Evidence Based Screening Case Study

Evidence Based Screening Case Study Christopher Mason Clinical scenario Miss. J, (not the patient’s real title or Initial), is a 37-year old female who was recently admitted to the hospital for chronic fatigue leading to exhaustion. As a career she says, â€Å"I am a professional writer and aspiring actress.† She lives alone on the Westside of Los Angeles in a one bedroom apartment. During our conversation she disclosed that after a five year period of not smoking; she has begun smoking again. Miss. J says that the stresses that come with her career path as an actress and writer along with the people involved in the same has most likely caused her to do so. Miss. J denies any illicit drug use but does occasionally use alcohol as a stress reducer. As far as she knows no one in her family has died from or developed any type of cancer. Her father passed away from Acute Myocardial Infarction and was a type 1 diabetic. Her mother has steroid induced type 2 diabetes. Miss. J says, â€Å"I have managed to avoid both. So far.† Identification of the Evidence Based Guideline Based on the interaction with Miss. J, several risk factors became apparent and they include a family history of diabetes, type 1 and type 2. Even with type 2 diabetes having a strong familial association her mother’s was induced by steroids rather than being genetic. The other risk factor that I identified was the smoking of cigarettes and casual use of alcohol as a stress reducer. This places her at an increased risk for use of other illicit drugs, driving accidents, lung cancer, COPD, and high blood pressure, as well as other smoking related diseases. Reason for Selecting Guideline Based on the United States Preventive Services Task Force (U. S. Preventive Services Task Force, 2010), being screened for high blood pressure is recommended as an â€Å"A† level screening. The current level defining hypertension in adults is equal to or greater than 140 for systolic and equal to or greater than 90 for diastolic. Based on variability between separate readings, it is recommended to obtain greater than 2 readings on different visits over several weeks to diagnose hypertension. (p. 35) Barriers and Facilitators for Client Miss. J has only one barrier that I could pinpoint to following up with the screening. Her fatigue. She told me that sometimes she misses appointments because she is too exhausted to drive to them. She agreed that she would make an appointment with her personal physician after being released from the hospital to be screened for hypertension. Adding that she just hoped that she would be able to make the appointments. One of the facilitators that allowed me to participate in a conversation with Miss. J concerning her hypertension was her stating to me that she wished she could have a smoke. That along with her being a captive audience in the hospital. No one had been to visit with her that I had seen, so I assumed and was correct that she would like to chat. Receptivity of Client Miss. J was receptive to the screenings I have listed below. She stated to me that she had recently had a pap smear and tested negative for abnormal cervical cells and HPV. Being asked about the Chlamydia screening because of being sexually active; she said it was something she was interested in receiving more information about. Evidence Based Screening Guidelines Pertinent to Patient Type Clinical Considerations and Currency Situation Cervical Cancer Women 21 to 65 (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years. Grade A+ Recommended. (Screening for Cervical Cancer, 2014). Yes, she is current. Chlamydia All sexually active non-pregnant young women aged 24 and younger and for older non-pregnant women who are at increased risk. Grade A+ Recommended. (Section 2. Recommendations for Adults (continued) | Agency for Healthcare Research Quality (AHRQ)#Chlamydia, 2014) No, she is not current. Folic Acid All women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800  µg) of folic acid. Grade A+ Recommended. (Folic Acid for the Prevention of Neural Tube Defects, 2014) Yes, she takes daily supplement. HIV Adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened. Grade A+ Recommended. (U.S. Preventive Services Task Force: Final Recommendation Statement, 2014) Yes, she is current. Tobacco Use This recommendation applies to adults 18 years or older and all pregnant women regardless of age. The USPSTF plans to issue a separate recommendation statement about counseling to prevent tobacco use in non-pregnant adolescents and children. Grade A+ Recommended. (Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women: Reaffirmation Recommendation Statement, April 2009) Yes, she has been instructed and understands she should quit. Healthcare Provider Barriers I am performing my clinical rotation at Cedars Sinai in Beverly Hills. They do not allow us to use electronics in or around the patients/clients. After explaining to my clinical liaison about our subject and assignment we were cleared to use the program as long as we did it outside of the patient’s rooms. This was limiting but not considered a complete barrier. Confidence in Providing Evidence Based Screening Guidelines This assignment made me feel uncomfortable at first. I realized that I would be asking some very personal questions to a patient that I did not know. However, it did allow me the chance to become familiar with the AHRQ evidence based guidelines application on the android market. Also, it allowed me to help my patient to learn more about the screenings that she should have based on her lifestyle. References Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women: Reaffirmation Recommendation Statement. (April 2009). from http://www.uspreventiveservicestaskforce.org/uspstf09/tobacco/tobaccors2.htm Folic Acid for the Prevention of Neural Tube Defects. (2014). from http://www.uspreventiveservicestaskforce.org/uspstf/uspsnrfol.htm Screening for Cervical Cancer. (2014). from http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm Section 2. Recommendations for Adults (continued) | Agency for Healthcare Research Quality (AHRQ)#Chlamydia. (2014). from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2a.html#tiptop U. S. Preventive Services Task Force. (2010). The guide to clinical preventive services, 2010-2011: recommendations of the U.S. Preventive Services Task Force. [Rockville, Md.]: Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force: Final Recommendation Statement. (2014). from http://www.uspreventiveservicestaskforce.org/uspstf13/hiv/hivfinalrs.htm

