Selection of your colleagues' responses.

  

The Assignment:

Read a selection of your colleagues’ responses.

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients. In APA Format and proper citation, provide at least two references in each response post.

Colleagues’ Response Post #1

Patient with Post -Trauma Stress Disorder

Post-traumatic stress disorder (PTSD) is common among U.S military war veterans and about 20 of them are affected with estimates ranging from 8.1% to 15.2. Post-Traumatic Stress Disorder (PTSD) is a chronic psychological disorder that can develop from exposure to traumatic events in an individual’s life. It can also be caused by witnessing or perceived traumatic events (as serious injury, violence, or death), but war time veterans are more at risk.  Symptoms may include flashbacks, nightmares, severe anxiety hypervigilance, as well as recurrent thoughts about the event (American Psychiatric Association [APA], 2013 (Lancaster et al., 2016).  

The Diagnostic and Statistical Manual of Mental disorders (DSM-5) criteria of the traumatic event must include an actual exposure or threatened death, serious injury, a violence in at least one criterion (American Psychiatric Association, 2013). In this case, William meet the criterion for PTSD. He is an Iraq war veteran captain which implies he would have directly experienced the traumatic event, witnessing the event occur to others, exposure to adverse details of the traumatic events, and self-destructive behavior (American Psychiatric Association, 2013).

The focus in the case study is William Thompson as a military captain and an Iraq war veteran, Lawyer, husband who is about to lose his job, has lost his home as a result of his inability to pay his mortgage due to alcohol use and PTSD. As a result, he lives with his elder brother and his family

Therapeutic Approaches

In the case of Williams, I will be utilized both the psychotherapy and psychopharmacological treatment to manage his PTSD.

The first psychotherapy treatment I will use for this patient with trauma is the Eye Movement Desensitization and Reprocessing (EMDR). This therapy was developed to resolved symptoms from disturbing and unresolved life experiences like trauma. EMDR is a unique kind of psychotherapy used to eliminate negative emotions linked with traumatic events’ memories by focusing less on the traumatic event but more on the disturbing feelings that derive from the event (Wheeler, 2014). This therapy used approach to address past and present aspect of memories. Francine Shiparo was to first to develop this approach. The Veterans Affairs/Department of Defense clinical practice guideline for PTSD recommends treating PTSD with individual trauma-focused psychotherapy over medications.

Studies have shown that trauma focused therapies can lead to greater outcomes and last longer compared to using just medications (Norman, Hemblen, Schnurr, & Eftekhari, 2018).

           Secondly, Cognitive Behavioral Therapy (CBT) will be utilized both PTSD and alcohol abuse. In his case, he has already lost his home and may soon lose his job due to alcohol, CBT will benefit him. CBT focuses on learning to diminish problematic behaviors linked to substance abuse, in this case, alcohol (Wheeler, 2014)

Another therapy for PTSD or trauma survivors is Prolonged Exposure therapy.  In this therapy sessions, the client is required to relates the traumatic event or experience for an hour in the treatment session, and then listens to the audiotape of the session for an hour every day. Exposure therapy also requires in vivo exposure homework in which the client engages in an avoided activity related to the trauma. When this therapy is delivered in an intensive format, it has been shown to be highly effective in the treatment of PTSD (Hendriks, Kleine, Broekman, Hendriks, & Minnen, 2018).

           Psychopharmacologic therapy can be used if psychotherapy is not effective or in combination. In this case both will be utilized since his PTSD is causing him life. Problems. The Veterans Affairs/Department of Defense clinical practice guideline recommends the use of medication therapy if the client is nonresponsive to psychotherapy or if the client refuses to engage in therapy (Norman, Hemblen, Schnurr, & Eftekhari, 2018). The recommended medications for the treatment of PTSD are sertraline, paroxetine, fluoxetine, or venlafaxine but only sertraline and paroxetine are approved by the FDA for the treatment of PTSD (Norman, Hemblen, Schnurr, & Eftekhari, 2018).

Treatment Outcomes

With the expected results from EMDR, the client will process negative feelings to the scope of traumatic memories and can recalled without producing negative emotions (Khan et al., 2018). William Thompson will recognize his health concern and the need for therapy.

In regard to CBT, the expected outcomes are that of learning communication skills to addresses avoidance related to PTSD, relationship problems and challenging trauma-related beliefs. The benefit of CBT will cause the client to be aware of his health-related concerns and the need to receive the intervention (Flanagan, Jones, Jarnecke & Back, 2018). Also, with CBT, another expected outcome is the ability to resist alcohol use as several studies have demonstrated that CBT significantly reduces alcohol use disorder.

