. This chapter provides an overview of gender identity development, beginning with an explanation of terms, followed by an exploration of theoretical perspectives which includes cognitive developmental theory, social learning theory, gender schema theory and feminist theory. Topics include current research and perspectives on how gender identity evolves in children and recent shifts in understanding atypical gender identities, including transgender, gender neutral, and gender fluid identification. Finally, implications and strategies for mental health professionals are discussed, especially related to counseling those who are experiencing conflict or distress surrounding issues of gender and gender identity.
This chapter focuses on the Scientific Revolution, a period of time roughly from the 16th to 17th centuries in which radical new developments and changes regarding the study of the natural world occurred as central to understand what science is. The development and establishment of what is usually taken to be the characteristic methodology of science has always been regarded as constitutive of the Scientific Revolution. The Scientific Revolution developed a “realist” view of mathematics in which it is believed that mathematical analysis reveals deeper truths about the world. During the Scientific Revolution, the naturalistic elements of magic were separated from other aspects of magic. In the most general terms, the Scientific Revolution introduced a completely different worldview, replacing a medieval/Renaissance teleological world with a modern mechanistic world. The Scientific Revolution is a complex phenomenon in itself and part of a larger complex social change in the West.
- Go to chapter: Next Steps Toward Practice Knowledge Development: An Emerging Epistemology in Nursing
This chapter focuses on introductory arguments about the Doctor of Nursing Practice (DNP) student and graduate’s clinical scholarship, a future practice-oriented nursing epistemology. It explores a model of scientific inquiry and stewardship for the nursing discipline through the development of a body of practice-oriented nursing knowledge to improve health. There is a very strong case to be made that the “good science” evolving from the DNP programs where nursing epistemology and practice knowledge development is valued is indeed being conducted within the framework of a Mode 2 knowledge production paradigm. Finally, there is an operational concern for how practice knowledge is made formal within the academy before it is then further synthesized, reduced, and disseminated in journal format and oral presentation. Practice knowledge generation only needs rigor, proper mentoring, an inquiring mind, and some creativity.
This chapter explores how practicum training may be enhanced through effective collaboration between trainers and field supervisors. Successful practicum training requires strong collaboration between the trainee’s university or institution and the supervising field psychologist. Successful collaboration between the university and field site includes consideration of site development and maintenance, effective communication, and training and support across settings. Field placement and coordination play a critical role in the training of school psychologists. The individual fulfilling this role may be recognized with a variety of formal titles, such as field placement coordinator, clinical professor, or director of clinical training (DCT). One of the primary responsibilities of the DCT is the coordination and supervision of practica-related activities, including the placement of candidates in appropriate training sites. The chapter focuses on how supervisors can address trainee problems of professional competence, develop and use remediation plans successfully, and help trainees balance fieldwork with coursework.
This book integrates theory and practice, and addresses the key principles of sport, exercise, and performance psychology. It reflects the broadening of sport psychology studies to encompass more widespread human performance research. Chapters address such essential concepts as the key principles of sport, exercise, and performance psychology, individual differences, identity development, individual differences associated with personality, motivation, self-efficacy, stress and coping, injury, decision making, job opportunities, and burnout in the context of human performance. Motivation is likely one of the most critical variables in determining one’s behaviors and ultimate success because it impels them to act or sit still. Self-efficacy is said to influence whether people are optimistic or pessimistic, the goals they select, and their willingness to persist in the face of failure. Stressors fall into one of three possible categories-bioecological, psychointrapersonal, and/or social. Bringing these topics to life are companion “Applying the Concepts” chapters demonstrating how these principles are directly applied in real-life situations. The text focuses on the core theories underpinning sport psychology. Interviews with researchers, coaches, athletes, and other individuals from performance-intensive professions vividly reinforce the book’s content. Additionally, the book contains insights on theories and research findings that students can apply to their own experience.
This chapter addresses the key principles of sport, exercise, and performance psychology. It reflects the broadening of sport psychology studies to encompass more widespread human performance research. It provides Dr. Sachs’s honest and open remarks along with interspersed additions from the authors to introduce the field and its accompanying issues. In explaining his career trajectory, Dr. Sachs recalls earning his undergraduate degree in psychology and then applying to graduate programs in applied behavioral analysis. Dr. Sachs’s somewhat zigzagged trajectory in the field demonstrates the important sport and exercise psychology principle that explains the benefits of focusing on the process rather than the outcome when setting goals. Dr. Sachs added that the United States leads the way in research and writing with regard to sport and exercise psychology, while other countries may be more advanced in the application of that knowledge at the professional levels.
This chapter addresses the key principles of sport, exercise, and performance psychology. It reflects the broadening of sport psychology studies to encompass more widespread human performance research. The topic of decision making has been covered in psychology, economics, and motor learning but addressed very sparsely in sport, exercise, and performance psychology. Rational decision making requires defining the problem, identifying criteria, weighing those criteria, generating alternative solutions, and ultimately computing the optimal decision. The chapter introduces the literature on decision making and provides examples of factors that influence the choices people make. The decision to act, move, or what move to make is decided in the response selection stage, and the final stage is when one’s brain and muscles are organized to make the actual move. The key to improve the decision-making over time is to increase personal awareness of own limitations and keep learning and collecting information from reliable sources.
Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.
Objectives have been used for decades in nursing education to set the stage for what is expected of students and to guide faculty in planning teaching and assessment. However, nursing education is evolving and the timeworn practices used to write objectives must evolve as well. This chapter focuses on how to write broad behavioral objectives to support learning in a constructivist, learner-centered online environment to guide teaching and learning that are in step with today’s innovations in education and that follow the call for radical transformation in nursing education. Objectives focused on the desired learning outcomes or intended behavior changes, termed performance. The psychomotor domain is the skills domain in the narrow sense of the word, in that this domain provides a means of identifying outcomes that involve fine, manual, and gross motor movements.
The creation of the online course in the learning management system (LMS) requires a certain comfort with technology, but more important, consideration of interface design, or the computer-user interface with the goal of making the interface as user-friendly or intuitive as possible. Success in this endeavor depends on understanding the relationship of the syllabus and organization of the LMS. This chapter focuses on expanding on that information to create consistent navigation in the LMS week after week, taking advantage of the efficiencies available in most LMSs, and basic interface design principles. Interface design is also referred to as the computer-user interface. The LMS design should be intuitive and easily navigated so that students can focus on learning and not spend an undue amount of time locating information. In a constructivist, learner-centered teaching paradigm, the lecture as the primary means of teaching has fallen out of favor, especially when teaching online.
This chapter provides a guide to conducting a life history from conceptualization to dissemination. Life history is used to explain an individual’s understanding of social events, movements, and political causes, that is, how individual members of groups or institutions see certain events and how they experience and interpret those events. As it is unlikely that nurses will be conducting traditional fieldwork to gather life histories because of the extensive periods of time involved, the chapter describes the process for collecting focused life histories by researchers whose only purpose is to document the story of the participant and not to frame this life history within a broader ethnography. It considers life history as a sociocultural methodology and leave oral history on historical research and life review to the one on clinical literature.