Developing a Counseling Plan Essay

As a counselor one constantly strives to help clients become successful members of society. In order to become successful in society one must be mentally healthy, there are clients that are so unhealthy mentally and that have struggled so much throughout their childhood and through adolescents that as a counselor you work and push that much harder to help your client overcome those obstacles. In some cases ones counseling can prevent a negative life and provide for a safer society. This case depicts a client that falls under those circumstances. As a client, John Wayne Gacy will be introduced to Family Therapy to help him understand his family environment and help him to cope and or change the way he feels about his family life. The counseling plan will deal with John Wayne Gacy’s issues of his father being an alcoholic, his father abusing him and the rest of his family, him liking boys, as well as his anti-social ways at school. These will be addressed by looking at creating a genogram. When looking at the research it is favorable to use family therapy in order to facilitate change within the family environment by looking at problem solving abilities, looking at the positive rather than the negative, and accepting family members. Case Study My client is John Wayne Gacy, a 15 year old boy living in Chicago, Illinois. He is a white male and has been referred by a judge to undergo a psych evaluation, after his psych evaluation he began coming to see me. This is Gacy’s first time seeking help from a licensed counselor. Presenting Problems John’s presenting problems are his father is an abusive alcoholic, John is attracted to boys, and John is anti-social at school. These three things lead to much confusion in John’s life which led to him hearing voices. John wants to see if family therapy could change some of his issues and feels that by going to family therapy his home environment might change into a more supportive one. Family Background and Developmental History John Wayne Gacy, the son of Marion Elaine Robinson Gacy and John Wayne Gacy Sr. was born on March 17th 1942 in Chicago, Illinois. His parents were of Polish and Danish heritage (Bell). John was the middle child of three; he had an older sister Joanne and a younger sister Karen. John and his sisters were brought up Catholic and went to catholic school. The environment in which he was raised in was that of middle class, he had a part-time job after school and was involved with the boy scouts. John and his two sisters were raised by a father that was an alcoholic; he abused them and their mother. John was not popular in school and was often left out of the loop. John had a playground incident at age 11 which led to him having a blood clot and the clot caused him to have blackouts (Bell & Bardsley). He could not play with the other kids because he had a heart condition which was another reason he was looked down upon by his father; he saw it as another shortcoming. John also discovered that he liked boys and often struggled with dealing with his sexuality (Bell). John’s father in a way resented him for this. He felt that it was a sign of weakness or another fault that John had. Current Living and Work Environment John is involved in many organizations within the community. He is a hard worker that often suffered from exhaustion and anxiety from the pressure he put on himself to succeed. John was a father and husband; and had a house in the suburbs. All of this came to a screeching halt when rumors of Gacy liking boys surfaced. Multiple charges and even a prison sentence were handed down to Gacy for the assault of a young boy. Physical Appearance, Mood, and Demeanor John was overweight and had heart and back problems; however, it did not stop him from his work or community activities. Gacy was sentenced to ten years in prison for assaulting a young boy. Gacy was in denial saying that the young boy willingly participated in the sexual acts in order to make extra money. He also did not take responsibility for his actions and tried to place blame on others. Gacy’s has an anti-social personality but is mentally competent. When he was in prison he followed rules and was not violent. Gacy took on different personalities as well as went through many different moods (Inside John Wayne Gacy’s Mind). Counseling Plan This counseling plan uses Family Therapy. â€Å"Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system.