A. Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:

1. Identify one country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.

The identified country for comparison is from the given list.

2. Compare access between the two healthcare systems for children, people who are unemployed, and people who are retired.

The comparison accurately describes access to healthcare systems in both the U.S. and the country chosen in part A1 for children, people who are unemployed, and people who are retired. The comparison logically describes the similarities and differences between access to each of the healthcare systems for all of the given groups of people.

a. Discuss coverage for medications in the two healthcare systems.

The discussion of coverage for medications is accurate and relevant to both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

b. Determine the requirements to get a referral to see a specialist in the two healthcare systems.

The submission accurately determines the requirements to get a referral to see a specialist for both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

c. Discuss coverage for preexisting conditions in the two healthcare systems.

The discussion of coverage for preexisting conditions is accurate and relevant to both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

3. Explain two financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).

The explanation logically discusses 2 financial implications for the patient in regards to the delivery differences in both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

Using Nightingale’s Environmental Theory

Nightingale theory is a nursing theory which focuses on the accountability, autonomy, and communication associated with nursing practices. It proponent, Florence Nightingale, as conspicuous and celebrated among the nursing theorist whose teachings were based on the impact and influence that the environment has for the recovery of the patients (Smith & Parker 2015).  The theorist stressed that the nursing care goals are to ensure that a patient’s position is in excellent condition as much as possible to permit ecological condition to help towards good health promotion. Therefore, the theory pays more attention to the science and art of nursing intending to shape its practices. In theory, Florence maintained that external conditions and influences have a significant impact on the contribution and containment of illnesses and diseases. Florence’s mission through the theory has to help patients in retaining their vitality through environmental control approaches. The theory stated three primary environments: psychological, physical, and social, and holds that the contribution of each determines the quality of life that can be exhibited by a patient upon exposure (Rahim, 2013). Putting patients in natural conditions to get back to healthy lives does mean that the patient is left alone but instead supported by their ecological conditions that determine their possible recovery. In the theory of Nightingale about the environment, the amount of time by nature for a patient to heal and overcome all the partial conditions that affect his or her wellbeing based on the possible outcome.

Mrs. Adams Case Study

Mrs. Adams, who is a sixty-eight, and a widow who was subjected towards a case management when she was discharged from the hospital. As recommended by her physician, she portrays the role of nature in offering solutions to the patients. It was according to the diagnosis that the patient should be given while in or out of the facility. Hence, it is determined via possible recurrence to the disease or condition she is suffering from. Mrs. Adams’s diagnosis, which includes hypertension, breast cancer, and diabetes, require thorough consideration. Being a few days from the post-op right-sided mastectomy, she requires proper care and attention. However, her located that is characterized by low-income attributes where criminal cases are high put the intended care implementations into a standstill. Yet, from the Community Health Nurse assessment, it was realized that her apartment was in a severe mess and might prevent the free flow of fresh air and light. She had no food and seems that she has not even changed her clothes for quite a while. In the small apartment are a puppy and three cats considered by Mrs. Adams as part of her consolation since her beloved husband passed a year ago. Therefore it leads to her posing complaints of draining and severe pain after her broken air conditioner and the surgical site.

First Assessment: Evaluating the environmental conditions surrounding a patient is essential to limit the number of prevalence that they can be exposed to. According to Florence’s Nightingale theory, ecological surroundings play a crucial role in the healing process. Therefore, in Mrs. Adams’s case, her environmental surroundings need to be evaluated at first glance. Her various care concerns need to be prioritized based on the initial assessments made. However, major ecological components such as bed and beddings, nutrition, cleanliness, light, noise, the condition of the house, ventilation, and warming are considered. As indicated, Mrs. Adams complains about the minimal airflow, and the non-functioning air conditioner needs to be adjusted and properly rectified. Due to high crime cases within Mrs. Adams’ neighborhood, keeping windows and doors locked will serve as the best safety measures. Additionally, due to a reduced amount of light in the area, Mrs. Adams’ house requires proper ventilation, sound lighting system, and temperature-controlled air to fasten the healing process of her post-surgical wounds. Notably, the three pets in her room expose the house to increased infection and more bacteria.

