Secret Club or Safety Net? Confidentiality with Children and Adolescents
Imagine a child whispering secrets into a trusted adult’s ear. This scenario highlights the importance of confidentiality in healthcare settings, especially when working with children and adolescents. Confidentiality creates a safe space for young people to express themselves freely, fostering trust and promoting their well-being [1]. But is it ever okay to break this promise? Let’s explore the complexities of confidentiality with this unique patient population.
Confidentiality builds trust between a healthcare professional and a child or adolescent [2]. Knowing their disclosures will be kept confidential, young people feel more comfortable opening up about sensitive topics like bullying, anxiety, or even substance abuse. This open communication allows for early intervention and support, leading to better health outcomes.
However, maintaining confidentiality isn’t always straightforward. In certain situations, healthcare professionals may need to disclose information to ensure a child’s safety [3]. If a child reveals suicidal ideation, plans to harm themselves or others, or experiences abuse, healthcare professionals have a legal and ethical obligation to intervene. Additionally, in cases of suspected child neglect, reporting may become necessary to protect the child’s well-being.
The key lies in striking a balance between building trust and ensuring safety [4]. Healthcare professionals should explain the limitations of confidentiality upfront, using age-appropriate language. For instance, they can explain that they need to tell someone if a child is planning to hurt themselves or someone else. This transparency fosters trust while setting clear boundaries.
Open communication and collaboration with parents or guardians are also crucial [5]. While maintaining confidentiality for the child, healthcare professionals can involve parents in a way that protects the child’s privacy. For instance, they can discuss general concerns without revealing specific details shared by the child.
Confidentiality in pediatric care is a complex yet essential concept. By creating a safe space for open communication while prioritizing safety, healthcare professionals can empower children and adolescents to navigate the challenges of growing up, fostering a foundation for healthy development.
References
[1] The Association for Play Therapy. (n.d.). Confidentiality and ethics. Association for Play Therapy. [confidentiality in play therapy ON Association for Play Therapy a4pt.org]
[2] American Academy of Child and Adolescent Psychiatry. (2022, December). Confidentiality and adolescents. American Academy of Child and Adolescent Psychiatry. [informed consent example for adolescents ON American Academy of Child and Adolescent Psychiatry aacap.org]
[3] The National Center for PTSD. (2023, May 12). Confidentiality and disclosure of mental health information. Veterans Affairs (.gov). [confidentiality in mental health ON Veterans Affairs (.gov) ptsd.va.gov]
[4] The Trevor Project. (2023, May 19). Confidentiality and privacy for LGBTQ youth. The Trevor Project. [youth confidentiality and privacy ON thetrevorproject.org]
[5] American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. [apa ethical principles of psychologists and code of conduct 2017 ON American Psychological Association apa.org]
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A Tiny Heart’s Big Fight: Understanding Congenital Heart Defects
Imagine a tiny heart, bravely pumping blood throughout a growing body, yet facing challenges from the very beginning. This is the reality for children born with congenital heart defects (CHDs) structural abnormalities of the heart and its vessels present at birth [1]. Despite these hurdles, with advancements in medical care, many children with CHDs can lead healthy and fulfilling lives. Let’s explore this complex medical condition.
CHDs encompass a wide range of abnormalities, affecting different parts of the heart and blood flow [1]. Some defects might be minor, causing few symptoms or requiring minimal intervention. Others, however, can be life-threatening and necessitate immediate medical attention or even surgery shortly after birth. Common CHDs include septal defects (holes in the heart walls), valve malformations that impair blood flow, and narrowed blood vessels.
The causes of CHDs aren’t always fully understood, but a combination of factors is likely at play [2]. Genetics can be a contributing factor, as can certain maternal exposures during pregnancy, such as medications, infections, or uncontrolled diabetes. In some cases, the cause remains unknown.
The symptoms of CHDs vary depending on the severity of the defect. Some children might experience no noticeable symptoms initially. However, common signs can include shortness of breath, fatigue, rapid heartbeat (palpitations), bluish skin color (cyanosis), and difficulty feeding in infants [3]. If you notice these symptoms in your child, seeking prompt medical attention is crucial.