Grounded theory is a systematic qualitative research method of data collection and analysis, ultimately leading to a theoretical explanation (a “grounded theory”) that is grounded in those data and that explains a phenomenon of interest. Widely used in nursing, grounded theory enables researchers to apply what they learn from interviewees to a wider client population. This book describes traditional and focused grounded theory, phases of research, and methodology from sample and setting to dissemination and follow-up. The grounded theory method was developed by Glaser and Strauss, in response to Blumer’s call for a method founded on concepts of symbolic interactionism, the social psychological theoretical framework that provides the guiding tenets of grounded theory methodology. Over the years, grounded theory has undergone an evolution of sorts. An alternate method of grounding data in qualitative research is dimensional analysis. Other scholars have developed variants of grounded theory, such as constructivist grounded theory and situational analysis. The book describes the extent to which nurse researchers have published grounded theory and presents an overview of the process of conducting a qualitative study using grounded theory as the method. Varied case studies range from promoting health for an overweight child to psychological adjustment of Chinese women with breast cancer to a study of nursing students’ experiences in the off-campus clinical setting, among many others. The book also discusses techniques whereby researchers can ensure high standards of rigor. Examples from published nursing research, with author commentary, help support new and experienced researchers in making decisions and facing challenges.
This book provides school personnel with information on how concussion (mild traumatic brain injury) can affect learning, mental health, and social-emotional functioning, skills in developing and leading a school-based concussion support team, tools for school-based concussion assessment, and information on a safe, gradual process of returning to the academic environment. It explains what happens to the brain at the moment of impact, terminology, prevalence rates, causes, risk factors, and issues related to underreporting of concussions. Educators will learn about developmental effects, how concussions can affect students of different ages, as well as difficulties that can result from concussions such as postconcussion syndrome and second impact syndrome. This book presents a school-based concussion team model, including the specific responsibilities of the concussion team leader (CTL), and a discussion of maintaining student privacy through regulations like the Health Insurance Portability and Accountability Act of 1996. Readers are familiarized with checklists that can be used within the school and assessment tools such as Acute Concussion Evaluation (ACE) and neuropsychological assessment. Readers are also familiarized with how physical and cognitive rest can be balanced with a return to activity during the recovery period. This book also book gives concussion team members guidance on the selection of appropriate strategies, as well as decision making during a student’s return to academics, and discusses concussion prevention information by providing guidance on how readers might train others on concussion recognition and response. Case studies are integrated throughout the chapters.
This chapter includes information related to the clinical evaluation of a concussion that a child might receive in a medical setting. It discusses guidelines for appropriate use of smartphone concussion evaluation apps. This chapter examines a brief section on the future of concussion assessment. The Acute Concussion Evaluation (ACE) can help the school concussion team obtain information regarding the injury, including the cause, severity, any amnesia, loss of consciousness (LOC), and any early signs. The computerized neurocognitive assessment typically measures player symptoms, verbal/visual memory, attention span, working memory, processing speed, response variability, nonverbal problem solving, and reaction time. Neurocognitive tests, sideline assessments, and smartphone apps can help district staff and parents determine the severity of a student’s symptoms. A neuropsychological assessment to assess cognitive functioning, memory, speed, and processing time may also be administered.
This book delivers everything nurses and other health researchers need to know about designing, testing, selecting, and evaluating instruments and methods for measurement in nursing. It features the most current content, strategies, and procedures available with direct applicability to nurses and health researchers engaging in interprofessional research, collaboration, education, and evidence-based practice. Chapters focus on challenges in using big data, evaluation, and measurement in interpersonal practice and education; metrics and benchmarking in health education and practice; and measurement issues in translational science. The book gives particular attention to measurement issues resulting from changes in nursing, health research, and the increased emphasis on and undertaking of interprofessional research and evaluation. Presenting the material in step-by-step format, the book is designed for readers with little or no experience in measurement, statistics, or interprofessional issues. It focuses on increasing the reader’s ability to use measures that are operationalized within the context of theories and conceptual frameworks, derived from sound measurement principles and practices and adequately tested for reliability and validity. Additionally, the text provides a pragmatic account of the processes involved in several aspects of measurement such as content analysis, interviews, and questionnaires. In nursing and health research, the Delphi technique is used for obtaining judgments from an expert panel about an issue of concern that is designed to structure group opinion and discussion. Visual analog scale (VAS) can be used even in high-stress, high-volume clinical settings, such as emergency departments.
The health professions have taken very seriously the importance of ethical considerations in research and practice. Most of the ethical issues regarding measurement of human subjects have been addressed in connection with biomedical and social research. Three basic, comprehensive ethical principles provide the foundation for the guidelines, recommendations, and standards that provide for the rights and well-being of human subjects in measurement and research: respect for persons, beneficence, and justice. In accordance with these ethical principles, researchers are obliged to recognize and protect the basic rights of subjects in measurement activities. The Health Insurance Portability and Accountability Act (HIPAA) privacy regulations took effect on April 14, 2003. These provisions, which require health care organizations and providers to protect the privacy of patient information, underscore the importance of privacy in the measurement context, and limit communication and use of individual patient health information in both practice and research.
This chapter addresses selected measurement issues that threaten the reliability and validity of the measurement effort. Topics include social desirability, process and outcome measurement, measuring state and trait characteristics, cross-cultural measurement, and triangulation. During the selection and/or development phase of instrumentation, the investigator should consider how the respondent is likely to think about each item when responding to the measure of interest. Outcome measures help health care and social welfare agencies establish indicators against which to evaluate the success of changes made to bring about improvement, and to identify areas in processes, programs, or interventions in which improvements are still needed. The specific process that is the focus of measurement should be clearly defined in a manner that captures the essence of its characteristics. Within nursing, specific nursing interventions or programs are common processes that are the focus of measurement.
One of the most important findings from the original battered woman syndrome (BWS) research was the existence of a three-phase cycle of violence that could be described and measured through careful questioning of the battered woman. This chapter describes the cycle, updates it by adding information from the courtship period, and divides the third phase into several different sections where appropriate so that there may not be any loving contrition or even respites from the abuse at times during the relationship. Teaching the woman how her perception of tension and danger rises to an acute battering incident after which she experiences feelings of relief and then gets seduced back into the relationship by the batterer’s loving behavior, often similar to what she experienced during the courtship period, has been found to be helpful in breaking the cycle of violence that keeps the woman in the relationship.Source:
The electrical discharge of neurons associated with seizure activity stimulates a marked rise in cerebral metabolic activity. Estimates from animal experiments indicate that energy utilization during seizures increases by more than 200", while tissue adenosine triphosphate (ATP) levels remain at more than 95" of control, even during prolonged status epilepticus. The brain generally withstands the metabolic challenge of seizures quite well because enhanced cerebral blood flow delivers additional oxygen and glucose. Mild to moderate degrees of hypoxemia that commonly accompany seizures are usually harmless. However, severe seizures and status epilepticus can sometimes produce an imbalance between metabolic demands and cerebral perfusion, especially if severe hypotension or hypoglycemia is present. A marked increase in glutamate release, which occurs during a prolonged seizure, is likely to result in the activation of all types of glutamate receptors. Although kainic acid produces seizures in the immature brain, it produces little cytotoxicity.
