Clinical Approach And Transition

My first encounter with a Certified Registered Nurse Anesthesia (CRNA) was during my undergraduate nursing OB/GYN rotation. I was impressed with the CRNA when she placed the epidural to the patient in labor. I remembered patient had difficulty staying still due to the contraction, but the CRNA took her time to explain the procedure while comforting the distressed patient. Once the epidural was in placed and the medication started working, I could tell the relief the patient experienced. I realized then that a CRNA goes beyond the delivery of anesthesia, pain management and monitoring of patients. Thus, obtaining this degree will prepare me to ease the patient’s mind through education, pain management, monitoring, experience and compassion.

Throughout my clinical experiences, there have been quite a few circumstances I have been placed in that have remained with me whether good or bad. All of them have been learning experiences for me whether it is how to improve and to do better next time from a mistake, for me to learn that this is or is not how a patient should be treated, how to handle family situations, and many others. One experience that I was able to participate in that will remain with me because I had not experienced this before was during my critical care rotation in the fall of 2015. This patient was dying and we were implementing comfort care for him.

Florida Assertive Community Treatment (FACT) is a program that provides comprehensive community counseling to individuals diagnosed with a debilitating mental illness. It is federally funded by the State of Florida Department of Children and Families and serves a clientele of 100 adults in the Volusia and Flagler County areas. It is a derivative of the Program of Assertive Treatment (PACT) which was developed in Wisconsin in the 1970s when deinstitutionalization was a major practice in the mental health field. This outpatient program is rehabilitation and recovery oriented. FACT is unique in that it is the only service available that offers a housing, medication, and flexible funding subsidy to enrolled individuals which help to integrate them back into mainstream civilization to be productive members of society—reducing hospitalization, homelessness, and criminal incarceration among the mentally ill.

This paper explores the scenario of a client and looks at the presenting problem from an ecological and strengths perspective. It will also explore advanced clinical skills, intervention strategies and ethical dilemmas encountered. Methods for evaluating progress will be discussed within the social context of the case. Termination and follow-up approaches, and any ethical dilemmas will be included. Any problems with oppressed populations will also be discussed. Finally, the limits of the chosen model and limits of the practitioner, evolution of client and practitioner identities, any ethical or social justice issues for the agency, and an evaluation of the practitioner’s effectiveness will conclude the paper.

First, the recovery model prioritizes individual life goals, which are developed by the person seeking treatment, not the provider. On the other hand, the medical model is focused narrowly on treatment goals which are developed by the provider or treatment team. The recovery model encourages high goal-setting. They facilitate hope through providing resources and education, and help to develop steps to achieve personal goals, whereas the medical model has low expectations of the client and does not facilitate positive outcomes that will increase one’s quality of life. While the recovery model is holistic and sensitive to the issues that encompass stigma, the medical model is reductionistic and identifies individuals by their illness. The recovery model is strengths based, which is focused on improving self-efficacy, whereas the medical model is focused on symptom management; the overall goal is to reduce symptoms and stabilize the client. The recovery model recognizes that relapse does exist, whereas the client would be considered non-compliant if treated under the medical model. The medical model is focused on systematic processes, undervalues the therapeutic relationship, and is less focused on the individual. With the recovery model, providers understand the importance of a strong therapeutic relationship and encourage clients’ self-direction and right to make decisions regarding treatment. Recovery based therapy values the impact that hope and empowerment can have on individual treatment. The provider maintains a facilitator role with the client, which helps to encourage and foster positive change. With the medical model, providers control all aspects of treatment and client involvement is not as stable as it may be in recovery based treatment. (National Association for Social Workers West Virginia,

The role of the social worker in this setting is to perform duties as an informed clinician based on evidence based practice to provide individualized case management to all clients. The social worker will complete a comprehensive intake assessment which includes demographics of the client, address presenting problem, and a risk assessment. Client’s also receive mental health screenings and individual and group counseling to gain new coping skills and address any triggers to prevent relapse utilizing interventions as CBT and Motivational Interviewing. The social worker will discuss limits of confidentiality and a signed informed consent from the client to receive services.

