Jo presented to the service. She appeared very distressed. She said she was very worried and anxious, feeling depressed and did not know where to turn. She disclosed having  a gambling problem with the Pokies. She said she started gambling 9 years ago. She stated she had developed the gambling problem when she started to feel depressed after her daughter, 6 years old at the time, was hit by a car.

The daughter, Chloe, 15y/o now, has an ABI as a result of the accident.  Jo had assistance from Gambler’s Help (GH) previously and had been self- excluded. She started playing again during the last year, while worrying more about her daughter.

She worried about Chloe falling behind in school (she was at the end of year 9), saying that she hated school, she was truanting; friends had seen Chloe in town while she was supposed to be at school, and she found Chloe was not being honest.

 

She worried about Chloe’s new boyfriend who she did not approve off, her vulnerability with the technology of internet and mobile phones. She had ‘caught’  Chloe on a dating site making arrangements to meet a man. With the worrying, their relationship is deteriorating:

Jo expressed she felt powerless and inadequate and tended to get stricter and angrier, and Chloe was responding by shouting back and withdrawing. The home environment has become stressful because of this conflict. Jo finds she is staying more and more in bed and is also finding it hard to control her eating

 

Counsellor self-reflection: Please read through the observation form.  If there is a skill not identified as having been demonstrated in the session, specify where could you have demonstrated it and how. What were some of your observations of the client requirements? What didn’t work so well in this session, and what will you do differently next time? How did you manage your own values so they do not impede effective work? What were some of the boundary issues you experienced or may experience with this client and how did you manage these? How was person centred therapy useful to you in understanding and working with this client? How will you plan for and prepare the client for termination of counselling? Please answer all 7 questions

Skill/Knowledge	Observations/ Specific Examples/ Strengths/Areas for improvement
Counselling Theory  Empathy Genuineness Congruency UPR	Note down whether any of the counselling theory skills, using/describing the specific example.
Conditions, professionalism and boundaries Contracting with client Informed consent Boundaries Values conflicts Integrity Non-judgement Building trust Alleviating fear Building rapport Attending	Note how the worker attempted to create rge conditions of the counselling session Eg: Was there an attempt to establish engagement or rapport? How?
Micros skills Questions (Open & Closed) Minimal responses/encouragers Restatement/ Paraphrasing Reflecting of feelings Owned statements Open ended statements Body language(SOLER) Summarising Listening	Note down whether any micro-skills were utilised, using/describing the specific example. Eg: Were open and closed questions used appropriately?  Explain. What sorts of minimal encouragers/responses were used? How?  Where they effective? How do you know?
Meta Skills/Use of Self Humour, Compassion, Creativity, Recycling, Fishing, Fluidity and Stillness	Note down whether any meta-skills were utilised, using/describing the specific example. Eg: Was any humour used? Effectively? What indicated that the worker demonstrated compassion?
Stages of Session Preparation Joining Active Listening Closure	Note down the relevant steps in the structure of the session. Eg: Was the purpose of session introduced? How? How was session terminated?  Was it appropriate?

One benefit of utilizing big data is the ability to drill down through large volumes of different types of data to determine patterns of care. With Medicare and Medicaid structuring their pay system upon quality, big data could be used as part of the quality improvement process.

While almost half of the healthcare organizations are using big data to support clinical decision-making, Wang et al. (2018) assert that utilizing this technology to determine patterns of care is another effective approach for healthcare organizations.

For instance, this approach could be used to determine the reason COPD patients are experiencing multiple emergency department visits in one year, improving patient care and reducing unnecessary hospital costs.  Since over ¾ of a healthcare organization’s information is unstructured data in the form of text files (McGonigle & Mastrian, 2022), use of big data systems to glean those patterns of care becomes an essential strategy. Additionally, patterns of care obtained through big data analytics could further research and establish evidence-based practices.  Use of big data analytics will allow researchers to forward an exponential growth in research through digging for patterns of care (Coatney, K., 2018).

Therefore, while not currently a significant use in medicine, I believe healthcare organizations will come to employ big data analytics to determine patterns of care for improved quality, provide better value, and deliver better results in significantly less time.

One challenge of relying on big data analytics to forward a healthcare organization is that data governance is still in its infancy.  While the Health Insurance Portability and Accountability Act of 1996 generally protects patient’s information from being unnecessarily disclosed (Centers for Disease Control and Prevention, 2022), limited legislation or regulatory requirements are given on how a healthcare system can used “stripped” data within their organization.