Fortunately, significant progress has been made in diagnosing and treating CHDs [4]. Advanced prenatal screening techniques can sometimes detect CHDs before birth, allowing for early intervention and planning. A variety of treatments are available, including medications, minimally invasive procedures using catheters, and open-heart surgery. With advancements in technology and surgical techniques, the success rates of these interventions are constantly improving.
Living with a CHD requires ongoing monitoring and management, often involving regular checkups with a cardiologist and potentially lifelong medication. However, with proper care and support, many children with CHDs can participate in most activities their peers enjoy and lead active, fulfilling lives.
References
[1] Centers for Disease Control and Prevention. (2022, March 31). Congenital heart defects (CHDs). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/heartdefects/facts.html
[2] Mayo Foundation for Medical Education and Research. (2023, March 24). Congenital heart defects – Causes). Mayo Clinic.
[3] American Heart Association. (2023, May 2). Congenital heart defects. American Heart Association.
[4] The Society for Thoracic Surgeons. (2023, January 11). Congenital heart defects – Treatment).
Bridging Borders, Building Trust: Cultural Competency in Global Health
Imagine a healthcare professional venturing into a new community, eager to help. But what if language barriers and cultural misunderstandings hinder their efforts? Cultural competency, the ability to understand and respect the beliefs, values, and practices of diverse populations, becomes paramount in global health initiatives [1]. Let’s explore why cultural competency is essential for effective healthcare delivery across the world.
Cultural beliefs and practices significantly influence health behaviors [2]. For instance, traditional medicine holds deep significance in many communities. Culturally competent healthcare professionals acknowledge and respect these practices, working collaboratively with traditional healers to provide holistic care [3]. Additionally, understanding dietary restrictions, religious beliefs surrounding childbirth, or even preferred communication styles fosters trust and rapport with patients.
Language barriers can be a significant hurdle in global health [4]. Imagine a doctor struggling to explain a diagnosis or a patient hesitant to express their concerns due to limited language proficiency. Culturally competent healthcare professionals utilize translation services, employ visual aids, and practice active listening to bridge this communication gap.
Cultural competency extends beyond language and beliefs [5]. Understanding social determinants of health, like poverty, access to clean water, and sanitation, is crucial. Culturally competent healthcare professionals consider the social context of illness and work with communities to address root causes that impact health outcomes.
Investing in cultural competency training for healthcare professionals is vital for effective global health initiatives [6]. This training equips healthcare workers with the skills and knowledge to navigate diverse cultural landscapes, fostering trust, and ultimately, improving health outcomes for all. By embracing cultural competency, healthcare professionals can become bridges of understanding, ensuring quality healthcare delivery across the globe.
References
[1] Betancourt, J. L., & Aguirre-González, V. (2017). Overview: Cultural competency in health care delivery. Journal of General Internal Medicine, 32(6), 547548. [cultural competency in health delivery ON National Institutes of Health (.gov) ncbi.nlm.nih.gov]
[2] World Health Organization. (2023, May 12). Traditional medicine. WHO. [world health organization traditional medicine ON who.int]
[3] National Center for Complementary and Integrative Health. (2023, May 19). Complementary, alternative, and integrative health: What is complementary, alternative, or integrative health? National Institutes of Health (.gov). [complementary alternative integrative health ON National Institutes of Health (.gov) nccih.nih.gov]
[4] Breakthrough ACTION. (2023, May 17). Language barriers in healthcare. [breakthrough action jake richards ON breakthroughaction.org]
[5] Centers for Disease Control and Prevention. (2020, December 1). Social determinants of health. Centers for Disease Control and Prevention (.gov). [social determinants and health cdc ON Centers for Disease Control and Prevention (.gov) cdc.gov]
[6] American Public Health Association. (2020, October 28). Culturally competent care. American Public Health Association. [association of state and territorial health officials cultural competency ON American Public Health Association apha.org]
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A World of Colors: How Culture Shapes Our Growth
Imagine a vibrant tapestry woven from diverse traditions, beliefs, and customs. This tapestry represents culture, a powerful force that significantly shapes our development from the moment we enter the world. Let’s explore how cultural influences paint their unique colors onto our journey of growth.
Culture plays a pivotal role in shaping our values, beliefs, and social interactions [1]. The way families are structured, how children are raised, and the importance placed on education can vary greatly across cultures. For example, some cultures emphasize collectivism, prioritizing the needs of the group, while others value individualism and personal achievement [2]. These cultural values influence how children learn to interact with others, perceive authority, and navigate social situations.