The purpose of the life histories is to introduce doctoral students to a methodology that is not usually covered in qualitative texts but that has applicability to the study of nursing phenomena. Three doctoral students conducted abbreviated life history interviews as a class assignment for their course on qualitative methods. Their interviews were part of a larger study by de Chesnay on successfully overcoming adversity, for which she obtained institutional review board (IRB) approval from the university. The first publication was a set of life histories with successful African American adults. The second publication was a series of life histories conducted by master’s degree students on clinical topics related to their interests. These topics were surviving colostomy surgery, multiple sclerosis, and bereavement. The third publication involved undergraduate nursing students who interviewed affluent adolescents about their experiences of substance abuse.
This chapter presents an overview of the state of the art ethnographies conducted by nurses and highlights a few works by the early generation. An extensive search of the literature was conducted to identify ethnographies completed by nurses. Nursing knowledge was a common thread throughout the literature reviewed. The literature review revealed the progress nursing is making in recognizing this gap and attempting to close it. Nursing knowledge is essential in patient care. Using the ethnographic method of inquiry, nurses have been able to identify areas of need both in knowledge and practice and make recommendations for enhanced practice. Caring and patient advocacy were other common themes in the literature. Caring is the essence of nursing and consequently should be incorporated in nursing research. The common purpose of the ethnographic studies reviewed was to explain or understand a phenomenon to increase nursing knowledge.
This chapter provides a brief overview of the research followed by a discussion of what issues the author considered in preparing a qualitative design, the challenges faced while conducting the study, and lessons learned from the process. Comparative politics and public policy are the two areas the researcher chose to focus on health policy. The process of seeking government assistance for a problem and obtaining a response is called the policy process. This process is composed of agenda setting, government response, program/policy implementation, and evaluation. Facilitators and barriers for implementing needle exchanges (NEXs) were identified and were available to policy makers to consider in planning and implementing NEX programs. The value of a shared philosophy about drug use, drug users, and implementation strategies was clearly important as an implementation strategy to the policy community.
This chapter presents the anatomy review of the human heart. The human heart is a hollow four-chambered muscle that is responsible for pumping blood throughout the body. The heart lies in the mediastinum in the thorax, pointing toward the left of the midline. The heart consists of four main layers: the pericardium, epicardium, myocardium, and endocardium. The epicardium is the outermost layer of the heart muscle. The middle layer of the heart is called the myocardium. The innermost layer of the heart is the endocardium. The heart is divided into right and the left side. The right side of the heart contains the right atrium and right ventricle. The left side of the heart contains the left atrium and left ventricle. The heart has four valves: tricuspid valve, mitral valve, aortic valve, pulmonary valve; acting as tiny doors that keep the blood moving in one direction.
The chapter explores how to measure the electrical direction for the P wave, the QRS complex, and the T wave, as well as for other forces. It provides a method for determining the direction of the electrical force for any of these waves, or complexes, on the electrocardiograph (EKG). The heart produces electrical and mechanical energy on a continuous basis. Both forms of energy come from specialized cardiac muscle fibers. These fibers provide electrical signals and mechanical energy that physically pumps the blood. Although the EKG does not show that mechanical energy, it can be used to measure a variety of electrical events. When a force is abnormal in size or direction, it may indicate that the specific part of the heart producing the force is abnormal. Therefore, learning the normal electrical direction of forces in the heart provides a simple and scientific way of understanding and interpreting an EKG.
This chapter explains various types of heart blocks such as premature atrial contraction, sinus arrest and asystole. It explains various types of pacemakers such as ventricular pacemaker and artrial pacemakers. Junctional rhythm is a regular rhythm. A P wave is frequently not seen because the rhythm originates in the AV junctional node. Junctional rhythm may be a manifestation of digitalis toxicity, sick sinus syndrome, and acute inferior wall infarction. Pauses are most commonly caused by premature atrial contractions (PACs) that do not conduct down to the ventricle and generate a QRS complex. These are called nonconducted PACs (NCPACs). Asystole is a prolonged period of no electrical activity. Cessation of function of the sinus node is called sinus arrest. Normally, when sinus arrest occurs, another pacemaker must take over, such as the junction or the ventricles. Ventricular pacemaker rhythm demonstrates a vertical electrical artifact (EA) at the beginning of the QRS.
This chapter presents the case examples of pressure and volume overload on the left ventricle and provides list of criteria for the diagnosis of Left Ventricular Hypertrophy (LVH) on the electrocardiogram (EKG). It also describes and explains how to identify ST changes in LVH and LVH simulating anterior wall infarction on the EKG. LVH refers to an increase in the wall thickness or dilation of the left ventricle. LVH is often the result of increased pressure, or volume, within the left ventricular chamber. Mitral regurgitation (MR) occurs when the mitral valve allows the backflow of blood from the left ventricle into the left atrium. The most common cause of pressure overload is hypertension (HTN). Hypertrophy of the left ventricle increases the amplitude of the left ventricular forces, because more mass generates more electricity. In LVH, the frontal plane, the horizontal plane, or both may show increased QRS amplitude.
You CAN Teach Med-Surg Nursing!:The Authoritative Guide and Toolkit for the Medical–Surgical Nursing Clinical Instructor
This book gives readers all the direction and resources they need to be a confident and competent medical-surgical nursing clinical instructor. It offers insight and examples related to student evaluations, syllabus preparation, and contracts that would typically be used by an adjunct instructor. Week-to-week instruction, along with medication quizzes and student learning activities, helps ensure that students are learning new knowledge and skills on an ongoing basis. A caring plan and medication forms are included, along with medication administration guidelines. The major body systems are addressed, with comprehensive resources included on each one. The increasingly significant topics of delegation and patient teaching are also included. Each clinical week is prepared and sequenced in such as way as to provide the clinical instructor with enough material to teach without redundancy. Each clinical course must meet for a certain number of hours to ensure the student is meeting attendance requirements. When a student misses a clinical class, a makeup assignment should be given to meet the attendance requirement. There are several types of assignments included in the book on makeup assignments. The work assigned for the makeup assignment must be written in American Psychological Association (APA) format and must be thoroughly investigated with reliable evidenced-based references. The assignment should be detailed enough to makeup for the hours missed.
This chapter examines pre- and postconference expectations and activities, explores forms to be used by the professor and the students, suggests care plans and patient assignments, and describes sample concept maps and a math skills assessment. A student with no experience in health care may be shy or sheepish when it comes to hands-on care. It may be of benefit for the students to be paired in the first few weeks of clinical classes. The care plan forms can help guide the student through the nursing process. Medication forms will help the student learn about various medications. Nursing education has adopted the use of concepts maps to assist students in gathering patient information. Patient safety is the number one priority for all health care professionals. Dose calculations are a daily activity for nurses.
This chapter discusses basic review of the admission process, and describes an admission assessment exercise that allows students to assume the roles of both patient and nurse. It also describes the role of nurse in which the student learns to collect patient data and record data appropriately, and also explains the role of the electronic medication administration record (eMAR). Preconference begins with a review of the skills previously mastered: hand washing, obtaining vital signs, and performing those daily nursing activities such as taking assessments and collecting data on patients. The student is responsible for making copies of the nursing notes for the required clinical assignments. With the admission assessment exercise, the clinical instructor can discuss the correlation of the vital signs, medications, past medical history, and familial history. New designs in technology have facilitated new medication administration practices that will reduce the number of medication errors in health care facilities.
