Community Health Nursing: “VULNERABLE POPULATION”. County of Los Angeles Public Health Custom Essay

“VULNERABLE POPULATION”. County of Los Angeles Public Health. (2016). LA County Public Health – Health Assessment. Publichealth.lacounty.gov. Retrieved on March 6, 2016, from https://www.publichealth.lacounty.gov/ha/ https://publichealth.lacounty.gov/CHS/SPA3/index.htm https://publichealth.lacounty.gov/ha/docs/2007%20LACHS/Key_Indicator_2007/KIHReport.2009.FINAL.pdf Week 3 Case Study for Discussion This case study provides you with an opportunity to immerse yourself in the role of a Community Health Nurse (CHN) and explore the resources in your community. As you work through the case, reflect on what you have learned about community health nursing in this course, and how you can apply it to this case. Your role: You are working as a community health nurse in your local health department. One of your roles with the health department is to case manage pregnant women who receive Medicaid. You work with an interdisciplinary team both within and outside the agency. Team members: • Anne is a fellow nurse with the health department. She is going on medical leave, so has asked you to assume this case. • Christina is a social worker with the health department. • Tracey is a case worker from Child Protection Services (CPS). • Mark is a dietician with the local Women, Infants, and Children (WIC) office. Your client: Mary is a 23-year-old Caucasian female. She is in her first trimester of pregnancy and is developmentally delayed. She has a dual diagnosis of a bipolar disorder. She is currently unemployed but receives Social Security Disability checks monthly. She lives with a roommate in a project apartment complex in a run-down part of town. Anne has visited Mary once and provided the following information as she hands the case to you. Mary had a baby removed from her care when she was 19 years old. Mary cannot explain why this baby was removed other than her house was dirty. She met the father of her current baby on the Internet and states that she has not heard from him recently. During Anne’s visit, Mary stated that she wanted to keep the baby. She asked many questions about healthy eating and having a healthy pregnancy. Mary stated that she has visited the WIC office, received WIC vouchers, and met with Mark who talked to her about what to eat. She asked for help to find a nice apartment and to make other improvements so that she can keep this baby. When Anne started to explore options and difficulties she might encounter in raising this child, she stated that Mary became agitated and did not comprehend why her baby might be removed from her other than “They are against me!” Christina, Mary’s social worker, was able to find the past court records indicating that her first baby was removed due to neglect and living in an unsuitable environment. At that time, Mary was living with her parents in another county. The records indicated that Mary did not show up to her court appointment to appeal the decision, so the baby was permanently removed and has since been adopted. According to Mary’s chart, Tracey from Child Protection Services has stated that CPS is planning on placing Mary’s baby into foster care when it is born due to her cognitive impairment and past history. Your charge: As your first assignment; 1. You are to identify resources in your community that could assist Mary during her pregnancy and help to optimize the health of her infant. 2. Assurance is one of the three core functions of public health. Find a resource in your community (other than WIC) that could assist Mary during her pregnancy. Start by searching the Internet for your local health department’s website. https://publichealth.lacounty.gov/hfd/howto.htm 3. What services (other than your visits and the social worker) do they provide for pregnant women? What about your local welfare office? https://www.financialhelpresources.com/details/department_of_social_services_los_angeles_county_el_monte.html https://dpss.lacounty.gov/dpss/offices/default.cfm?orgid=436 4. Are there prenatal or mental health services available? 5. Are there any service organizations, crisis pregnancy centers, or churches providing help for pregnant women? Briefly describe the types of services that you found and then choose one agency and assess this agency in terms of the 4 A’s. Is it Accessible, Acceptable, Affordable, or Available for Mary or other pregnant women that you case-manage? VULNERALBE POPULATION Specifically identify and describe two priorities for Community Health Nurses (CHNs) working with the vulnerable population of homeless. Remember that a priority is similar to a goal and is NOT the same as an intervention. An intervention is an action that is done by the RN to address the priority. To answer the main discussion question of VULNERABLE POPULATION, you are directed to list priorities or goals—NOT INTERVENTIONS. For instance, for the homeless population, a priority is shelter. An intervention for the priority of ‘secure shelter’ is to make sure there is enough room in the shelter on all days of the week to accommodate those who are homeless. Please note the difference between a priority and an intervention. Specifically identify in your coursework response ‘risk factors’ and ‘priorities’ so those who read your response know what you are referring to. How can Community Health Nurses (CHNs) assist the vulnerable population of the homeless in addressing the priorities? Use and cite scholarly resources to support your decision-making process.

