Discussion: Developing a Philosophy, Goals, and Objectives

 

As addressed in this week’s Learning Resources, an organization’s philosophy statement derives from its mission and indicates the values and beliefs that steer decision making. An organization’s philosophy statement should be used to develop goals and objectives that lead to assured action.

 

As effective organizations recognize, “setting specific goals in a clear and compelling way—and insisting that people work together to achieve them—is the best way to get results” (Ashkenas, 2012, para. 9).

 

This Discussion builds on the Week 2 Discussion 2, as you create a philosophy statement, goals, and objectives for Mountain View Health Center, the organization featured in the case study introduced last week.

 

You will continue to work within the same small group. Note: You will develop an individual philosophy statement, goals, and objectives independently. Through the collegial exchange that follows, you will offer each other suggestions for refinement.

 

To prepare:

 

Review information on philosophy statements, goals, and objectives in Chapter 7 of the Marquis and Huston text and in the other Learning Resources.

Review the Mountain View Health Center case study presented in this week’s media, and reflect on the mission and vision statements you developed for Discussion 2 in Week 2.

Conduct additional research as necessary to strengthen your understanding of the process for creating a philosophy statement and developing goals and objectives and to deepen your thinking about the organization. For instance, you may research organizations with similarities to Mountain View and examine their philosophy statements, goals, and objectives.

Draft a philosophy statement for Mountain View Health Center.

Craft at least one goal and at least one related objective to operationalize the philosophy.

Consider what you have learned about the importance of the philosophy statement and the process of developing one, as well as the significance of and distinctions between goals and objectives.

 

Post a philosophy statement for Mountain View Health Center, at least one goal, and at least one related objective. Offer insights you have gained about the process of developing a philosophy statement, as well as the significance of and distinctions between organizational goals and objectives.

 

Read a selection of your colleagues’ responses. Consider the following:

Are the philosophy statements, goals, and objectives clearly written and easy to understand?

How well does the philosophy statement align with the mission and vision statements posted in Discussion 2 of Week 2? Does it reflect accepted values of the organization?

Are the goals and objectives specific, measureable, attainable, relevant, and time-bound?

How well do the philosophy statements, goals, and objectives reflect the stakeholders?

 

Respond to at least two of your colleagues on two different days by evaluating the strengths and weaknesses of their philosophy statements, goals, and objectives. Suggest opportunities for refinement.

 

Required Readings

 

Cara, C. M., Nyberg, J. J., & Brousseau, S. (2011). Fostering the coexistence of caring philosophy and economics in today’s health care system. Nursing Administration Quarterly, 35(1), 6–14.

Retrieved from the Walden Library databases.

 

The article addresses caring as a part of mission and philosophy and the benefits of this for nursing satisfaction and performance, patient satisfaction, quality of care, and cost reduction.

Lorenzi, N. M. (2011). AMIA’s realigned strategic plan. Journal of American Medical Informatics Association, 18(2), 203–208.

Retrieved from the Walden Library databases.

 

As you read this article, consider the process used to set goals and evaluate the extent to which the identified goals are specific, measureable, attainable, relevant, and time-bound.

                

              

Kenny, G. (2012). From the stakeholder viewpoint: Designing measurable objectives. Journal of Business Strategy, 33(6), 40–46.

Retrieved from the Walden Library databases.

 

Measurable objectives are an important part of the strategic planning process, yet many organizations struggle with formulating good objectives. In this article, the author suggests strategies for developing better objectives, which will then facilitate the planning process.

Urbanski, J., Baskel, M., & Martelli, M. (2011). Strategic planning—A plan for excellence for South Haven Health System. Nursing Administration Quarterly, 35(3), 227–234.

Retrieved from the Walden Library databases.

 

The article addresses stakeholder involvement as a key component of South Haven Health System’s success in strategic planning and describes how the system develops goals and objectives.

 Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., . . . Rosamond, W. D. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic impact goal through 2020 and beyond. Retrieved from http://circ.ahajournals.org/content/121/4/586.full.pdf+html

 

As you read this report, consider the process used to set goals and evaluate the extent to which the identified goals are specific, measureable, attainable, relevant, and time-bound.

Required Media

 Laureate Education (Producer). (2013b). Case study: Mountain View Health Center [Interactive media]. Retrieved from CDN database. (NURS 6241)

 

This interactive multimedia piece presents a case study of an organization, with information about the types of activities performed there, organizational structure, strategic priorities, and financial allocations. You will use this as a resource for this week’s Discussion.

Optional Resources

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Chapter 7, “Strategic and Operational Planning” (pp. 138–161)

 

Review as needed.