Teaching Cultural Competence in Nursing and Health Care, 3rd Edition:Inquiry, Action, and Innovation
Preparing nurses and other health professionals to provide quality health care in the increasingly multicultural and global society of the 21st century requires a comprehensive approach that emphasizes cultural competence education throughout professional education and professional life. The ideas and suggestions presented in this book are offered to stimulate new ideas and invite health professionals to explore new paths on the journey to developing cultural competence in themselves and in others. The book is divided into five parts. Part I is composed of three chapters filled with resources to help educators begin teaching cultural competence. Essential background information about the multidimensional process of teaching cultural competence offers a valuable guide for educators at all levels who are planning, implementing, and evaluating cultural competence education. Educators and researchers are continually challenged to measure outcomes following educational interventions. Part II addresses this challenge by introducing several quantitative questionnaires and assessment tools and discussing implementation and data interpretation strategies in a detailed, user-friendly approach that can be easily adapted by novice and advanced researchers. The tools include Transcultural Self-Efficacy Tool (TSET) and Clinical Setting Assessment Tool-Diversity and Disparity (CSAT-DD). Parts III, IV, and V offer a wide selection of educational activities that can easily be applied by educators everywhere. Three chapters provide a general overview and a menu of activities for use in three areas: the academic setting, the health care institution, and professional associations. Five chapters creatively link strategies via detailed case exemplars that spotlight various populations and settings. The book’s final chapter presents important implications for educators everywhere.
- Go to chapter: Social Work and the Law: An Overview of Ethics, Social Work, and Civil and Criminal Law
This chapter demonstrates how social work ethics apply to ethical and legal decision making in forensic social work practice. It discusses the context of social work practice in legal systems. The chapter also details the basic structures of the United States (U.S.) civil and criminal legal systems. It lays the foundation for the criminal and civil court processes in the United States and introduces basic terminology and a description of associated activities and progression through these systems. The chapter focuses on providing an introductory, and overarching, picture of both civil and criminal law in the U.S. and introduces the roles social workers play in these systems. It focuses on the ETHICA model of ethical decision making as a resource and tool that can be used to help forensic social workers process difficult and complex situations across multiple systems.
This chapter explains the theoretical basis for motivational interviewing (MI). It reviews the empirical evidence for the use of MI with diverse populations in forensic settings. MI involves attention to the language of change, and is designed to strengthen personal motivation and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. It is now internationally recognized as an evidence-based practice intervention for alcohol and drug problems. MI involves an underlying spirit made up of partnership, acceptance, compassion, and evocation. The chapter discusses four key processes involved in MI: engaging, focusing, evoking, and planning. It also describes five key communication microskills used throughout MI: asking open-ended questions, providing affirmations, offering summarizing statements, providing information and advice with permission, and reflective statements.
In this chapter, the author began working in international medical humanitarian aid, with an organization called Medecins Sans Frontieres/Doctors without Borders (MSF). Pediatrics and Pediatric Intensive Care are where the author’s nursing career had started. With assignments in the Democratic Republic of the Congo (DRC), Haiti, and South Sudan, the author have provided care for people who have been displaced due to conflict, victims of war trauma, women with high-risk pregnancies, malnourished and critically ill children, and people with HIV and tuberculosis, and responded to outbreaks of preventable illnesses such as measles and cholera. MSF opened the Sibut project, with a focus on providing care for young children and women of child-bearing age. The security system includes daily contact with all of the village leaders in Sibut, including the Catholic priests, the imams at the Muslim mosque, the village elders, and the militia leaders.
The author worked in a public health research lab, after graduation from college. She liked the flexibility of nursing and the promise to always have a job. She was fascinated by the intricacy of the mind-body intersection and how horribly wrong things could get with seemingly small perturbations. She felt that nursing school discouraged any consideration of a career in psychiatric nursing, as a mentor shared a comment by one of her advisors years ago that “only the bad nurses go into psychiatry”. A common occurrence was the admission of patients with psychiatric needs in addition to medical comorbidities. She cared for patients who had anxiety as a consequence of hospitalization, depression due to chronic illness, persons suffering from acute delirium, as well as someone with dementia secondary to HIV. Later she accepted a job at a local community health center that serves a predominance of Latino immigrants.
Today’s culture change movement is the result of an effort to change the impersonal nature of the nursing home environment and the “institutionalization” of individuals who reside in this setting. This chapter describes signs of “institutionalization” and explains the risks associated with individuals becoming institutionalized. It identifies similarities between institutional life and homelessness and describes core elements of culture change. The chapter reviews positive outcomes associated with culture change and describes the four stages of culture change. The stages of culture change are: the institutional model, the transformational model, the neighborhood model, and the household model. The chapter also describes the actions nurses can take to support culture change. Heightened interest in creating a different style of nursing home life is driving a transformation in this setting. Nurses need to be actively engaged in this process to ensure that change occurs thoughtfully and is based on sound evidence.
The Minimum Data Set (MDS) provides a uniform approach to conducting a comprehensive assessment that is recorded on a standardized tool. This chapter identifies the times when an MDS assessment must be completed. A registered nurse (RN) must conduct or coordinate the assessment with the input of other health team members and the resident. Upon completion, the MDS is electronically transmitted to the quality improvement evaluation system assessment submission and processing system designated by Centers for Medicare and Medicaid Services (CMS). The MDS offers a standardized approach for collecting assessment data. The chapter describes the data that are collected in the MDS assessment tool and explains the Care Areas and their purpose. It also describes the time period for which MDS assessments must be maintained by the nursing home.
Grief is the process that occurs before people come to acceptance. It can be a painful experience involving many different feelings. Losses includes health issues, loss of a career, loss of relationships, an unborn child, and/orability or desire to have children. Experiencing loss and grieving may include physical, emotional, social, and spiritual responses. Grieving is essential for coming to terms with and processing the trauma and resultant losses. Trauma and its accompanying sense of loss may result in a terrible sense of disappointment and failure. Working with mental health professionals and other survivors can be extremely helpful in working through the grieving process. The grieving process involves acknowledgment and acceptance of loss. Psychotherapy is a process of “re-parenting” the inner child who may have had less than ideal caretaking. The neural connections in the brain can heal and change with new experiences.
- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
- Go to chapter: ACT-AS-IF and ARCHITECTS Approaches to EMDR Treatment of Dissociative Identity Disorder (DID)
This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.
One way of thinking about procrastination is to regard it as a form of addiction; an addiction to putting things off. As with other addictive patterns, the client will choose a short-term gratification instead of going for a long-term result that might, in the end, be more satisfying or empowering. As with other addictions, a procrastinating client often suffers ongoing erosion of her self-esteem. Quite often, procrastination may function as a defense as a way to avoid other life issues that are disturbing. With this type of problem, we can use a variation of Popky’s addiction protocol, and the level of urge to avoid (LoUA) procedure. It is also important to use resource installation procedures to help the client develop an image of the benefits that would come with being free of this problem.