The most important risk factors that threaten Mrs. Adams’s social wellbeing are the residence disarrays and her dirty clothes (Aspen University, 2018). Lack of quality and adequate food items and the residence disarrays shows that she lives in isolation with a minimal support network. Her condition and health starts are the major setbacks for her efforts in maintaining hygiene to a required level. Therefore, to make the cleaning effect, it should include frequent airing and changing her bedsheets and linens. According to Nightingale, most patients usually deposit wild floras on their beds if they are not adjusted for a long time (Wayne, 2014). Hence, this shows a possible infection if the patient re-enters in them, thus more infections.

Additionally, Mrs. Adams also requires daily hygiene support to make her safe for any possible further infections. Unwashed skin, according to Nightingale, blocks the air pots leading to possible poisoning of the body. Moreover, Mrs. Adams’ nurse should take immediate interventions to help her get her family members.

Five Essential Components of from the Theory

The five vital constituents advocated for by Nightingale to guarantee proper sanitation of various abodes for the improvement of health outcomes include:

Pure Water: The patient needs to avoid impure water because they contributed to diseases.

Pure Fresh Air: Ensuring fresh air in a location boosts the breathing systems of the patients.

Cleanliness: At all times, cleaning is necessary for all patients. Nurses must ensure that the environment is clean to minimize contaminations and poisoning.

Light: According to Wayne (2014), an adequate lighting system is needed in treating diseases, especially direct sunlight.

Effective Drainage: Proper drainage systems are needed to ward off ill-health causing organisms and epidemic diseases due to contamination by home sewer systems

Care Plan

The care plan for the case study will capture the following:

Nursing Diagnosis: Acute and severe pain evident in the verbal complaint made by Mrs. Adams about the new surgical procedure will be handled with proper pain medication.

Impaired physical mobility associated with damage of nerves and muscle, lymphedema as well as severe pains are seen in Mrs. Adams will be addressed with proper assistance.

Infection risks related to the wound that Mrs. Adam had after the surgery, her environment, and medical history will be addressed to ease the tension of possible infections.

Objective Information: The patient is a sixty-year-old female widow who has breast cancer, hypertension, and diabetes. The patient has blood-tinged fluids of serious oozing from her surgical site. The residence is poorly ventilated. There are three pets in a small room—no food for observation of nutritional support. Mrs. Adams appears untidy.

Subjective Information: There is a complaint from the patient about severe pains and broken air conditioner and pain. The reports from the patient show that she has no assistance because she is a widow.

Nursing Results: Mr. Adams Goals: The residence will have proper ventilation and adequately cleaned. All the bed linens will regularly and frequently change like daily bathing. The patient will utter two ways to limit any physical injuries that might be realized within the week. The patient will exercise mobility and sitting posture strength during this time. There will be daily hygiene performance by the patient to minimize the risk of infections. The nutritional status of the patient will be improved.

Nursing Interventions: The nurse responsible for the patient will ensure that the patient seeks out at least two friends that she has to help in support during her healing process. Additionally, the nurse in her daily services will ensure that she is ready to obtain her goals through increase strength, improved residence cleanliness, developed ambulation, and proper body hygiene. Implementation of in-house rehabilitation may be needed to make the efforts satisfying. Moreover, the nurse will ensure that the patient has a paramount focus in her care plan. Any option that might be available may be used to improve, however, current status. All possible risk factors will be addressed based on the effect on the patient.

Conclusion

The patient-centered approach, Nightingale’s Environmental Theory in medical care, contains several environmental aspects. It holds that environmental systems play a significant role in checking for the wellbeing of a patient. A balance in the ecological factors reveals the healing process that can be seen from the health conditions of a patient. However, Nightingale believed that it is the responsibility of nurses to ensure that a patient’s environment is safe and in good condition. They must also ensure that all the needed factors to boost the healing process are in place for all patients within their localities.

References

Aspen University (2018). Concepts and Theories in Nursing. Module 1. Assignment 1. Retrieved from https://aspenuniversity.edu/conceptsandtheoriesinnursing /assignment1/

Rahim, Shirin (2013). Clinical application of Nightingale’s environmental theory. i-manager’s Journal on Nursing, 3(1), 43-46, February/April 2013

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. FA Davis.