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Mircoeconmics – research paper relating to an economic topic or current economic event in microeconomics Custom Essay

You will be writing a research paper relating to an economic topic or current economic event in microeconomics. The essay should be 6 pages in length (excluding any cover pages, bibliography, works cited, or endnotes pages), double-spaced, and in APA format. The purpose of the research paper is for you to employ economic concepts (scarcity, opportunity cost, comparative advantage, supply and demand, price signals, diminishing returns, marginal utility, competition, monopoly, labor markets, income distribution, externalities, public goods, and many others) in a practical way to a business or social issue, bridging the gap between theory and practice. The research paper should clearly incorporate the economic analysis and topics of discussion covered in both the textbook and the workshops (as they pertain to the topic of research). You should attempt to see business and social issues through the lens of economic logic. The conclusions should reflect a deeper economic way of thinking. Dividing the paper into six specific sections as follows: Introduction: Topic, statement of problem to be discussed. Objectives: Thesis statement, what is the goal of the essay? Method: The research method used: case study, books and newspaper or magazine articles, personal statistical research, or previously conducted statistical surveys. Findings and Observations: Data, facts ascertained, what did you discover? Conclusions: Interpretation, analysis of findings, arguments, personal comments and your informed opinions. Documentation: works cited, reference page. Sections 1, 2, and 3 (Introduction, Objectives, and Method) should not consume more than one to two pages of the final draft. The bulk of the research and writing should be concentrated in the fourth and fifth sections where discussion should occur, evaluation of theories should be conducted, and conclusions may be drawn.

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Reference to at least four of the core countries, analyse the reasons for falling trade union membership density and whether declining union power and influence is likely to be reversed Custom Essay

The core countries including UK, Germany, France, Sweden and Hungary. The essay should includ introduction, main body and conclusion. The lecturer advice is that the essay should analyse why Union membership has fallen, which shows different patterns in many countries between the public and private sector, also the decline of manufacturing sectors relative to the service sector is a relevant issue to look at.

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Using leadership theories, analyze your selected leader to identify characteristics and provide specific examples of leadership qualities you think contributed to that person’s success Custom Essay

Select and describe a leader you admire. Your selected leader may be either a real-life individual or a fictional character from television, the movies, or a book. Using leadership theories, analyze your selected leader to identify characteristics and provide specific examples of leadership qualities you think contributed to that person’s success. Evaluate your own leadership style and work with your mentor to identify your own leadership characteristics. Write a paper in which you explain your leadership style and your ideas and plans for improving your effectiveness as a leader based on your comparison with an admired leader and your work with your mentor. Required Elements: No more than 825 words Format your paper consistent with APA guidelines Evaluate your chosen leader and yourself, based on the leadership theories. Summarize the discussion with your mentor

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Aim To introduce the student to different questioning techniques and their usefulness in the counselling process Custom Essay