Sare, M., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care.Sudbury, MA: Jones and Bartlett.

Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action” (pp. 117–143)

 

Review as needed, focusing on the information about goals and objectives.

Kramer, M., Schmalenberg, C., & Maguire, P. (2010). Nine structures and leadership practices essential for a magnetic (healthy) work environment. Nursing Administration Quarterly, 34(1), 4–17.

Retrieved from the Walden Library databases.

 

The authors discuss the clinical environment of nursing and the leadership practices needed to promote quality patient care outcomes.

For this task, you are required to read a case study question and address the concerns raised. I have attached support documents to guide your approach of this paper in kind. My friend has sent the below message to help elaborate further this paper in kind. She says,
“Assignment details are on page 13-23. (Lola’s Independence). I need 30/40 to pass this unit.

“Attached are some images make sure you have a look at them .in these images under template my teacher has given examples on how to do it properly…you will have a very good idea when you see them …it is step by step on how to do this case study”

In last step of template you need to do referrals to community regarding lolas issue…one referral for one issue…such as for poor nutrition we need to refer lola to dietician in community…you need to provide name of the service. Phone number , how much it will cost lola i.e whether its free or bulk billed or lola has to pay for it…please make referrals in Melbourne region as i am from Melbourne…community service has to be real and not superficial as my teacher will check it online or even can call them…also you need to mention how the service will help lolas issue and other co morbities…Also please send me a draft when its half way, so can i can confirm whether we are on right track… (For this section, use the following details;
for each issue you have mentioned you need to refer lola to some sort of service which is available in cummunity that will help lola with perticular issue and other co morbities.you need to provide the name of service and number. For example issue is poor Nutrition as lola doestnot cook much these days . you will refer her to Nutritionist or dietician . There are lots of dietician or nutritionist services available in community. OR you can refer her to a service who provides meal a home or provides a carer who will go to lolas home and help her with meal. for instance Called KinCare (1300763510).here we have mentioned name of service which is KINCARE and we have given their number aswell.then we will explain how this service will help lola. The organization will provide a caregiver that would take care of Lola while at home and help her make healthy meal choices. The RATES for the giver would include government subsidized costs that Lola will discuss once she has met with the caregiver and they agree. then you will explain through reseach that how heathy meal choice help older generation with their co morbities. example lola has got osteo porosis.she needs to have healthy diet to keep bone strong(with refernces) and also it will increase her energy level as lately she is feeling tired due to not eating properly . aslo she goes not see Max daily so she need to have high energy diet.etc…..

out of 4 referrals 1 of the referral need to be made through Common Wealth Home Support Programme (CHSP). this program provides a wide range of services. but you can use it only in one Referrali was checking this site and found out regarding meal services at home
City of Whittlesea – Delivered Meals Phone: (03) 8401 6232

and it is government subsidized.

For nutritionist and dietician i was looking at
AlfredHealth (03)90763063……

just confirming, did you actually check in pictures teacher has explained in template itself(In white portion). in images she has given instructions , furthermore in pictures the template(white portion) she actually has attended one of issues herself.

Most importantl, fill in the first three columns and as for referral, we can mutually discuss further.

 

Thanks and Regards

  

Answer Critical Thinking Question 2 for Chapter 10 on page 297 and Clinical Application Question 3 for Chapter 11 on page 329. Answers should be submitted in a word document with any associated references used.

Answer Critical Thinking Question 2 for Chapter 10 on page 297

Describe the use of a DNA probe and PCR for:

a) Rapid identification of an unknown bacterium.

b) Determining which of a group of bacteria are most closely related

Clinical Application question 3 for chapter 11 on page 329

A Woman complaining of lower abdominal pain with a temperature of 39  degree C gave birth soon after to a stillborn baby. Blood cultures from the infant revealed gram-positive rods. The woman had a history of eating unheated hot dogs during her pregnancy. Which organism is most likely involved 

                                                 Assgn 2 – WK10 (C)

Practicum: Decision Tree

Childhood psychosis is extremely rare; however, children that present with psychosis must be carefully assessed and evaluated with appropriate interviewing of parent, child, and use of assessment tools.

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with early onset schizophrenia.

The Assignment:

Examine Case 3. You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. 

(N: B. A CASE STUDY WITH ANSWER SAMPLE IS ATTACHED WITH THIS ASSIGNMENT)

At each Decision Point, stop to complete the following:

                                          · Decision #1: Differential Diagnosis

o Which Decision did you select?

o Why did you select this Decision? Support your response with evidence and 

     references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your 

    response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #1 

    and the results of the Decision. Why were they different?