Wayne, Gil (2014). Florence Nightingale’s Environmental Theory. Nurselabs.com. Retrieved from https://nurselabs.com/florence nightingale’s environmental theory

Signature Assignment Description/Directions:

This week, you will develop a PowerPoint presentation reviewing the theories from each module.

Please select one theory from each module (1-8) and answer the following questions. You should have two slides per theory:

Describe the theory

Provide 3 examples of how the theory applies to current practice

Provide 3 positive patient outcomes resulting from utilizing the theory

Explain 3 benefits to nursing satisfaction when utilizing the theory

Describe two barriers to using the theory in practice and at least one method for overcoming each barrier (support methods with sources)

Support from literature clearly noted throughout

The PowerPoint presentation should include at least two outside references and the textbook. The presentation should contain 2 to 4 slides per theory, for a total of 16 to 32 slides.

Total Point Value of Assignment: 500 points

THE JOB IS TO REPLY WITH A COMMENT TO EACH POST, POST 1 AND POST 2. WITH 2 COMPLETED REFERENCE IN APA WITH CITATION ABOVE 2013 PER COMMENT.

POST 1

Individual vs. Family CBT

Cognitive behavioral therapy is short-term psychotherapy that emphasizes the need for attitude change in order to maintain and promote behavior modification (Nichols, 2014). Cognitive behavior therapy (CBT) has been found to be effective in a broad range of disorders. CBT can be done as an individual treatment or in a family setting. Individual CBT has a broadly defined framework with an emphasis on harm-reduction, especially with clients that have anxiety and substance abuse (Wheeler, 2014).

Cognitive-behavioral therapy for families is also brief and is solution-focused. Family CBT is focused on supporting members to act and think in a more adaptive manner, along with learning to make better decisions to create a friendlier, calmer family environment (Nichols, 2014). An example from practicum is a male (T.M) that participates in individual CBT once a week and family CBT once a week. T.M is struggling with alcoholism.

He originally presented for individual CBT because he had been “told by his wife” that he had a problem with alcohol. He reported that he drank “a few vodka drinks” three times a week but none for six weeks. Individual CBT therapy is a collaborative process between the therapist and client that takes schemas and physiology into consideration when deciding the plan of care (Wheeler, 2014). We worked with him using open-ended questions to assist with obtaining cognitive and situational information.  He would become angry easily and it was a felt that he was not being truthful about his alcohol use. Each time he was questioned about it, the story would change. He attended two individual sessions and it was then recommended he begin family CBT with his significant other (S.M) because “things were not going well at home.”

With family CBT, cognitions, emotions, and behaviors are seen as having a mutual influence on one another (Nichols, 2014). The first session was stressful, to say the least. T.M began talking about his alcohol use. S.M interrupted and said, “what about that one-time last month at the hotel. You were seeing things.” He became defensive, raised his voice, and said, “I was drugged. It had nothing to do with drinking.” She then looked down and was tearful. When he left the room to use the bathroom, S.M questioned if he could be tested for alcohol. This led the therapist to believe that T.M’s last use was not six weeks ago.

T.M’s automatic thoughts were that his alcoholism was not a problem in the marriage or in life. One of the core principles in using CBT for SUDs is that the substance of abuse serves as a reinforcement of behavior (McHugh et al., 2010). Over time, the positive and negative reinforcing agents become associated with daily activities. CBT tries to decrease these effects by improving the events associated with abstinence or by developing skills to assist with reduction (McHugh et al., 2010).

It was noticed that when T.M was alone, his stories would change. But when his wife was in the room, he would look at her while he spoke to ensure what he was saying was accurate. The therapist informed the client that it would be appropriate to continue individual therapy and family CBT once a week with the recommendation of joining the ready for change group. The CBT model for substance use states that, when a person is trying to maintain sobriety or reduce substance use, they are likely to have a relapse (Morin et al., 2017).