The important elements of the Eye Movement Desensitization and Reprocessing (EMDR) and Phantom Pain Research Protocol are client history taking and relationship building, targeting the trauma of the experience, and targeting the pain. This protocol is set up to follow the eight phases of the 11-Step Standard Procedure. This chapter presents a case series with phantom limb patients obtained a few before and after EMDR magnetoencephalograms (MEGs) at the University of Tübingen, Germany on arm amputees that show the presence of phantom limb pain (PLP) in the brain images before EMDR and the absence of it after EMDR. In these case series, it is found that PLP in leg amputations is much easier to treat than arm amputations, likely due to the much more extensive and complex arm and hand representation in the sensory-motor cortex compared to the leg and foot representation.
The CARES tool, in addition to assisting nurses with delivery of evidence-based care of the dying and viewing the care of the dying as an acute event, also needed to be portable and readily accessible. An extensive review of the literature found the most basic common needs of the dying included pain management and comfort measures, breathing assistance, control of delirium, emotional and spiritual support, and self-care for caregivers. This chapter discusses some issues: Nurses receive little to no education on care of the dying and feel they have minimal time to attend in-services, and can be resistant to learning new skills; communication is the foundation for end-of-life care; the nurses’ past personal and professional experiences with death can greatly impact the care they provide dying patients and their families. These issues and concerns helped organize and shape the final version of the CARES tool.
Embracing the role of a nurse practitioner with a doctorate in nursing practice (DNP) requires taking on the additional challenge of acting as an effective change agent. A DNP’s primary role is to act as a bridge between research and the bedside nurse. A strong clinical background assists in translating research findings into realistic evidence-based practices that nurses can readily incorporate into their daily routines. Nurses needed to learn what resources were available to meet the specific needs of the dying and how to promote a peaceful death. The CARES tool attempts to give some sense of order and structure to the care of the dying. The CARES tool is based on the immense educational resources provided by experts from the End-of-Life National Education Consortium (ELNEC), the National Consensus Project for Quality Palliative Care, and from evidence-based literature reviews.
This chapter presents an overview of the restorative justice movement in the twenty-first century. Restorative justice, on the other hand, offers a very different way of understanding and responding to crime. Instead of viewing the state as the primary victim of criminal acts and placing victims, offenders, and the community in passive roles, restorative justice recognizes crime as being directed against individual people. The values of restorative justice are also deeply rooted in the ancient principles of Judeo-Christian culture. A small and scattered group of community activists, justice system personnel, and a few scholars began to advocate, often independently of each other, for the implementation of restorative justice principles and a practice called victim-offender reconciliation (VORP) during the mid to late 1970s. Some proponents are hopeful that a restorative justice framework can be used to foster systemic change. Facilitation of restorative justice dialogues rests on the use of humanistic mediation.
This chapter describes some of the recent restorative justice innovations and research that substantiates their usefulness. It explores developments in the conceptualization of restorative justice based on emergence of new practices and reasons for the effectiveness of restorative justice as a movement and restorative dialogue as application. Chaos theory offers a better way to view the coincidental timeliness of the emergence of restorative justice as a deeper way of dealing with human conflict. The chapter reviews restorative justice practices that have opened up areas for future growth. Those practices include the use of restorative practices for student misconduct in institutions of higher education, the establishment of surrogate dialogue programs in prison settings between unrelated crime victims and offenders. They also include the creation of restorative justice initiatives for domestic violence and the development of methods for engagement between crime victims and members of defense teams who represent the accused offender.
In a method-limited research program, the researchers keep choosing the trodden path, the beaten path that keeps that path a sacred groove. The current state of knowledge on the research topic and the findings from the researcher’s most recently completed project help determine whether the next step in the program of research will lead down a quantitative path, a qualitative path, or perhaps a mixed methods path. Once that is decided, the specific type of quantitative, qualitative, or mixed methods research design is the next decision to be made. The ideal point of entry for a program of research is during doctoral studies. This chapter shows some types of minds a successful researcher needs to achieve one’s goals. The synthesizing mind is also needed for nurse researchers throughout a trajectory of research. With a creative mind, a person can break new ground and consider new ideas and ways of thinking.
This chapter provides guidelines for psychologists on the assessment of oral language proficiency (OLP) of culturally and linguistically diverse (CLD) children and adolescents who study in their second language (L2). It discusses the issues that should be considered in the assessment of OLP, including the aspects of oral language that should be assessed in L1 or L2, the factors that should be considered in interpreting assessment data, and the advantages and challenges of assessing children in their L1. The chapter then describes specific methods for assessing OLP. It discusses issues involved in interpretation of data from OLP assessments, including a discussion of the diagnosis of a language disorder. The chapter also explains specific tasks and observational schedules that psychologists might find helpful when conducting assessments of OLP.
The most challenging and arguably most important part of any assessment is the diagnostic formulation and recommendations for intervention. This chapter explains clinical decision making and diagnostic formulation using a developmental systems approach (DSA) that is based on developmental bioecological theory. It provides suggestions for organizing assessment data and methods for thinking about the data in order to formulate the case systemically. The chapter discusses key issues involved in linking assessment with academic and psychosocial intervention. It reviews the knowledge, strategies, skills, and attitudes that are essential competencies for psychologists who conduct assessments with culturally and linguistically diverse (CLD) children and adolescents. Assessments and intervention with CLD children and adolescents are both challenging and rewarding. Psychologists who work with these children and families effectively have a set of attitudes that stimulate them to find information and research, as well as develop effective strategies.
Nursing practice is a symbiotic relationship between the art and science of professional care. One cannot exist in isolation from the other. Nurses are inclined to connect the art of nursing with terms such as compassion, caring attitudes, the therapeutic relationship, presence, professionalism, advocacy, and competence, otherwise known as the “soft or caring side of nursing”. The greatest threat to the disappearance of the art of nursing lies with the perceived “big three”: time, fiscal restraint, and failure of the system to support a full staff of nurses, so those employed are working at full capacity. It is important to recognize that different practice settings have varying needs. One size does not fit all. Yet the requirements for nursing assessments, developing a plan of care, coordinating care with other health care providers, implementing interventions, and evaluating care outcomes are a requirement of all.
This chapter discusses both successes and failures in affiliation and collaboration techniques among nonprofits, including details on what the parties involved found to be the most valuable or most problematic aspects of the affiliations. It explores an overview of what has been and is versus what could be in the business models for both the nonprofit and the for-profit sectors, with the aim of shaking things up in the nonprofit world’s business-as-usual model. Clearly, a new business model is needed for the new paradigm, one that enables nonprofit organizations to adapt to the industry’s greater demands and the emerging market for corporate control without sacrificing core values. Capitalizing on the opportunities presented by the new human service paradigm will require nonprofit providers to adopt a new business model that is both capable of pursuing traditional consolidation strategies and supported by innovative organizational and financial designs.