†(Genopro) Basically family members feed off each other, positivity feeds positivity and vice versa. The best way to put together a treatment plan is to build your family genogram. Study your own behavior patterns and how they fit in with the rest of your family throughout generations. This will bring out options in which could be used in order to solve problems and figure out how one fits into the family and what ones role is within the family (Genopro). The genogram structure of family therapy will allow John and me to create a counseling plan very easily. Conceptualization of Client’s Presenting Problem and Developmental History John shows signs of multiple personality disorder as well as having an anti-social personality. John also hears voices. Family Therapy eludes to the fact that Family development and the environment that he was brought up in, along with family makeup could be a contributor to why John suffers from what he does (Capuzzi & Gross, 2011). Family patterns or expectations are looked at in many ways from parental beliefs, personalities, and extended family influence. This allows each family to be unique in their own ways. This uniqueness can be very overwhelming and takes a toll on all members whether it is negative or positive (Pope). For example, John’s father puts a lot of pressure on him to be successful. John’s shortcomings were looked down upon by his father most likely do to the beliefs and personality that he formed based upon his parental upbringing. John admits that his father was abusive to his mom, sisters, and him as well. John took on many personalities and even called himself pogo the clown at times. John was attracted to boys and this is something that has haunted him his whole life and the reason he is in the predicament he is in. He hated being a disappointment to his father and he was always looking to please his father. John’s confusion with his sexuality ultimately lead to him killing those he sexually encountered because the voices he heard were telling him it would please his father. In session we will discuss with John  and his family ways in which the environment John is brought up in could be altered. Conceptualization of Human Nature According to Family Theory The goal of Family Therapy models is to take the problem presented by the individual dealing with their relationships with other people in the family setting and change the negative aspects (Franklin). The Family Therapy counselor believes the development of family life include family life cycle, family life spiral, and the family genogram (Capuzzi & Gross, 2011) The family life spiral looks at how the members of the family go through the stages of development from young to old age. The family life spiral looks at generations and how they coincide with each other. The genogram charts development of generations. Counseling Goals The overall objective is for John Wayne Gacy to be able to find a way to cope with his anger towards his father and to be able to express how his father’s abuse towards the family affected him in a negative way. John said he wants to break down the barrier between him and his father because he loves him and ultimately wants to make him proud. To advocate for this John’s goal is to try and change the cognitive, affective, and behavioral aspects of his family system (Capuzzi & Gross, 2011). In other words he wants to change the environment in the Gacy household completely around. The abuse needs to stop, the constant pressure needs to stop, and the pointing out of his weaknesses needs to be approached differently. Course of Treatment In order to get a complete understanding I believe the first action that needs to be taken is the nuclear family emotional system needs to be broken down, what this is looking at is the possible relationships with in a family and look at where problems could possibly come about. For John, 3 of the relationship patterns are touched upon in his situation. His father is abusive to his mother and siblings, in John’s fathers eyes there is an impairment of John because he likes boys, and lastly there is an emotional disturbance suffered by John because of his father’s view of him (Genpro). The second part that needs to be addressed is differentiation of self which is the dependency on others to give acceptance and approval. This is something John struggled with and never received from his father. He never felt like his father truly accepted him or approved of the life style that he lived (Genpro). John agreed to do 2 things a day to satisfy his needs, meaning if he wanted to work in the community do it because it made him feel good not because he wants or needs approval from his father. Treatment plan was developed and signed by John and we will meet on a weekly basis. Family Therapy Interventions Due to John stating that the pressure his father puts on him within the family system to be successful, the first intervention to be used will be the family interview. We will follow the five stages of the interview which are social, problem, interaction, goal setting, and ending (Capuzzi & Gross, 2011). This interview will give me the tools necessary to properly assess the situation. The interview will also help John and his family understands how each other feels and come up with some interventions to help facilitate change. â€Å"the first obligation of a therapist is to change the presenting problem offered. If that is not accomplished, the therapy is a failure† (Capuzzi & Gross, 2011). The first intervention needs to address the problem that John has presented, based upon the interview the interventions that will be implemented will be geared towards progressing with Johns presenting problem. Research Support The research that was obtained was very helpful in forming a counseling plan or treatment plan for this particular client. Family Therapy is known for helping individuals whose presenting problems deal with issues that stem from the family and the environment the individual was brought up in. Family therapy is the best way to look at â€Å"the patterns of communication and the relationships that connect people with one another and to their social and physical environments† (Capuzzi & Gross, 2011, p. 