Ready for change meetings was recommended because like this week’s media showed, clients may relate to others that are going through similar situations. Getting T.M to realize that his alcohol use is a problem, is the primary goal currently. This example was shared because it shows the difficulties that may be encountered with psychotherapy and that both individual and family may be needed to ensure that goals are met. Some challenges that counselors face when using CBT in the family setting are wondering if the structure of the session and if the proper techniques were effective (Ringle et al., 2015). Evaluating and consulting with peers may also assist with meeting client and family goals.

References

McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511-25. doi:10.1016/j.psc.2010.04.012

Morin, J., Harris, M., & Conrod, P.  (2017, October 05). A Review of CBT Treatments for Substance Use Disorders. Oxford Handbooks Online. Ed.  Retrieved fromhttp://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.0001/oxfordhb-9780199935291-e-57.

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Patterson, T. (2014). A Cognitive-Behavioral Systems Approach to Family Therapy. Journal of Family Psychotherapy, 25(2), 132–144. https://doi-org.ezp.waldenulibrary.org/10.1080/08975353.2014.910023

Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas, R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatric services (Washington, D.C.), 66(9), 938-45. doi:10.1176/appi.ps.201400134

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice. New York, NY: Springer.

POST 2

Cognitive Behavioral Therapy is one of the most effective psychotherapy approaches, whether it be used in group, family, or individual treatment. It is important to understand the purpose of it what its process consists off. It can be used to treat different mental health conditions, ranging from addiction to more severe illnesses. Its approach is to work with the patient into strategizing ways to change unhealthy thoughts and behaviors. Throughout the process, the patient not only learns solving skills, but also to re-evaluate and learn how to understand other’s perspectives, skill that helps build their confidence.

Some believe group therapy is more effective than individual therapy, as established by Kellett, Clarke, and Matthews (2007, p. 211). It has been established that CBT in general can be effective, but based on the Johnson Family Session video, it leads me to believe that either group/family or individual would be effective depending on the condition that is being treated. It is clear from the video that the girl who had been sexually assaulted at the fraternity does not believe talking or sharing her experience, even if it is with other girls who went through the same experience, will help in any way. She still has some internal issues that need to be addressed individually in order to make progress and get her to a place where she can participate in group/family therapy with an awareness that it will help her and purpose to it. Another important aspect of having a client be committed to the treatment is that research has showed “Poor compliance can adversely affect the remaining group members who may become worried or insecure” (Söchting, Lau, Ogrodniczuk, 2018, p. 185).

An example during practicum that supports my belief is the case of a terminally ill patient who had been recommended comfort care through hospice. She was ready to do so, understood and accepted her prognosis, but her daughters and husband were in denial. Every time they participated in a family session the patient held back on her wishes and verbalized whatever their wishes were as if they were her own. When treated as an individual client, she would express her concerns of not being able to “disappoint and abandon my family”. She had suffered all her life from anxiety, insecurities, severe depression, and low self-esteem. Those were issues that should have been addressed individually before she could fully engage in a family session in a healthy and productive way, if she would’ve had the time. CBT would have still been the choice of treatment for individual therapy for this client, as evidenced by Driessen et al. who stated it “is the psychotherapy method with the best evidence-base in the treatment of depression” (2017, p. 654). Not being fully engaged in the program, or believing the treatment will not help, or having other issues that need to be addressed on an individual basis, are all challenges presented in a family setting when relying on CBT.

References

Kellett, S., Clarke, S., & Matthews, L. (2007). Delivering Group Psychoeducational CBT in

Primary Care: Comparing Outcomes with Individual CBT and Individual

Psychodynamic-Interpersonal Psychotherapy. British Journal of Clinical Psychology,

           46(2).

Söchting, I., Lau, M., & Ogrodniczuk, J. (2018). Predicting Compliance in Group CBT Using the

Group Therapy Questionnaire. International Journal of Group Psychotherapy, 68(2).

Driessen,E., Van, H. L., Peen, J., Don, F. J., Twisk, J. W. R., Cuijpers, P., & Dekker, J. J. M.

(2017). Cognitive-Behavioral Versus Psychodynamic Therapy for Major Depression:

Secondary Outcomes of a Randomized Clinical Trial. Journal of Consulting Clinical

Psychology, 85)7).