    

                      · Decision #2: Treatment Plan for Psychotherapy

o Why did you select this Decision? Support your response with evidence and 

    references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your 

    response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 

    and the results of the Decision. Why were they different?

                  · Decision #3: Treatment Plan for Psychopharmacology

o Why did you select this Decision? Support your response with evidence and 

    references to the Learning Resources.

o What were you hoping to achieve by making this Decision? Support your 

    response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 

   and the results of the decision. Why were they different?

. Also include how ethical considerations might impact your treatment plan and 

  communication with clients and their families.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

                                                                      Case #3
A young girl with strange behaviors

BACKGROUND

            Carrie is a 13-year-old Hispanic female who is brought to your office today by her mother and father. They report that they were referred to you by their primary care provider after seeking her advice because Carrie’s behavior has been difficult to manage, and they don’t know what to do.

SUBJECTIVE

            Carrie’s parents report that they have concerns about her behavior, which they describe as sometimes “not normal for a 13-year-old.” They notice that she talks to people who aren’t real. Her behavior is calm and “passive.” Her parents noted that when she was younger, she was irritable at times, but have noticed that this has given way to passivity. Her parents state that they understand that it’s normal for younger children to have “imaginary friends,” but they feel that at    

           Carrie’s age, she should have grown out of these behaviors. Carrie’s parents report that she has friends that are half-cat and half-human, and “spirits” who speak with her “in her head.” She also reports that the people on television know when she is home and that they have certain shows “just for her.”

           Carrie’s parents report that they have taken her to her pediatrician who has given her a “clean bill of health.” Carrie’s parents note that they had some early concerns as she was lagging in meeting developmental milestones. Initially, when she first started school, Carrie managed to keep up with her peers in terms of academic performance, but she was noticed by her teachers to be isolative. It was also noted by her teachers and guidance counselor that Carrie’s social skills do not seem to match what they see in other children her age. Initially the school counselor suspected that Carrie may have been suffering from attention deficit hyperactivity disorder (primarily inattentive type), but now is not certain and has recommended a psychiatric evaluation. Her grades were “ok” in school up until last year when she left junior high school, and entered high school, where the academic demands began to increase. Carrie’s teachers had wanted to hold her back a grade, but her parents acknowledge that they were “insistent” that this did not happen. Now they are describing some regrets over this as Carrie seems “more lost than ever” in her schoolwork. Carrie’s mother produced a copy of a paper that Carrie had to submit as a homework assignment. You attempt to read the assignment, but there does not appear to be any clarity to the work, and it can best be described as a hodge-podge of thoughts and ideas.

           Carrie’s parents want you to know that although they are concerned about Carrie, they are opposed to giving her medications that would turn her “into a zombie.” Carrie’s mother also confides that her husband’s grandfather spent “a few years in the nut house.” When you probe further, she began crying and said, “He was schizophrenic … what if Carrie is schizophrenic?”

            During your interview with Carrie, she seems pleasant, but somewhat distant. When you ask her about her friends at school, she shrugs her shoulders and says, “I don’t really have any. I don’t like those people.” You inquire if she is sad or upset that she doesn’t like them, to which she states “no, why should I be? I guess they would be friends with me if I asked, but I’m not interested. I could make them be my friends if I wanted, but I don’t … but if I wanted them to, all that I have to do is make up my mind that they will be my friend and they would have to.” When you ask Carrie if she believes that she can control the thoughts of others with her mind, she puts her index finger up to her mouth and looks toward the door. “My mom gets upset when I talk about these things. I try not to think about them either because if she is close enough, she could read my thoughts and they upset her. She may think that I’m into witchcraft or something.”

When you ask Carrie about the homework assignment that you read, she explains that her teacher “is just miserable. She doesn’t understand how I think—I think high, she just can’t get it.”

OBJECTIVE

            The client is a 13-year-old Hispanic female client who appears appropriately developed for her age. She is dressed appropriately for the current weather and ambulates with a steady upright gait. She does not appear to be demonstrating any noteworthy mannerisms, gestures, or tics. No psychomotor agitation/retardation apparent.

MENTAL STATUS EXAM

            Carries is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Carrie self-reports her mood as “good.” However, her affect does appear somewhat constricted. Her eye contact is minimal throughout the clinical interview and at times, Carrie seems preoccupied. Carrie is oriented to person, place, and time. She endorses hearing and seeing strange “things that I talk to. They don’t scare me; they come to see me from another world.” No overt paranoia is appreciated. She does report delusions of reference (she believes that the people on TV play programs “just for her” and at times, television commercials were designed to tell her what to do), as well as other delusional thoughts (as described above). Carrie denies any suicidal or homicidal ideation.