           In summary, the important thing to remember regardless of the treatment choice, is that therapy should be adjusted to the clients need. Using an individualized therapy, the therapy will be use with clients who get the greatest response. Also, the willingness to engage in therapy will depends on the patient. As PMHNP we have lots of different options to explore to help someone with a trauma in their life.  Everybody responds differently so one therapy might not work for one person but will work for the others.

Colleagues’ Response Post #2

Observation of Client

           William, the client in question, is a former military Captain and Iraqi war veteran. He is currently homeless and staying with his brother and his brother’s family due to an inability to pay his rent previously. William moved in with his brother because of these issues and is currently dealing with problems with his job being in jeopardy because of his current alcohol troubles. William presents with a flat affect and his family describes him as not “having it together”. According to the American Psychiatric Association (2013), DSM-5 criteria for a Post- Traumatic Stress Disorder diagnosis includes many things that William displays. Some diagnostic criteria includes “exposure to actual or threatened death or serious injury” (APA, 2013). William was exposed to these things and could have possibly experienced fellow platoon members die in war. Along with this, William exhibits signs that his disturbances cause significant distress or impairment “in social, occupational, or other important areas of functioning” by attempting to cope with his problems with alcohol use (APA, 2013). Mahoney et al. (2020) explain that PTSD “is associated with higher levels of alcohol use among returning veterans” as they turn to alcohol when they don’t know how to cope.

Therapeutic Approaches

           When considering the treatment approach for clients with PTSD and excessive alcohol use, it is important to think about the specific targeted outcomes as well as the trauma the client has gone through that has caused the issues at hand. Simons et al. (2017) explains that PTSD often debilitates Operation Iraqi Freedom veterans, and the prevalence of these veterans having PTSD has significantly increased since the year 2002, to a “current estimate of 23%”. Goodnight, Ragsdale, Rauch, and Rothbaum (2019) note that clients with PTSD should be approached with trauma-focused therapies as treatment as “trauma-focused treatments are safe and effective for PTSD even when higher-risk comorbidity presents”. If the client struggles with flashbacks and nightmares that interrupt sleep, one could consider prescribing Prazosin. If the client struggles with stopping his alcohol dependence, rehab could be considered, or even prescribing Naltrexone would be acceptable. Taylor, Petrakis, and Ralevski (2016) found that pharmacotherapy, specifically Zoloft, is helpful in reducing PTSD symptoms, and naltrexone combined with psychotherapy is “better for drinking outcomes”.

Expected Outcomes

           For this client specifically, it is important for his treatment goals to include becoming free of alcohol addiction and learning ways to effectively cope with his PTSD. Some medications may be needed in reaching these goals, but without a doubt, this client could benefit greatly from psychotherapy. Alcohol use and PTSD both have shown great improvements with effective psychotherapies. This client will likely need trauma-focused therapy and pharmacotherapy both to get himself to a desired level of functionality. Ultimately, with these issues addressed, we would want the client to have no issues with his job and financial situations, able to work without problems, and be able to move out of his brother’s house and support himself in a stable environment, both financially and emotionally.

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Nue 631 d11 q2r2

Minimum of 350 words with  at least 2  peer review reference   6th edition apa style.

Think about what questions you might consider including in discussions with patients if you or the patient has a concern about OSA. When should you begin considering this diagnosis for your patient? 

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Implementation of the IOM Future of Nursing Report

  

Due Date: Jan 12, 2019 23:59:59        
 

Details:

 

In a formal paper of 1,000-1,250 words you will discuss the work of the Robert Wood Johnson Foundation Committee Initiative on the Future of Nursing and the Institute of Medicine research that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.” Identify the importance of the IOM “Future of Nursing” report related to nursing practice, nursing education and nursing workforce development. What is the role of state-based action coalitions and how do they advance goals of the Future of Nursing: Campaign for Action?

Explore the Campaign for Action webpage (you may need to research your state’s website independently if it is not active on this site): http://campaignforaction.org/states

Review Florida’s progress report by locating your state and clicking on one of the six progress icons for: education, leadership, practice, interpersonal collaboration, diversity, and data. You can also download a full progress report for your state by clicking on the box located at the bottom of the webpage.

In a paper of 1,000-1,250 words: Discuss      the work of the Robert Wood Johnson Foundation Committee Initiative on the      Future of Nursing and the Institute of Medicine research that led to the      IOM report, “Future of Nursing: Leading Change, Advancing      Health.” Identify      the importance of the IOM “Future of Nursing” report related to nursing      practice, nursing education and nursing workforce development. What      is the role of state-based action coalitions and how do they advance goals      of the Future of Nursing: Campaign for Action?

Summarize two initiatives spearheaded by Florida’s action coalition. In what ways do these initiatives advance the nursing profession? What barriers to advancement currently exist in your state? How can nursing advocates in your state overcome these barriers?

A minimum of three scholarly references are required for this assignment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this assignment to TURNITIN 

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