- Go to chapter: Administrative Consolidations, Administrative Services Organizations, and Joint Programming
This chapter focuses on a series of case studies and best practices for partnerships that discuss in detail the provision of back-office support for nonprofit partners. Public Health Management Corporation (PHMC) is a nonprofit public health institute that creates and sustains healthier communities using best practices to improve community health through direct service, partnership, innovation, policy, research, technical assistance, and a prepared work force. Traditional back-office services are usually designed to address many of the challenges of today’s changing nonprofit environment. Services depend on the level of organizational need and affordability, but are usually identified through a comprehensive organizational assessment of the nonprofit client. The Urban Affairs Coalition (UAC) is a Philadelphia-based nonprofit that was founded in 1969 following a historic meeting between the city’s business and community leaders. Most nonprofits never rise to the scale of having a full internal administrative staff and purchased equipment.
For nonprofit agencies, there are generally two ways of growing: organically, which takes longer and is more detailed, or through strategic partnerships with other nonprofits. This chapter focuses on a wide range of strategic partnerships. Few nonprofits in the sector, other than hospitals and insurers, enter into strategic partnerships, and far fewer merge or affiliate with other nonprofits. The Public Health Management Corporation (PHMC), however, is one of the rare nonprofit health and human service organizations that has been engaged in mergers and affiliations in the past 20 years. Environmental factors such as increased organizational competition or decreased foundation or donor funding encourage nonprofits to contemplate mergers. Nonprofit mergers provide a variety of benefits including the opportunity for expanded social impact. Merged nonprofits can roll together annual audits, combine insurance programs, and consolidate staffs and boards. Mergers and affiliations are one way that organizations are attempting to temper competition.
This chapter focuses specifically on nursing research program vertical infrastructure. Vertical infrastructure refers to the pillars of the program: the foundation that provides the support to build other services. Three essential components are used to develop a solid nursing research program foundation that advances the scientific foundation of nursing practice and promotes integration of evidence-based practices. The three components are nurse researchers who coach or mentor clinical nurses in nursing research, intranet website resources, and a research departmental database. A successful nursing research program is contingent on having the right nurse researcher personnel who can move research from project inception to dissemination in peer-reviewed literature and translation into practice. Nurse leadership may benefit from educational programs or a business plan that includes the benefits of a nursing research program and information about how a specific nursing research program aligns with strategic goals.
This chapter provides examples of programs and services beyond the foundational elements and global resources that can be used to overcome traditional nursing research barriers. It is assumed that at least one doctorate-prepared nurse researcher is available to facilitate research opportunities and educate nurses about research and evidence-based practice. Many clinical nurses fully understand their clinical roles but are completely unaware of opportunities and resources in nursing research within their hospital. Since contributions of nursing research are vital to the science and art of nursing and provide foundation for evidence-based practices, it is important to overcome the traditional cluster of barriers that include problems with nursing research visibility/priority, time and money, and research education. Nurses need confirmation that nurse leaders support research; when it is visible, it is valued. Moreover, nurses need time, education, and resources to complete rigorous research that leads to discoveries and answers to important clinical problems.
This chapter addresses the need for dissemination of research and focuses on dissemination both inside the hospital organization and outside. Disseminating results of research is often the most exciting phase of the process, as it is the culmination and highlight of countless hours of work. Common areas for dissemination internally include presentations to colleagues on people’s unit, as well as across hospital organization. Internal presentations offer a direct way for people to provide new evidence for practice in their hospital organization. In addition, however, it is important that results of their research reach nurses and other health professionals nationally and internationally. Thus, people want to participate in media dissemination of their research, systematically look for calls for abstracts to present at professional conferences, and disseminate their research through professional publications. Disseminating results, whether internally or externally, by media, poster, oral presentation, or publication, requires effort and attention to detail.
This book presents theoretical underpinnings of perinatal and pediatric bereavement, chapters on dimensions of perinatal and pediatric loss that have been of interest recently, and clinical interventions derived from research. It is divided into two sections. The first section has 10 chapters focusing on aspects of perinatal loss. It presents background content on various grief theories developed in the past five decades. These theories have expanded our understanding of the processes of death, dying, and bereavement. Grief after pregnancy loss can be more complicated for certain groups. The book provides a comprehensive overview of perinatal grief among lesbian couples and an overview of perinatal loss in adolescents, discussing normal adolescent growth and development, and using Sanders’s integrated theory of bereavement to discuss the common physical, emotional, social, and cognitive reactions to loss. The second section has eight chapters focusing on various aspects of caring for families whose children are dying or who have died, and caring for children who are grieving. Sometimes, the death of a child can occur under traumatic circumstances, setting the stage for very intense psychological responses. The book focuses on the impact of the cause of the death on posttraumatic stress responses and overall parental health after the traumatic loss of a child and describes supportive interventions for bereaved parents. Suicide is one of the most traumatic losses a family can experience. Finally, the book presents the importance of creating and capturing meaningful moments in the time leading up to and after the death of a child, focusing on the importance of relationships among families and professionals as they prepare for the child’s death.
- Go to chapter: When the Unthinkable Happens: A Mindfulness Approach to Perinatal and Pediatric Death
This chapter explores traumatic grief and loss and discusses various treatments for it. It focuses on mindfulness-based interventions for specific use in traumatic grief with bereaved parents. Traumatic grief appears relatively responsive to the psychosocial approach, particularly when it includes exposure elements, such as retelling the story of the loss, reutilization, and building tolerance to the emotions associated with loss. More recently, Thieleman, Cacciatore, and Hill have presented evidence for a mindfulness-based, psychosocial approach for specific use in traumatic grief with bereaved parents. Western culture’s interest in mindfulness has grown exponentially, and practices have been integrated into a variety of general, psychotherapeutic treatment approaches including acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT), mindful- ness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR). Of all mindfulness practices, one of the most cost-effective strategies to help providers working with bereaved parents is meditation.
This chapter highlights key elements of adolescent growth and development and outlines communication strategies to serve as a guide for health care clinicians. It provides a summary of research findings on the adolescent female bereavement response to an early pregnancy loss prior to 20 weeks gestation like miscarriage, ectopic pregnancy, or elective termination. To gain a greater understanding of the adolescent response to pregnancy loss, it is helpful to review normal adolescent emotional and psychological development. Erik Erikson’s classic developmental theory offers an outline of the psychosocial tasks of adolescents. Blos described three separate phases of adolescence: early, middle, and late, which evolve throughout the transition from childhood to adult hood. Sanders’s integrated bereavement theory has been used to organize grief responses and the bereavement process. When adolescents have experienced an early pregnancy loss they will experience grief responses that are physical, emotional, social, and cognitive in nature.
Creativity must represent something different, new, or innovative. It has to be different and also be appropriate to the task at hand. The first chapter of the book deals with the Four-Criterion Construct of Creativity, which attempts to integrate both Western and Eastern conceptions of creativity. This is followed by a chapter which addresses how creativity operates on individual and social/environmental levels, and the effects and outcomes of the creative mind. Chapter 3 discusses the structure of creativity. A key work on creative domains is that of Carson, Peterson, and Higgins, who devised the creativity achievement questionnaire (CAQ) to assess 10 domains. The fourth chapter discusses measures of creativity and divergent thinking tests, Torrance Tests, Evaluation of Potential Creativity (EPOC) and Finke Creative Invention Task. Some popular personality measures use different theories, such as Eysenck’s Personality Questionnaire, which looks at extraversion, neuroticism and psychoticism. Chapter 6 focuses on a key issue, intrinsic versus extrinsic motivation and their relationship to creativity. While the seventh chapter deals with the relationship between creativity and intelligence, the eighth chapter describes three ’classic’ studies of creativity and mental illness which focus on the connection between bipolar disorder and creativity, usage of structured interviews and utilization of historiometric technique. One school admissions area that already uses creativity is gifted admissions—which students are chosen to enter gifted classes, programs, or after-school activities. The book also talks about creative perceptions and dwells upon the question whether creativity is good or bad.