Aim To introduce the student to different questioning techniques and their usefulness in the counselling process. Questioning is an important part of counselling, but should be kept to a minimum. The idea is that when seeking to deal with a client’s emotional material, the counsellor should not need to ask too many questions. Rather, they will be able to glean most of the information they need by reflecting content and feeling and using the other skills mentioned so far. Within the counselling process the counsellor should restrict themselves to asking questions that are of therapeutic value, i.e. questions that acknowledge, explore or challenge the client rather than just seeking factual information. It is important not to ask too many questions, so as to avoid the client from feeling that they are being interrogated. If this happens, the clients are less likely to freely submit information. It is important to allow the client to go in the general direction that their feelings take them. It is also possible that by asking too many questions, you do not permit the client to think for themselves so that they become reliant on being asked questions to proceed. Most clients will also be aware when the counsellor is asking questions as fillers, where the answer bears little or no relevance to the counselling process. Even experienced counsellors will occasionally find themselves asking these types of questions. The counsellor needs to avoid questions that are intrusive and which produce information of little value. Therefore, asking questions is really only appropriate when it is necessary for the session to continue. Open & Closed Questions Closed Questions These types of questions generally have a specific answer, e.g. yes or no. They are useful when the counsellor is after a specific piece of information. There are, however, problems with this mode of questioning: • The client may go ahead and expand on the question • The client is restricted in the sort of response that they can give. • It can also act as a leading question making the client think that they have to go into a particular direction in order to satisfy the counsellor. Open Questions These allow the client far more scope in terms of adding information, typically requiring several sentences to answer. The information supplied by the client could be unexpected by the counsellor and hence revelatory leading the counselling process into a new direction. Open ended questions allow the client to express what is most significant to them with regard to a subject area or problem, rather than what is most important to the counsellor. Other Types of Questions Although it is suggested that questions be used sparingly, when used appropriately they can be extremely powerful in accessing information. Linear Questions These types of questions are used to probe for information that helps to assess the client’s problems. For example, ‘What are the things that are troubling you right now?’ Information-seeking Questions Caution should be recognized when asking questions that attempt to seek information. It is only necessary to ask such questions when they are going to be of benefit to the counsellor’s knowledge. If they are not going to reveal anything that will help the counselling relationship, then they should not be asked. They should certainly not be asked in order to satisfy the counsellor’s curiosity. Strategic Questions These are used to encourage a client to challenge their beliefs, values or behaviour. Questioning for Clarification This is useful when clients offer vague or ambiguous statements. It allows them to be more specific so that it becomes clear to both the counsellor and the client exactly what is being described. Questions to Heighten Awareness This type of questioning is most useful for helping a client to understand what is happening inside them, both mentally and emotionally. They are then able to deal with these feelings and associated thoughts. Reflective Questions These are used to assist the client to generate new possibilities and consider making changes to their lives. Transitional Questions This type of question is used to draw the conversation back to an earlier part of the discussion. They tend to begin to begin with a statement about an earlier topic and then raise a question pertaining to this. When using these questions the counsellor is steering the conversation into a direction that they wish to take it. It is important therefore to ensure that it is only introduced at a point where it is not going to prevent the client from imparting important emotional material. Choice Questions These are similar to reflective questions but have been used mostly when dealing with adolescents. They infer that the client has a choice about past / present and future actions, and enable them to consider what the different consequences of their behaviour are likely to be: e.g. ‘In what other ways could you respond to that?’ Guru Questions These types of questions invite clients to step outside of themselves and consider someone in their situation, and ask what advice they would give to this person. Career Questions These sorts of questions help the client to see that they have choices that they can make in their present lifestyles that could have a profound impact on their future. They normally have an exaggerated or paradoxical content that helps the client to see beyond their present behaviour. Care should be taken to only use these questions where the client can interpret the paradox, rather than take it literally as a suggestion. Circular Questions These can be useful for helping clients to understand their own feelings, thoughts, attitudes and behaviour. Instead of asking them directly about how they feel or what they think, the questions ask about how the client thinks someone else feels or thinks about something. This may be less threatening than asking the client directly how they feel about something. Exploratory Questions These are also circular in nature, but tend to focus on identifying patterns and connections in a client’s behaviour, problems, thoughts and ways of coping. For example the counsellor might ask; ‘What type of situations make you feel really angry?’ Questions to Avoid It is preferable in counselling to avoid ‘why?’ type questions. The reason being, that they tend to open up intellectual explanations rather than invite clients to disclose what is happening internally. ‘What?’, ‘How?’ and ‘When?’ questions are generally more productive as they focus more on feelings and emotions. Goals of Questioning It is important to restrict questioning during counselling sessions so that the client does not feel interrogated. Questioning should only be used as an addition to the main tool of reflection. Timing is also important. The counsellor needs to know when to and when not to ask a question. The counsellor can master timing by learning the therapeutic value of the question, and the likely response of the client. Case Study Ellen comes into the counselling room. She is obviously agitated. C = counsellor E = Ellen C “Hello, are you OK?” E “No” C “Is there something I can help you with?” E “No”. C “Are you upset about anything in particular?” E “No.” C “Is there something you want to talk about?” E “No”. The counsellor is not encouraging Ellen to talk by asking these closed questions. Go through the questions again and think of ways that the counsellor could have used other questions for encourage Ellen to talk about what was bothering her. These are not definite answers. You may have come up with different questions to these, but these are some suggestions. C “Hello, are you OK?” Perhaps – “you don’t look very happy today … followed by a pause to allow Ellen to talk” Or “you don’t look very happy today, can you tell me why?” C “Is there something I can help you with?” “I think there is something the matter, so talk to me about it and we’ll see if I can help”. C “Are you upset about anything in particular?” “Tell me what you are upset about in particular” or “What in particular are you upset about?” C “Is there something you want to talk about?” “What is it you want to talk about?” These new questions or statements encourage Ellen to make a response that is not a yes/no response. They encourage her to talk, even if only with one sentence. But this one sentence will also allow the counsellor to open up the conversation more. Activity As you go through your day, when you are talking to other people, look at your own use of open and closed questions and theirs. Are there times when you use closed questions to end a conversation? Or open questions to prolong a conversation? Try to make a conscious note to use more open questions when talking to people. The more counselling skills are practised within our daily lives, the more natural they become to us. Example – Questioning in Crisis Counselling The following article gives you some idea of how questions may be used in crisis counselling. Reproduced with permission from www.ericdigests.org. ERIC Identifier: ED405535 Publication Date: 1995-00-00 Author: Stevens, Brenda A. – Ellerbrock, Lynette S. Source: ERIC Clearinghouse on Counselling and Student Services Greensboro NC. Crisis Intervention: An Opportunity To Change. ERIC Digest. Crisis intervention is emergency first aid for mental health (Ehly,1986). This digest provides a brief, conceptual overview of crisis intervention, and summarizes the steps a worker may use to identify, assess, and intervene with an individual experiencing crisis. The Chinese language contains two characters which, taken together, connote the concept of crisis. The first character, “wei,” indicates a critical or dangerous situation, while the second one, “ji,” means an opportunity for change. Thus, these characters together indicate that crisis is a point in time that allows the opportunity to change. Crisis intervention involves three components: 1) the crisis, the perception of an unmanageable situation; 2) the individual or group in crisis; and 3) the helper, or mental health worker who provides aid. Crisis intervention requires that the person experiencing crisis receive timely and skilful support to help cope with his/her situation before future physical or emotional deterioration occurs. A crisis may occur when an individual is unable to deal effectively with stressful changes in the environment. A stressful event alone does not constitute a crisis; rather, crisis is determined by the individual’s view of the event and response to it. If the individual sees the event as significant and threatening, has exhausted all his/her usual coping strategies without effect, and is unaware or unable to pursue other alternatives, then the precipitating event may push the individual toward psychological disequilibrium, a state of crisis (Caplan, 1964; Smead, 1988). Psychological disequilibrium may be characterized by feelings of anxiety, helplessness, fear, inadequacy, confusion, agitation, and disorganization (Smead,1988). At this point, the individual experiencing this disequilibrium may be most receptive to outside assistance, thus providing an opportunity for behavioral change and a return to balance. To summarize, a crisis results from a person’s negative perception of a situation. Psychologists, counsellors, social workers, mental health personnel, and therapists are trained to provide services to individuals in crisis. These workers can assist an individual or group in crisis by providing direct intervention, by identifying alternative coping skills, or by consulting with others. A helper’s primary goals in a crisis are to identify, assess, and intervene; to return the individual to his/her prior level of functioning as quickly as possible; and to lessen any negative impact on future mental health. Sometimes during this process, new skills and coping mechanisms are acquired, resulting in change. IDENTIFICATION Identification recognizes that a problem exists and it focuses on 1) the event’s significance in the person’s environment, and 2) the person’s current functioning. The event or crisis may be categorized as either developmental or situational (Smead,1988). Developmental crises result from predictable change, and are due to normal growth or development, such as the onset of adolescence. Situational crises are either predictable, arising from certain events, such as divorce or failing a grade, or are unpredictable, such as an accidental death or natural disaster. Both types involve a change in circumstances, usually accompanied by a loss, which can precipitate a crisis reaction in an individual. Therapists must promptly identify a person in crisis, as well as assess the degree to which his/her functioning is impaired. In addition to psychological disequilibrium, other signs and symptoms may indicate a problem for those experiencing a crisis. Physical symptoms such as changes in overall health, energy, or activity level, as well as in eating or sleeping patterns, may point to a problem. Emotional signs that may indicate a person in crisis include increased tension or fatigue, and changes in temperament, such as angry outbursts or depression. Behavioral signs such as the inability to concentrate, being preoccupied with certain ideas, or social withdrawal may also indicate a person in crisis (Ehly,1986; Greenstone & Leviton, 1993). ASSESSMENT After identifying a crisis situation and a person in crisis, workers assess the crisis’s impact on the individual. This assessment usually takes the form of an interview, during which the worker strives to convey an atmosphere of acceptance, support, and calm confidence about the future. Communication with the person experiencing a crisis is vital; this involves establishing eye, and