The most effective method of over coming this challenge is to be as transparent as possible with patients.

According to McGonigle and Mastrian (2022), over 80 percent of genetics research companies’ users agreed to information from their individual results to be used for research purposes.  Therefore, if a healthcare provider wants to avoid any ethical or legal concerns regarding the use of an individual’s information in big data analytics projects, the organization should attempt to share as accurately as possible how their data may be used and ask if it may be included for these purposes.  Anticipating future projects specifically can be a challenge as well.

Therefore, ethically, organizations may need additional consents when future uses are too far outside of an initial agreement.  This transparency not only protects patients’ rights, but it also allows for more fluid sharing of knowledge as McGonigle and Mastrian (2022) encouraged in their foundations of knowledge model.

 

 

References

Centers for Disease Control and Prevention. (2022).  Health Insurance Portability and Accountability Act of 1996. https://www.cdc.gov/phlp/publications/topic/hipaa.html#:~:text=The%20Health%20Insurance%20Portability%20and,the%20patient’s%20consent%20or%20knowledge.

Coatney, K.(2018). Big data analytics capabilities, the business value of information technology, and healthcare organizations: The need for consensus in evidence-based medical practices. American Journal of Medical Research, 5(2), 28-33. https://doi.org/10.22381/AJMR5220183.

McGonigle, D. & Mastrian, K. (2022).  Nursing Informatics and the Foundation of Knowledge (5^th ed.). Jones & Bartlett Learning.

Wang, Y., Kung, L., & Byrd, T. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126, 3-13. https://doi.org/10.1016/j.techfore.2015.12.019

Davis. American Psychiatric Association (2000). Diagnostic and statistical manual of Neitzel, J., Sendelbach, S., & Larson, A. (2007). Delirium in the mental disorders (4th ed.). Washington, DC: APA. orthopedic patient.

Orthopedic Nursing, 26(6),354-363. Deglin, J. H., & Vallerand, A. H. (2009). Davis’s drug guide for nurses Nursing Standard of Practice Protocol: Delirium: Prevention, Early (1 1th ed.). Philadelphia: F. A. Davis. Recognition, and Treatment Dillon, P. (2007). Nursing health assessment:

A critical thinking and case studies Tullman, D.F, Mion, L. C., Fletcher, K., & Foreman, M.D. (2008). approach (2nd ed.). Philadelphia: F. A. Davis. Van Leeuwen, A. M., Poelhuis-Leth, D. J., & Bladh, M. L. (2011). Davis’s Erikson, E.H. (1950).

Childhood and society. New York: Norton thensive handbook of laboratory and diagnostic tests with nursing Hartford Institute for Geriatric Nursing http:/ /consultgerirn.org/ implications. (4th ed.). Philadelphia: F. A. Davis. topics/delirium/want_to_know_moreRetrieved 1/2/08 Waszynski, C. (2007a).

The confusion assessment method (CAM). Try this: best nouye, $, van Dyck, C., Alessi, C., Balkin, S., Siegal, A., & Horwitz, R. practices in Nursing Care to Older Adults, Issue Number 17. Retrieved (1990). Clarifying confusion:

The confusion assessment method. Annals from http://www.hartfordign.org/publications/trythis/issue13.pdf. of Internal Medicine, 113(12), 941-948. Waszynski, C. (2007b) How to try this:

Detecting delirium. AJN, American Kuehn, B. (2010). Delirium often not recognized or treated despite Journal of Nursing, 107(12), 50-59. serious long-term consequences. JAMA, 304 (4), 389-390, 395.

Liver enzymes Screening Tools 9. Altered sleep-wake cycle: excessive daytime sleepiness Postoperative incidence: 15-72% Urinalysis ECG CAM (The Confusion Assessment Method Instrument) with insomnia at night Onset: usually third day of hospitalization 1. Acute onset; acute change in mental status from CAM Diagnostic Algorithm Duration: <5 days, symptoms can last 3-6 mo Treatment baseline?

Feature 1: Acute onset or fluctuating course (Source: Hartford Institute for Geriatric Nursing http://consultgerirn.org) Medications 2A. Inattention difficulty focusing, easily distracted? Acute change in mental status " Low-dose phenothiazines 2B.