287). In this case we will be looking at how John fits into his family and what his father’s expectations are of John. Interviewing as an intervention will be crucial in figuring out John place in the family and seeing how his and his father’s view of the roles conflict with each other. Family therapy allows for John  and his family to work on their problem solving with each other within the family, expressing their individuality with each other, discussing the positive and negative aspect of their family atmosphere as well as with each other on an individual basis, and lastly the acceptance of each other (Capuzzi & Gross, 2011). Family therapy allows for clients to understand their environments as well as to understand their role within that environment. The counselor’s role within the session is to basically guide the discussion and conduct the interview. Family Therapy I feel is the best theory to use for a client such as John Wayne Gacy due to his confusion within his family, particularly when it comes to the relationship with his father and the expectation that his father has for him or at least how John see those expectations. Conclusion This counseling plan reviewed the use of Family Therapy for counseling John Wayne Gacy. Family Therapy is designed to be an extensive look at John Wayne Gacy’s family makeup. John Wayne Gacy’s presenting problems are his father abusing him and his family, his father being an alcoholic, he struggles with his sexuality, and he is anti-social. Family therapy is used to deal with these concerns, so for John, the counseling objective is to find a way to cope with his anger towards his father and to be able to express how his father’s abuse towards the family affected him in a negative way. The counseling plan addresses John’s concerns of worrying about his father’s abuse and constant push for perfection as well as his anti-social tendencies. Due the treatment plan and goals presented and the attitude of John to want to get better, I feel that Family Therapy will be successful for John Wayne Gacy as well as his family. References Bell, R., & Bardsley, M. (n.d.). John wayne gacy jr. In R. BELL (Ed.), Retrieved from http://www.crimelibrary.com/serial_killers/notorious/gacy/gacy_1.html Bell, R. (n.d.). Retrieved from http://www.biography.com/people/john-wayne-gacy-10367544 Capuzzi, D., & Gross, D. R. (Ed.). (2011). Counseling and psychotherapy: Theories and interventions (5th ed.). Alexandria, VA: American Counseling Association Franklin, C. (n.d.). Retrieved from http://www.utexas.edu/courses/franklin/62670/Week1.html GenoPro. Family systems theory. Retrieved from http://www.genopro.com/genogram/family-systems-theory/ Inside John Wayne Gacy’s Mind. Chicago: CBS. Retrieved from http://chicago.cbslocal.com/video/6658917-inside-john-wayne-gacys-mind/ Pope, J. (n.d.). Retrieved from http://www.webmd.com/balance/family-therapy-6301

Poor Parenting Techniques Displayed in Maurice Sendaks...

Poor Parenting can cause poorly behaved children Where The Wild Things Are was first published in 1963 and is the first part of a trilogy of award - winning books by American author and illustrator Maurice Sendak. Where The Wild Things Are is haunting and imaginative and describes how a young child, called Max, creates a fictitious fantasy world in order to deal with the terrifying reality of anger. Poor parenting is a lack of parenting techniques and skills in relation to the responsibilities and obligations, which need to be fulfilled in order to accomplish prominent problems within the family relationship. Poor parenting is most likely to come from an absence of cooperation from both child and parent, satisfying both needs and†¦show more content†¦As Max interprets the difference between acceptable and unacceptable behaviour in the picture book Where the Wild Things Are by Maurice Sendak, it is clearly evident that the ways in which he and his mother are portrayed influence the depiction of characters by the implied reader. Maxs mother is represented in the text as the authoritarian. She has the dominating position in the family and is likely to be the family decision maker. In the 1960s, women were the housekeepers and wives and were the sole minder of the children as the father was a workingman who supplied the bread and water. It should come as no surprise to the implied reader that Maxs mother was therefore the dominant authoritarian as her main job was to care for the children. Max is represented as an adventurous but monstrous 6 to 8 year old child with destructive behaviour. He is wearing a wolf suit as a disguise; it symbolizes a sense of development and privacy. Maxs behaviour is represented in the monster picture he drew. It suggests the adventure he is about to enter is not something that is new. He could have been thinking of a fantasy world, far away from the reality of his anger at his mother, and that he has a history of destructive behaviour. Maxs poor behaviour and characteristics are influenced by his mothers parenting skills and techniques. In a time of great development and growth in this phase of his childhood, Maxs social development characteristics includedShow MoreRelatedpreschool Essay46149 Words   |  185 PagesAdministrators Baccalaureate Pathways in Early Childhood Education (BPECE) *During the development of the foundations, these individuals worked for the California Department of Education. ix California Alliance Concerned with SchoolAge Parenting and Pregnancy Prevention (CACSAP/Cal-SAFE) California Association for Bilingual Education (CABE) California Association for the Education of Young Children (CAEYC) California Association of Family Child Care (CAFCC) California Association

Synthesis of The Reading-Writing Connection and Literary...