As everyone knows, true creativity comes from simple formulas and the memorization of data. This chapter focuses on divergent thinking tests, which are still the most common way that creativity is measured. Guilford derived the core ideas behind divergent thinking as well as many popular measures. The people who score the Torrance Tests are specifically trained to distinguish responses that are truly original from those that are just bizarre. There are other tests that measure creativity, but most are either a variation on divergent thinking or use some type of raters. For example, the Evaluation of Potential Creativity (EPOC) has begun to be used in some studies and may be promising, but is still largely rooted in a mix of divergent thinking scoring and raters. Another test is the Finke Creative Invention Task, which is clever but also requires raters for scoring.
The Big Five, which this chapter discusses in more detail, are extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience. Each of these five factors represents a continuum of behavior, traits, and inclinations. There are some popular personality measures that use different theories, such as Eysenck’s Personality Questionnaire, which looks at extraversion and neuroticism as well as psychoticism. The personality factor most associated with creativity is openness to experience. Indeed, one way that researchers study creativity is by giving creative personality tests. Being open to new experiences may also help creative people be more productive. King found that people who were creative and high on openness to experience were more likely to report creative accomplishments. DeYoung and S. B. Kaufman, of course, are not the only people to blend or split different factors of personality to present new models. Fürst, Ghisletta, and Lubart suggest three factors: plasticity, divergence, and convergence.
This chapter explores three ’classic’ studies of creativity and mental illness. The first is Jamison whose focus is on the connection between bipolar disorder and creativity. The second is Andreasen, who used structured interviews to analyze 30 creative writers, 30 matched controls, and first-degree relatives of each group. The writers had a higher rate of mental illness, with a particular tendency toward bipolar and other affective disorders. The third major work is Ludwig, who utilized the historiometric technique. All three studies have come under serious criticism. Many of the studies of Big-C creators are historiometric, akin to Ludwig’s work. Some such studies claim that eminent creators show higher rates of mental illness. A much more common approach is to look at everyday people and give them measures of creativity and mental health. Typically, researchers look at what are called subclinical disorders—in other words, they’re not clinically significant.
One school admissions area that already uses creativity is gifted admissions—which students are chosen to enter gifted classes, programs, or after-school activities. Both education and business play great lip service to creativity. Puccio and Cabra review the literature on creativity and organizations and do a nice job of highlighting how every couple of years, a new report from industry emphasizes the importance of creativity. It is important to note that there is a large inconsistency between gender differences on creativity tests and actual creative accomplishment. Although gender differences on creativity tests are minor or nonexistent, differences in real-world creative accomplishment are large and significant. This chapter shows how creativity can play a role in admissions and hiring. Hiring measures tend to have better validity, even the general mental ability (GMA) measures; even if minorities score lower, the accuracy of prediction is consistent by ethnicity.
Creative people are also often seen as being outsiders and eccentric. Sen and Sharma’s examination of creativity beliefs in India tested beliefs about the Four P’s and found that creativity was more likely to be described as a holistic essence of an individual, and less likely to be focused on the product or process. Romo and Alfonso studied Spanish painters and found that one of the implicit theories that the painters held about creativity involved the role of psychological disorders. Plucker and Dana found that past histories of alcohol, marijuana, and tobacco usage were not correlated with creative achievements; familial drug and alcohol use also was not significantly associated with creative accomplishments or creative personality attributes. Humphrey, McKay, Primi, and Kaufman did find that illegal drug use predicted self-reported creative behaviors even when openness to experience was controlled.
This chapter explains the seminal Institute of Medicine (IOM) report: The Future of Nursing (
FoN): Leading Change, Advancing Health and the background organizations that wrote it. It demonstrates some key recommendations of FoN: Leading Change, Advancing Health report and its “fit” with Indian Country. The chapter differentiates between challenges in obtaining nursing education in Indian Country and those in dominant culture settings. The IOM’s effort with the Robert Wood Johnson Foundation (RWJF) on the FoN has been noticed by many, yet direct care nurses are largely unaware of the report. The chapter outlines the FoN recommendations into two groups: gaining education, practicing to its fullest scope, and pushing for more, including lifelong learning; and shaping policy, being at the table as full partners in health care redesign, and leading change. For American Indian/Alaska Native (AI/AN) nurses graduating from tribal colleges and universities (TCU), the majority will have an associate’s degree.
This chapter aims to give the behavioral health specialist (BHS) a basic understanding of pain, knowledge about how to effectively evaluate chronic pain, and a description of effective pain management techniques. Knowledge of the biological and psychological basis of pain is important to understanding the experience of chronic pain. A biopsychosocial assessment is the foundation for providing behavioral health treatment to the chronic pain patient. Chronic pain is less responsive to treatments commonly used for acute pain such as opioid analgesia and avoiding physical activity. A multidisciplinary team approach can substantially improve outcomes in chronic pain treatment. Whatever the format of service provision, utilizing multiple interventions such as physical therapy/exercise, emotional management, pacing, and medication, rather than a single modality can substantially improve outcomes for chronic pain. Providing psychoeducation about chronic pain can be an important strategy.
The medical model in psychiatry assumes medical intervention is the treatment of choice for the constellations of diagnosed symptoms that comprise various mental disorders. These treatments may include pharmacotherapy, electroconvulsive treatment, brain stimulation, and psychosurgery. Therefore, psychopharmacology for older adults can be considered palliative rather than a cure for a brain disease causing psychopathology. Older adults experience many psychopathological problems, including anorexia tardive, anxiety disorders, delusional disorders, mood disorders, personality disorders, schizophrenia, and co-occurring disorders with substance abuse/dependence disorders. Therefore, it is critical for the social worker to understand the various manifestations of psychological problems in older adults from the perspective of an older adult, rather than extrapolating information commonly taught in social work programs that neglect to focus on older adults and restrict teaching to psycho-pathological problems in younger and middle-aged adults.
The baby boom cohort brings with it multiple types of substance abuse. Bisexual older adults have more co-occurring psychological problems than heterosexual older adults, older gay males, and older lesbians. An interesting finding is that immigration is contributory to older adult substance abuse. Older adults with alcohol-abuse problems do not seek help for their problems. Rather, they are often identified as having an alcohol-use problem when seeking care for other medical or psychological problems. Social workers assessing an older adult for alcohol abuse often confuse symptoms of possible alcohol abuse with dementia. Prescribing opioids and synthetic opioids to an older adult is complicated. An older adult can suffer from many forms of inner tension. Combining motivational interviewing with cognitive behavioral therapy is shown to be more effective for treating substance abuse that either therapeutic modality alone.
