As individuals grow older, they experience biological changes, but how they experience these changes varies considerably. Senescence, or the process of aging, “affects different people, and various parts of the body, at different rates” (Zastrow & Kirst-Ashman, 2019, p. 644).

What factors affect the aging process? Why do some individuals appear to age faster than others? In this Discussion you address these questions and consider how, you, as a social worker, might apply your understanding of the aging process to your work with older clients.

To prepare for this Discussion, read “Working With the Aging: The Case of Francine” in Social Work Case Studies: Foundation Year.

Working With the Aging: The Case of Francine

Francine is a 70-year-old, Irish Catholic female. She worked for 40 years as a librarian in an institution of higher education and retired at age 65. Francine has lived alone for the past year, after her partner, Joan, died of cancer. Joan and Francine had been together for 30 years, and while Francine personally identifies as a lesbian, she never came out to her family or to her colleagues. When speaking to all but her closest confidantes, Francine referred to Joan as her “best friend” or her “roommate.” Francine’s bereavement was therefore complicated because she did not feel she could discuss the true nature of her partnership with Joan. She felt that there was little recognition from her family, and even some of her close associates, of the impact and meaning of Joan’s death to Francine. There is a history of alcohol abuse in Francine’s family, and Francine abused alcohol from late adolescence into her mid-30s. However, Francine has been in recovery for several decades. Francine has no known sexual abuse history and no criminal history.

Francine sought counseling with me for several reasons, including an ongoing depressed mood, a lack of pleasure or enjoyment in her life, and loneliness and isolation since Joan’s death. She also reported that she had begun to drink again and that while her drinking was not yet at the level it had been earlier in her life, she was concerned that she could return to a dependence upon alcohol. Francine came to counseling with several considerable strengths, including a capacity to form intimate relationships, a successful work history, a history of having maintained her sobriety in the past for many years, as well as insight into the factors that had contributed to her current difficulties.

During our initial meetings, Francine stated that her goals were to feel less depressed, to reduce or stop drinking, and to feel less isolated. In order to ensure that no medical issues were contributing to her depression symptoms, I referred Francine to her primary care physician for an evaluation. Francine’s physician did not find any medical cause of her symptoms, diagnosing Francine with moderate clinical depression and recommending that Francine begin a course of antidepressant medication. Francine was reluctant to take medication and first wanted to try a course of counseling.

In order to help Francine meet her goal of reducing her depression symptoms, I employed a technique called behavioral activation (BA), which is drawn from principles of cognitive behavioral therapy and helps to reengage people in pleasant physical, social, and recreational activities. We began with a small initial goal of having Francine dedicate at least 5 minutes of each day to an activity she found pleasant or rewarding. Over the following weeks, we increased the time. Francine’s treatment progress was monitored through weekly completion of the Patient Health Questionnaire (PHQ-9) in order to determine whether or not her depressive symptoms were improving.

I helped Francine address her drinking by reconnecting her with effective coping strategies she had used in the past to achieve and maintain her sobriety. These included identifying triggers for the urge to drink and exploring her motivations for both continuing to drink and for stopping her use of alcohol. Francine began attending regular meetings of Alcoholics Anonymous™ (AA) and found several meetings that were specifically for older women and for lesbians. In addition, Francine spoke regularly with a sponsor who helped her to remain abstinent during particularly stressful moments during her reengagement in sobriety.

Finally, in order to address Francine’s goal of feeling less lonely and isolated, we explored potential avenues to increase her social networks. In addition to spending time with her family, friends, and her AA sponsor, Francine began to visit the local lesbian, gay, bisexual, and transgender (LGBT), center for the first time in her life and attended a support group for women who had lost their partners. Francine also began spending time at her local senior center and went there at least three times a week for exercise classes, other recreational activities, and lunch. She also began to do volunteer work at her local library once a week.

Over several months of counseling, Francine stopped drinking; significantly increased her daily involvement in pleasant and rewarding activities, including social and recreational activities; and reported feeling less lonely, despite still missing her partner a great deal. Francine’s scores on the PHQ-9 gradually decreased over time, and after 16 weeks of counseling, Francine reported that she no longer felt she needed the session to move on with her life. In addition, Francine visited her primary care physician, who found upon evaluation that her depression had lifted considerably and that an antidepressant was no longer indicated. By the end of counseling, Francine’s focused work on identifying her depression symptoms and her triggers for drinking equipped her to better recognize when she might need support in the future and to whom she could reach out for help if she needed it.

By Day 3

Post a Discussion in which you:

• Apply your understanding of the aging process to Francine’s case. How might Francine’s environment have influenced her aging process? How might you, as Francine’s social worker, apply your knowledge of the aging process to her case?
• Identify an additional strategy you might use to apply your knowledge of the aging process to social work practice with older clients in general. Explain why you would use the strategy.

Performance management is, ideally, an ongoing quality-assurance-based process. The process provides an organization, its employees, regulatory agencies, accreditors, and other stakeholders with a structured means to support and accomplish mutually identified strategic goals and objectives.

Assume the role of a newly-hired risk management officer for a hypothetical new allied health organization in your chosen career field. You and your team will need to develop the organization’s policies.

The first item you will create will be a performance management plan. The HIM Briefings (2019) article, which includes Lean, Six Sigma, or PDSA, is located in the Topic Materials. Using the resources in HIM Briefings or another qualified framework, craft a proposal (1,250-1,500 words) for a performance management plan for the new organization that includes the following:

• Organizational Goals: Provide a statement of the organization’s goals regarding workplace safety, risk management, or quality improvement; select one area, and develop five goals for that specific area.
• Outline of Organizational Objectives: Outline and provide a brief evaluation of specific objectives that support the organizational goals you previously identified, to include the use of an interdisciplinary approach to patient care.
• Rationale: Evaluate the use of the interdisciplinary approach to patient care in the performance management plan. What provisions were planned in order to include this approach effectively?
• Quality and Process Outcomes: Describe the importance of quality and process outcomes within one’s scope of practice.
• Summary of Relevant Performance Measures: Summarize the steps and measures the new organization will adopt to measure performance. Consider (a) how well measures will align with the stated goals, (b) how these measures demonstrate the importance of quality and the relationship to positive health outcomes, (c) how the measures are able to be controlled by the organization (i.e., how the organization can affect change in this area), and (d) how the measures meet criteria related to reliability and validity, and are standardized.
• Performance Baseline: Determine a performance baseline for the measures selected. This will enable the organization to conduct comparisons of desired goals versus actual results over time.
• Performance Evaluation: Select one of three commonly accepted methods to measure provider quality. Summarize the features and why it applies best to the organization. Refer to the assigned reading, “The Measurement of Health Care Performance: A Primer from the Council of Medical Specialty Societies.” 
• Definition of Success: Define what success means to the organization. Now that you have chosen measures to assess organizational performance, identify what success means to the organization; otherwise, you are chasing a moving target. Be explicit in the level of performance you see as acceptable. This will change as an organization grows, but you need to start somewhere in order to get anywhere.

In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:

• Describe the project you propose.
• Identify the stakeholders impacted by this project.
• Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.
• Identify the technologies required to implement this project and explain why.
• Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.

Search the GCU Library and find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the Topic Materials or textbook.

Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template. See Chapter 5 of your textbook as needed, for assistance.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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

Minimum of 250 words with peer review reference

Ensuring the protection of human subjects is necessary when conducting research projects. What are some methods that can be used to protect personal rights of someone in one of the groups that is labeled as vulnerable? Consider how a patient’s values and your own clinical judgment must be considered before applying the evidence in clinical decision making for an individual patient.