If present: does behavior come and go, increase or Feature 2: Inattention Outcomes Avoid barbiturates and sedatives that may increase decrease in severity Difficulty focusing, easily distracted

3. Disorganized thinking: incoherent, illogical flow of Decreased independence, loss of ability for self- agitation, confusion, and disorientation. Feature

3: Disorganized thinking ideas, switching subject? "Incoherent, illogical, unpredictable thinking determination Nursing Management

4. Altered level of consciousness: alert, hyperalert, and Feature 4: Altered level of consciousness Increased morbidity, such as falls, pressure ulcers, overly sensitive to environmental stimuli, lethargic, coma adverse effects from medications, infections, continued Vital signs and pulse oximetry Hyperalert, lethargic, stupor, or coma cognitive impairment, institutionalization Intake and output

5. Disorientation: place time, person + Diagnosis of delirium if features 1 and 2 and Increased mortality; six times more than nondelirious a Identify and remove toxic substance 6. Memory impairment: unable to remember events in either 3 or

4. Treat underlying cause hospital (Source: Inouye, S, van Dyck, C., Alessi, C., Balkin, S., patients Goal: Provide therapeutic environment

7. Perceptual disturbances: hallucinations, illusions or Siegal, A., & Horwitz, R. [1990]. Clarifying confusion: the Increased length of stay, increased acuity, increased cost Appropriate sensory stimulation misinterpretation confusion assessment method. Annals of Internal Medicine, Risk Factors m Reassure and reorient

8A. Psychomotor agitation: restlessness 113(12), 941-948.) Increased age Consistent caregivers 8B. Psychomotor retardation: sluggishness, staring into Increased severity of illness Encourage family members to be at bedside space Multiple health problems, polypharmacy Sensory aids History of dementia, depression, or previous delirium Minimize relocation Substance or alcohol abuse Simplify environment REVIEW QUESTIONS Sleep deprivation Avoid excessive medication and restraints 1. How would you differentiate signs and symptoms of delirium from dementia and depression?

Immobility Goal: Provide general supportive nursing care Answer: Sensory impairment Comfort measures Prevent complications of immobility Characteristics of Dementia, Delirium, and Depression Causes of Delirium Assist with basic needs Acute illness Communicate clearly Feature Dementia Delirium Depression Infection (UTI, URI)

Reassure and educate family Onset Medications (anticholinergics, sedatives, psychotropics, Minimize invasive procedures narcotics, H2 blockers) Prognosis Dehydration and electrolyte imbalance Evaluation/Outcome Criteria Oriented to person, place, and time Course Hemodynamic status, hypovolemia Environmental challenge (sensory overload or deprivation)

Cooperative Attention Pain Decreased agitation Memory Acute Delirium Assessment/Screening Tools for Delirium This condition is seen in postoperative electrolyte distur- Assessment Perception bance, systemic infection, renal and liver failure, overseda- Confusion Assessment Method (CAM) Psychomotor tion, and metastatic cancer.

Cognitive function: behavior Ask: Assessment Change in thinking or memory Cause Disorientation to time, especially at night m Strange thoughts Hallucinations, delusions, illusions Assess: Alterations in mood Alertness, hyperalert, lethargy, stupor, comatose Increased emotional lability Attention, ability to focus digit span, serial subtrac- Agitation tion, spelling backwards, clock drawing test Source: Dillon, P. (2007). Health assessment:

A critical thinking, case study approach. Philadelphia: F. A. Davis.

Lack of cooperation Orientation, may be disoriented to time and place Withdrawal Memory, recent and remote Feature Dementia Delirium Sleep disturbance Thinking, logical vs disorganized, rambling Alterations in food intake Perception, recognition of objects and persons Onset Diagnostic Tests Psychomotor, hypo- or hyperkinetic, unusual or Prognosis a CBC inappropriate Course m Electrolytes Attention Memory

Identify four main factors that demonstrate a parallel between the current situation of Pygmy Peoples of Africa and the early agricultural societies that experienced the First Epidemiologic Transition

 

Based on the readings and your viewing of “Resettlement,” how did change in land use affect the social structure of the Kung community, the cultural practices and daily lives of the community, and the experience of health and disease. How did land use affect the communal values and practices of the Kung (Ju Huaonsi)?