For older adults, the phenomenon of death is accepted and does not induce the fear experienced by younger adults. Older adults who do not engage in end-of-life planning may receive unwanted, unnecessary, costly, and painful medical interventions or withdrawal of desired treatment. Many older people feel that the goal of palliative care is to make the best possible dying experience for the older adult and his/her family. In addition to palliative care, an older adult will most likely find himself or herself in an intensive care unit as part of his or her terminal care. Euthanasia, or hastened death, is seen by some as an alternative to palliative care. A psychological aspect of death that an older adult is concerned with, in addition to place of death, is whether he or she will die in his or her sleep or die suddenly, making the death experience an individual phenomenon.
Dorothea Lynde Dix was born into an upper-class, highly educated, intelligent, and politically connected Bostonian family. These opportunities provided the foundation necessary to propel her into a leadership role as national and international advocate for the most vulnerable groups in the mid-1800s. Dorothea utilized her Methodist father’s background to augment the teachings of her adopted religious calling, Unitarianism, which promises salvation through leading a directed life. This chapter explores her leadership role in this period of American history. It also shows how her family background, pursuit of education, personality, and religious commitment to humanitarianism enabled her to confront seemingly insurmountable obstacles to implement national and international reform of care for psychiatrically disabled and imprisoned populations. In the final phase of her career, Dorothea was chosen for a national role to lead nursing during the American Civil War, a role that she considered as within her scope of knowledge and skills.
Multiple physical changes can impair the mental health of the aging individual. These changes include: acid-based imbalances, dehydration, electrolyte changes, hypothermia or hyperthermia, and hypothyroidism. This chapter reviews the most common mental health disorders affecting the elderly population and trends affecting care delivery. Moreover, chronic, unresolved pain has been associated with an increased risk of a mental health disorder such as depression, suicide, or anxiety. The aging individual may exhibit signs and symptoms of insomnia such as sleeping for short periods during the night, sleeping during times of normal social activities, arising early in the morning while others sleep, and experiencing daytime sleepiness. The chapter concludes by applying the nursing process from an interpersonal perspective to the care of an elderly patient with a mental health disorder.
Depression is sometimes referred to as the common cold of psy-chopathology. Consistent with this aphorism, epidemiological studies demonstrate that depressive disorders are indeed rather common across the life span. Given the importance of the social relationships and context to understanding depression, it seems likely that culturally informed and diverse research will yield important findings about those critical components of human cognition, emotion, and social relationships that underlie risk for depression, as well as those that serve to aid in recovery from these disorders. Most researchers believe it is unlikely there is a direct effect of hormones on depression, but rather that they indirectly increase risk via any one of several mechanisms, including: the effects of hormones on brain development, the development of secondary gender characteristics that are generated by these hormones, or the hormonal changes that occur during the pubertal transition may interact with life events and the social context.Source:
Depressive disorders are characterized by etiological heterogeneity, which means that many diverse causal factors or causal pathways can lead to the same clinical outcomes. Women are at higher risk for depressive episodes beginning at early adolescence and then throughout the life span. Unipolar depressive disorders can onset at any point in the life span, but are most prevalent in late adolescence through early to mid-adulthood. Bipolar disorder (BD)s generally onset before mid-adulthood; new cases are rare thereafter. More severe cases of unipolar and bipolar disorders are characterized by a chronic/recurrent course. Both unipolar and bipolar disorders are commonly comorbid with other forms of psychopathology; overall severity and poorer outcome over time is associated with comorbidity. If gender differences are of interest, the effects of potential etiological factors are measured in persons of both genders and their associations with depressive disorders are statistically compared across genders.Source:
Respiratory disorders are the most common causes of illness and hospitalization in children. Respiratory disorders range from mild and self-limiting to life-threatening. Pediatric respiratory health is promoted through prevention, early detection, treatment of disorders, and education efforts. This chapter reviews common pediatric respiratory disorders, explores etiology of pediatric respiratory disorders, and discusses specific care of pediatric clients with respiratory disorders. Newborns have less mucous production, making them more susceptible to infection. Throughout childhood, infants/preschoolers have larger tongues, tonsils, and adenoids, which can cause airway obstruction even in the absence of disease. The common cold is the most common upper respiratory infection (URI) or nasopharyngitis. The causes of a URI include rhinoviruses, parainfluenza, and the respiratory syncytial virus (RSV). Pediatric disorders that affect the lower respiratory tract can be short- or long-term conditions depending upon the cause.
Musculoskeletal disorders are some of the most common causes of illness and hospitalization in children due to their active nature. This chapter reviews common pediatric musculoskeletal disorders, etiology of pediatric musculoskeletal disorders, and pediatric-specific care of musculoskeletal disorders. The musculoskeletal system supports the body structure and provides for client movement. Skeletal growth is most rapid during infancy and adolescence. Injury to the epiphysis can affect bone growth. The most common pediatric musculoskeletal disorders involve pediatric trauma. Torticollis is a symptom that causes a child’s chin to be rotated to one side and the head to the other side. The two most common disorders that can cause torticollis include: Congenital muscular torticollis, and Acquired torticollis. Osteomyelitis is an infection of the bone that occurs most often in infancy or between the ages of 5 and 14 years.
The endocrine or ductless glands work with the nervous system to regulate the body’s metabolic processes. Hormones interact with specific target organs to create an effect on the body. This chapter reviews the pathophysiology behind the metabolic system in pediatric clients. It describes nursing care required for pediatric clients with various metabolic conditions. The chapter explores instruction necessary for families of clients with metabolic conditions. Most of the glands and structures of the endocrine system develop during the first trimester of fetal development. Hormonal control is immature until approximately 18 months of age, leaving the infant prone to dysfunction of the endocrine system. Hundreds of hereditary biochemical disorders affect the metabolism. As the infant adjusts to life, symptoms can rapidly emerge that are life-threatening. The most common endocrine dis.
The “Image Director Technique” was developed to target recurring nightmares or bad dreams and those targets that are directly related to a traumatic experience. This technique is a special module that is embedded in the Standard Eye Movement Desensitization and Reprocessing (EMDR) Protocol. The technique begins with the worst image of the dream and then accesses and measures it as in Phase 3 of the Standard EMDR Protocol that includes the image, cognitions, emotions, and sensations. Clients are more likely to work with short clips or films if the subjective units of disturbance (SUD) of the target image is low. This technique can also be considered an imagery exposure method that is based in systematic desensitization, a behavioral approach. Often, clients prefer the tactile bilateral stimulation (BLS) because they can close their eyes in order to be visually undisturbed during the creation of the new images.
This chapter focuses on office automation and systems that are useful in the mental health field, along with principles to be aware of when considering the use or purchase of such systems. Most managers have to rely on input from outside in order to form an opinion about how to resolve complex issues. The complexity of the issue increases significantly when the current federal health care laws are incorporated into the task of choosing appropriate clinical information management software. The significance of Health Insurance Portability and Accountability Act (HIPAA) would seem to dictate at least a brief foray into its content because it lays the foundation for virtually everything that is happening in the clinical information management (CIM) realm. The information provided in the chapter can give a backdrop by which current practices can be examined for goodness of fit with the available client information management systems.