sometimes, physical contact. Questions addressed to the individual may include his/her perception of the problem, the frequency and sequence of events, his/her feelings, and a history of attempts to deal with the problem. Forced choice or open-ended questions may be used to assess the individual’s ability to communicate, as he/she may experience difficulty in expressing him/herself, in making decisions, or in solving problems. Assessment may include what the individual is saying as well as his/her nonverbal communication, i.e., facial expression, posture, body and eye movements, and mannerisms. An essential part of this assessment is an evaluation of the person’s current safety as well as any risk to his/her own or someone else’s life. Additionally, factors such as alcohol and drug use, current stress level, and emotional affect, such as hopelessness and helplessness, should be identified. INTERVENTION After identification and assessment of the crisis and the person involved, the intervention occurs. While specialists (Hoff, 1989; Greenstone & Leviton, 1993; Sandoval, 1988; Sandoval, 1991; Zins & Ponti, 1990) in this area may differ on the name and number of steps involved, they agree that certain points are integral to intervention and are basic to a best-practice, problem-solving approach. First, while supporting and empathizing with the individual in crisis, the worker should listen and avoid using the phrase “I understand” so as to allow the individual full and open expression of feelings and emotions. Second, the individual in crisis should answer the worker’s questions so as to define and clarify the incident and acknowledge any social and cultural factors which may relate to the crisis. This second step places the problem in a framework. As Burak (1987, p. 1) states, “Understanding of and respect for the differences inherent in each culture are needed for rapid, effective, and sensitive treatment of emergency situations” (p. 1). Third, the worker develops an awareness of the significance of the crisis from the individual’s point of view. These first three steps may have been partly completed during the identification and assessment stages of the crisis; it is important that they be finished before going on to the fourth step. Fourth, mutual brainstorming of alternatives and discussion of available resources are jointly carried out by the individual in crisis and the worker. At this point, the worker may need to be more directive, by focusing on the current situation, proposing ideas and strategies for action, as well as suggesting other resources for support, instead of just listening and reflecting. (Sandoval, 1988). Fifth, the individual in crisis and the worker choose one or more specific, time-limited goals which take into account the person’s significant others, social network, culture, and lifestyle. Complete planning, including recognition of all the steps involved, as well as consideration of any barriers to success, should be completed before the solution is attempted. Some brief education, modelling, role playing or rehearsal of potential situations may be done in this step to empower the individual further. Sixth, the worker and individual implement their plan and, if possible, evaluate its effectiveness. They then adjust the plan as necessary. Seventh, the worker provides for follow-up or refers the individual in crisis to a resource that can provide ongoing support. The worker then terminates the established crisis relationship. SUMMARY In summary, crisis intervention provides the opportunity and mechanisms for change to those who are experiencing psychological disequilibrium, who are feeling overwhelmed by their current situation, who have exhausted their skills for coping, and who are experiencing personal discomfort. Crisis intervention is a process by which a mental-health worker identifies, assesses, and intervenes with the individual in crisis so as to restore balance and reduce the effects of the crisis in his/her life. The individual is then connected with a resource network to reinforce the change. Thus, as the Chinese characters suggest, crisis truly holds the opportunity for change. REFERENCES Burak, P. A. (1987). Crisis management in a cross-cultural setting Washington, D.C.: National Association for Foreign Student Affairs. (ERIC Document Reproduction Service No. ED 329 870). Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books. Ehly, S. (1986). Crisis intervention handbook. Washington, D.C.: National Association of School Psychologists. Greenstone, J. L. & Leviton, S. C. (1993). Elements of crisis intervention: Crises and how to respond to them. Pacific Grove, CA: Brooks/Cole Publishing Co. Hoff, L. A. (1989). People in crisis: Understanding and helping (3rd ed.). Redwood City, CA: Addison Wesley Publishing Co. Sandoval, J. (Ed.). (1988). Crisis counselling, intervention, and prevention in the schools. Hillsdale, NJ: Lawrence Erlbaum Associates. Smead, V. S. (1988). Best practices in crisis intervention. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (pp. 401-414). Washington, D.C.: National Association of School Psychologists. Zins, J. E. & Ponti, C. R. (1990). Best practices in school-based consultation. In A. Thomas, & J. Grimes (Eds.), Best practices in school psychology II (pp. 673-693). Washington, D.C.: National Association of School Psychologists. SET TASK You will need to repeat this set task several times asking different types of questions. Get together with a friend, relative, or colleague, etc. Simulate a counselling situation. Ask them lots of closed questions about an emotional issue (but not something that is going to upset them, or that is going to stir up feelings that you cannot deal with) so as to try and get to the heart of a problem that they have. (If you find it easier you could always not disclose that you are researching your counselling techniques, until you have pursued with your questioning, though you should disclose this information to them afterwards) Try to balance your questioning with reflection, and other techniques, so as not to upset your ‘client’ by bombarding them with too many questions. Make notes of their responses. ASSIGNMENT 1. Report on your set task. How did your ‘client’ respond to your questioning? Did they become defensive or avoid talking about the main issues that were bothering them? Submit approx 200 words. 2. Repeat the task using open questions and comment on your findings. Submit 200 words. 3. Compare your use of open and closed questions in your set task, and the information that these 2 types of questions produced. Submit ½ to 1 page. 4. What do you see as being the main risks involved in asking too many questions? Why is it important to avoid questions beginning with ‘why?’ (If you asked any ‘why’ questions in your set task site them as an example in your explanation). Submit 200 – 300 words.