Florida Assertive Community Treatment (FACT) is a program that provides comprehensive community counseling to individuals diagnosed with a debilitating mental illness. It is federally funded by the State of Florida Department of Children and Families and serves a clientele of 100 clients in the Volusia and Flagler County areas. It is a derivative of the Program of Assertive Treatment (PACT) which was developed in Wisconsin in the 1970s when deinstitutionalization was a major practice in the mental health field. This outpatient program is rehabilitation and recovery oriented. FACT is unique in that it is the only service available that offers a housing, medication, and flexible funding subsidy to enrolled individuals which help to

Transition of care appeals to me the most in my practice as a case manager. When a patient gets admitted, the interdisciplinary team starts working on the discharge planning. I always wonder how can the team know for sure, that the patient is ready to be transitioned and how can we know for sure that the transition of care is safe and it would not be overlook?

He waltzed into the ward and introduced himself to every patient as a gambling man with a zest for women and cards. Randle P. McMurphy, a swaggering, gambling, boisterous redheaded con man, arrived at the ward from the Pendleton Work Farm. He was sentenced to six months at the prison work farm, but pretended to be insane in order to obtain a transfer to the hospital because he thought it would be more comfortable than the work farm. Bromden senses that there was something different about this new patient. After his first experience with the excruciating routine of the Group Meeting, McMurphy tells the patients that Nurse Ratchet is a genuine “ball-cutter.” The other patients tell him that

The “transition” from pediatric to adult care in the healthcare system has been defined many ways. One such definition, from the American Academy of Pediatrics (AAP), discusses health transitions for youth with special health care needs (YSHCN). Blum et al discuss the AAP’s states that health transitions can be defined as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems”. 1 It is estimated that 21% of US adolescents have special health care needs due to physical, mental, or emotional conditions and that every year almost 75,000 of these individuals cross the threshold from adolescent to adult health care.2 As the transition

The goal |with the advocacy program ended up being to describe the introduction of someone advocacy program inside the Eastern surrounding suburbs of Sydney (NSW, Australia). This method is made within the connection from the study concerning the after effect of client-focused techniques to community management for clients with schizophrenia and bipolar (O’Donnell, Proberts, & Parker, 1998). Limitation of the presentation on the consumer advocacy program creates restrictions in implementing with the research methodology, the study gave the chance to illustrate

When developing a treatment plan for any complex case, it is critical to consider any factors that contribute to the client’s situation. One must generate a plan of action that will support the client appropriately and yet not be overwhelming. It often takes a long time for a client to come to terms that they need help. For many, seeking mental health services can be both a daunting and intimidating laden with feelings of failure and disappointment.

There is no better teacher than experience itself. This statement holds true with regards to acquiring knowledge and necessary skills in the nursing profession. Clinical rotation is when theories are actually put in to practice and competencies acquired. Indeed, during this clinical rotation I felt like I gained a whole lot of understanding about the nursing process, the legal and ethical matters surrounding the practice, and the public health nursing as a profession.

Also, the objective is to find patient’s document finding and correlate it with chronic disease process of elderly adults. With this reflection, I will discuss what I’ve learned, and my strengths and weakness in my clinical experience.

Psychosocial rehabilitation has its theoretical roots in evolving a failed effort, by the mental health system, to help mentally ill patients in coping with the psychosocial devastation brought on by severe mental illness and behavioural problems (Correctional Services Canada, 2013). The traditional methods of treatment viewed recovery as a process of curing an illness, usually with medication, but recovery does not subsequently occur once their illness is “treated” (CSC, 2013). This traditional method was ineffective because their recovery was halted by limited support and skills and ‘abnormal’ behaviours learned in institutions (CSC, 2013). These deficits resulted in chronic impairments and maladaptive social functioning (CSC, 2013). These individuals were unable to fulfill normal social roles and successfully live independently in the community (CSC, 2013). The PSR approach to recovery incorporates more than just eliminating the signs and symptoms of the illness, is based on understanding the patients voice and experiences and encouraging participation and self-determination in treatment (CSC, 2013). This approach recognises the care values such as hope, empowerment, and determination are essential to recovery (CSC, 2013). The importance of skill development and community support are also highlighted (CSC, 2013).