Communication styles are also heavily influenced by culture [3]. In some cultures, children are expected to be more reserved and respectful towards elders, while others encourage open expression and questioning. These communication styles shape how children learn to express themselves, build relationships, and resolve conflicts.
Cultural traditions and rituals also leave lasting impressions on development [4]. Participating in cultural celebrations, religious ceremonies, or traditional storytelling sessions can foster a sense of belonging, identity, and connection with the past. These experiences contribute to a child’s understanding of their place in the world and the values their culture holds dear.
The impact of culture extends beyond social and emotional development. Certain cultures may emphasize specific skills or learning styles [5]. For instance, a culture with a strong emphasis on craftsmanship might encourage children to develop their fine motor skills and learn practical skills early on. Conversely, a culture that values academic achievement might prioritize early literacy and numeracy development.
Understanding cultural influences on development is crucial for creating inclusive and supportive environments for all children. By recognizing the diverse ways cultures shape growth, we can better appreciate the richness of human experience and nurture the potential within every child.
References
[1] Berry, J. W., Tobin, J. T., & Dasen, P. R. (1999). Cross-cultural psychology: Research and applications. Wadsworth Publishing Company.
[2] Hofstede, G. (2011). Culture’s consequences: Comparing values, institutions, and organizations across nations (2nd ed.). Sage Publications.
[3] Matsumoto, D. (2008). The Cambridge handbook of culture, communication and social cognition. Cambridge University Press.
[4] Rogoff, B. (2003). The cultural nature of human development. Oxford University Press.
[5] Greenfield, P. M. (1997). Culture and human development. In W. Damon (Series Ed.) & R. M. Lerner (Vol. Ed.), Handbook of child psychology: Vol. 1. Theoretical models of human development (5th ed., pp. 679-770). John Wiley & Sons, Inc.
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Unequal Playing Fields: Disparities in Childhood Healthcare
Imagine a world where a child’s zip code dictates their access to quality healthcare. This is the unfortunate reality of disparities in childhood healthcare, where social determinants like race, ethnicity, income, and geographic location create uneven opportunities for health and well-being [1]. Let’s explore some of the concerning gaps in pediatric care.
Children from low-income families and minority communities often face significant barriers to accessing healthcare [2]. These barriers can include limited access to transportation, lack of health insurance, and cultural or linguistic challenges. Consequently, these children may experience delays in preventative care, immunizations, and treatment for chronic conditions like asthma or diabetes [3]. This lack of access can have long-term consequences, impacting a child’s physical and mental health throughout their life.
Geographic location also plays a role in disparities [4]. Children living in rural areas may have limited access to specialists, advanced medical facilities, and mental health services. This lack of resources can further exacerbate existing health inequalities.
The consequences of these disparities are far-reaching [5]. Children without access to quality healthcare are more likely to experience preventable illnesses, chronic conditions, and developmental delays. These disparities can also contribute to educational and economic disadvantages later in life.
Addressing these disparities requires a multi-pronged approach [6]. Increasing access to affordable health insurance, expanding transportation options for families, and providing culturally competent care are crucial steps. Additionally, investing in telehealth services can bridge geographical gaps and ensure children in rural areas have access to specialized care.
Creating a more equitable healthcare system for children requires a commitment from policymakers, healthcare providers, and communities at large [7]. By working together to dismantle these disparities, we can ensure all children, regardless of their background, have a fair shot at a healthy future.