At this point, please discuss any additional diagnostic tests you would perform on Carrie.

                                                     Decision Point One

BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO CARRIE?

In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.

 

Early Onset Schizophrenia

Schizoaffective Disorder

Schizotypal Personality Disorder

                                            

                                                        Answer Chosen:  

Early Onset Schizophrenia

                                                   Decision Point Two

BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

 

Refer for psychological testing

Begin Clozaril 100 mg orally daily

Begin psychotherapy using a psychodynamic approach

                                               Answer Chosen:

Refer for psychological testing

RESULTS OF DECISION POINT TWO

·  Client returns to clinic in four weeks

·  Although there are no specific psychometric tests available for schizophrenia, the consulting psychologist administered a comprehensive psychological battery of tests in order to assess personality and cognitive functioning as well as to identify any underlying intellectual disabilities that could account for the difficulty Carrie is having in school. Tests administered included the Minnesota Multiphasic Personality Inventory; Kaufman Adolescent and Adult Intelligence Test; Rorschach test; Whitaker Index of Schizophrenic Thinking (WIST) test; Wide Range Achievement Test – 4th Edition (WRAT-4); and the Millon Adolescent Clinical Inventory (MACI). The consulting psychologist opined that early-onset schizophrenia was strongly suspected in this client.

                                                           Decision Point Three

BASED ON THE ABOVE INFORMATION, SELECT YOUR NEXT ACTION. BE CERTAIN TO DISCUSS THE RATIONALE FOR YOUR DECISION.

 

Begin Clozapine 100 mg orally daily

Begin family interventions

Begin Lurasidone 40 mg orally daily

                                               Answer Chosen

Begin Lurasidone 40 mg orally daily

Guidance to Student 

           It is not always necessary to procure a consult with a psychologist. However, psychologists by virtue of their advanced training and licensure are able to conduct comprehensive psychological testing on clients more advanced than those tests that could be conducted by the psychiatric/mental health nurse practitioner. In this case, we would like to know if the poor academic performance was the result of an intellectual disability, versus poor premorbid intellectual functioning that is often seen in schizophrenia.

            In terms of treatment decisions, Clozapine is FDA-approved for treatment-resistant schizophrenia. Since the child has not yet been treated with any agent, we have no way of knowing if her schizophrenia is treatment resistant. Additionally, if we were to use Clozapine, the starting dose is approximately 25 mg in adults (perhaps 12.5 mg in a child, depending on body weight). Clozapine 100 mg would most likely cause significant side effects that both the child and parents would find objectionable, thus making compliance an issue.

Although not FDA-approved for use in children, Lurasidone is used as an off-label drug in this population. There are no legal prohibitions against any prescriber using drugs “off-label”; however, attention must be given to the concept of informed consent. When working with children/adolescents, the PMHNP must explain pros/cons, discuss therapeutic endpoints/goals of treatment, etc. The parent/guardian must have all of the information needed to make an informed consent. Therefore, Lurasidone would be the best choice. Additionally, Lurasidone may be the preferred antipsychotic, as it appears to have the least impact on body weight and lipid profile.

           Recall that with any antipsychotic medication, you should determine fasting plasma glucose levels, monitor weight and BMI during treatment, as well as blood pressure and fasting triglycerides.

            Family interventions are important as well, as they do have a positive benefit on symptom relapse and admission/readmission to the hospital. Family interventions should include teaching about the disease, medications, and anticipatory guidance.

                                                                Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter      31, “Child Psychiatry” (pp. 1268–1283)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• “Schizophrenia Spectrum and Other Psychotic Disorders”

McClellan, J., & Stock, S. (2013). Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 976–990. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00112-3/pdf

Giles, L. L., & Martini, D. R. (2016). Challenges and promises of pediatric psychopharmacology. Academic Pediatrics, 16(6), 508–518. doi:10.1016/j.acap.2016.03.011

Hargrave, T. M., & Arthur, M. E. (2015). Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. International Journal of Psychiatry in Medicine, 50(1), 60–72. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1702699596?accountid=14872

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. 

Required Media

Laureate Education (Producer). (2017b). A young girl with strange behaviors [Multimedia file]. Baltimore, MD: Author. (THE ATTACHED CASE STUDY IS THE MEDIA)

PLEASE PART OF THE CONTRACT IS TO HAVE IT DONE IN 12 HOURS. THANKS