There is no question that a connection between reading and writing exists. Although, to what degree does one have to be immersed into literature for it to influence students’ writing experiences? Some ideas to help formulate answers and support this connection can be found in the two following articles in which, authors address the relationship between reading and writing. In the first piece titled The Reading-Writing Connection, author Olness (2005) offers insight to this connection by assembling many teachers and researchers information on the connection between reading, writing, and the value of quality children’s literature. Olness provides examples and ideas of how to successfully join reading with writing in the classroom. In†¦show more content†¦In the second article, Lancia (1997) begins by illustrating a student’s experience with â€Å"literary borrowing† (p. 470) in which he states that this borrowing has taken place within his clas sroom without his instruction to do so. He continues by discussing his design of a classroom study in which he attempted to identify patterns of literary borrowing. He states that his results show a â€Å"saturation with literature directly influences writing by providing important models for successful work† (p. 470). He then continues by discussing existing research on the influence of literature on students’ compositions. In summation the research he includes recognize the important role that literature plays in writing and that literary borrowing should not be viewed as plagiarism but as temporary use of ideas while developing his or her own writing style. Lancia continues by discussing the context and methodology for his study. His study was conducted within his second grade classroom which has identified learning disabled students, students receiving support from Title I, and a gifted and talented student where the students reading development ranging from late emergent to students who were reading fluently. He continues by explaining the components of the reading program he enlists within his classroomShow MoreRelatedPeculiarities of Euphemisms in English and Difficulties in Their Translation19488 Words   |  78 Pages Chapter I is a theoretical one. Here we speak about the euphemisms and their influence on the ambiguity of a sentence and present different classifications of euphemisms. We also investigate the connection of euphemisms and logic, equivocal words and ambiguity. Chapter II is an analytical one. This chapter deals with the sources of appearance of euphemisms. We speak here about the language of political correctness which is often the main source ofRead MoreMetz Film Language a Semiotics of the Cinema PDF100902 Words   |  316 Pagespublished articles. The disparity between ten and twelve is caused by the fact that Chapter 5 was condensed out of three separate articles. As the title indicates, the articles included in this volume have been selected exclusively from the author s writings on cinematographic problems.* Since this is, therefore, a collection, I have not tried to eliminate or disguise the few inevitable repetitions. Similarly, I have not allowed myself to excise or replace passages that, as a result of the lapse in timeRead MoreAnnotated Bibliography: Plagiarism39529 Words   |  158 Pagesbjet12008-bib-0002#bjet12008-bib-0002 o Link to bibliographic citation 1159) And that presents us with a problem when we are writing about our work for publications, whether in conference presentations, organisational websites or in journals like BJET. It is essential that we distinguish between the work that has been carried out by others and the work and the writing that is due to our original efforts. Most research projects will start with a comprehensive study of the literature to determineRead MoreMarketing Management 14th Edition Test Bank Kotler Test Bank173911 Words   |  696 Pagesdesired responses from other parties. Answer: E Page Ref: 5 Objective: 2 Difficulty: Moderate 4) A social definition of marketing says ________. A) effective marketing requires companies to remove intermediaries to achieve a closer connection with direct consumers B) a company should focus exclusively on achieving high production efficiency, low costs, and mass distribution to facilitate the broadest possible access to the companys products C) marketing is the process by which individuals