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Managing Transformation and Learning CQI To succeed in a rapidly changing environment, health care organizations need to smoothly manage the transformation process and take on the challenge of becoming learning organizations Custom Essay

Managing Transformation and Learning CQI To succeed in a rapidly changing environment, health care organizations need to smoothly manage the transformation process and take on the challenge of becoming learning organizations. Using figure 10-1 found on page 292, write a paper using APA formatting, comparing and contrasting the distinguishing characteristics of the transformational model with the model that most closely aligns with the military hospital. Support your work with proper citations. McLaughlin and Kaluzny’s Continuous Quality Improvement in Health Care 4th edition. I will provide scanned pages.

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The Radiographer of the 21st Century’ Custom Essay

Imagine you have been invited by the editor of “Radiography” to write a short review article relating to the ‘The Radiographer of the 21st Century’ It is accepted that this area is vast BUT there have been so many changes / advancements / developments over recent years that you now have the opportunity to research, discuss, evaluate and assess these. You should start by researching the role of the radiographer / radiography profession in the past and the present and finally attempt to identify further advancements / changes to the future role based on research evidence. The article should contain NO MORE than 3500 words and should follow the journal publication guidelines for a review article. You should consider the readership of the journal and write appropriately Guidelines 1. Obtain a recent (2015/2016) copy of the ‘Radiography’ journal’s guidelines for publication which requires you to Reference using the Vancouver / Numerical Reference method ACCESSED FROM . http://www.elsevier.com/wps/find/journaldescription.cws_home/623068/authorinstructions 2. Using the publication structure outlined in the guidelines, submit the review article. 3. The maximum word limit is 3500 words.

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Recommend Gender/Race: the American Sociological Association on work and organizations Custom Essay

In order to figure out a specific topic to write about within the general topic areas, read about a topic area on Work in Progress (http://workinprogress.oowsection.org/2014/10/29/panel-the-future-of-organizational-sociology/), a blog of the American Sociological Association on work and organizations. Write the essay on the theme you pick. The article must be based on at least four academic journal articles or book chapters, TWO of which must be from the authors of the two blog articles you picked (if a blog article has more than one author, you only need to cite a journal article by one of the authors). The other two journal articles or book chapters can be from the same authors or from different authors. Make an argument about the topic, using the journal articles or book chapters as the basis for your points. *Topic need to be related to Sociology*

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