References
[1] American Academy of Pediatrics. (2023, May 1). Child health equity. HealthyChildren.org [child health equity healthy children pediatrics ON HealthyChildren.org]
[2] The Henry J. Kaiser Family Foundation. (2023, May 10). Disparities in children’s health insurance coverage. KFF. [disparities in children’s health insurance coverage ON Henry J. Kaiser Family Foundation kff.org]
[3] Centers for Disease Control and Prevention. (2020, December 1). Social determinants of health and health disparities. Centers for Disease Control and Prevention (.gov). [social factors that determine health ON Centers for Disease Control and Prevention (.gov) cdc.gov]
[4] Rural Health Information Hub. (2023, May 12). Access to pediatric care in rural areas. Rural Assistance Center. [access to pediatric care in a rural setting ON Rural Assistance Center rac.rural.org]
[5] Children’s Defense Fund. (2023, May 17). The state of our children 2023. Children’s Defense Fund. [association of state children’s health insurance programs ON Children’s Defense Fund childrensdefensefund.org]
[6] The Robert Wood Johnson Foundation. (2023, May 15). Building a culture of health equity. The Robert Wood Johnson Foundation. [how would you define health equity ON The Robert Wood Johnson Foundation rwjf.org]
[7] The National Conference of State Legislatures. (2023, May 18). Policy solutions to address health disparities. National Conference of State Legislatures. [ncsl health disparities health equity & access ON National Conference of State Legislatures ncsl.org]
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Battling the Beast: Effective Pain Management Strategies
Imagine a relentless beast, a dull ache or a sharp pang, disrupting your daily life. Pain, a universal human experience, can range from a fleeting discomfort to a chronic condition. Fortunately, an arsenal of strategies exists to help manage pain and reclaim a sense of well-being. Let’s explore some effective pain management approaches.
The first step in effective pain management is understanding the source of the discomfort [1]. Consulting a healthcare professional for a proper diagnosis is crucial. Different types of pain require different approaches. For instance, acute pain caused by an injury might benefit from over-the-counter pain relievers like ibuprofen or acetaminophen [2]. In contrast, chronic pain due to conditions like arthritis might call for a more multifaceted approach.
Pharmacological interventions play a significant role in pain management [2]. Medication choices vary depending on the pain type and severity. Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be effective for mild to moderate pain. Stronger medications like opioids might be prescribed for severe pain, but their use should be carefully monitored due to potential side effects and dependency risks.
Beyond medication, a holistic approach to pain management is often recommended [3]. Therapy techniques like physical therapy, massage therapy, and acupuncture can help reduce pain and improve mobility. Relaxation techniques like deep breathing exercises and meditation can also be beneficial in managing pain perception and reducing stress, which can exacerbate discomfort.
For chronic pain, focusing on lifestyle modifications can significantly improve quality of life [4]. Maintaining a healthy weight, engaging in regular exercise programs tailored to individual needs, and getting adequate sleep all contribute to pain management. Additionally, practicing good posture and learning proper body mechanics can help prevent pain from recurring.
Living with pain doesn’t have to mean suffering in silence. By understanding the source of pain, exploring medication options, and incorporating holistic and lifestyle modifications, individuals can effectively manage discomfort and regain control of their lives. Remember, open communication with healthcare professionals and a proactive approach are key to battling the pain beast and reclaiming a sense of well-being.
References
[1] National Institutes of Health. (2022, August 24). Pain management. [invalid URL chronic pain ON National Institutes of Health (.gov) ninds.nih.gov]
[2] Mayo Foundation for Medical Education and Research. (2023, April 15). Pain medication. Mayo Clinic. [invalid URL pain killers ON mayoclinic.org]
[3] National Center for Complementary and Integrative Health. (2021, December 16). Pain management: In depth. National Institutes of Health (.gov). [invalid URL chronic pain centers ON National Institutes of Health (.gov) nccih.nih.gov]
Navigating a Difficult Journey: End-of-Life Care Decisions
Imagine a loved one facing a terminal illness. Open and honest communication about end-of-life care becomes crucial. These decisions, though emotionally challenging, empower individuals to maintain control and express their wishes for their final chapter [1]. Let’s explore navigating these sensitive conversations.
End-of-life care decisions encompass a range of choices concerning medical interventions, pain management, and desired level of comfort care [1]. Advance directives, legal documents outlining an individual’s preferences for care in the event of incapacitation, play a vital role in ensuring wishes are respected [2]. These documents can specify preferences for artificial respiration, resuscitation, and other life-prolonging measures.
Open communication with loved ones is paramount [3]. Discussing end-of-life wishes beforehand allows families to understand the patient’s preferences and avoid confusion or potential conflict during a difficult time. These conversations can be facilitated by healthcare professionals who can provide information and address concerns in a compassionate and sensitive manner.
While open communication is important, respecting individual autonomy remains crucial [4]. Ultimately, the decision regarding end-of-life care rests with the competent patient. Family members and loved ones can offer support and encouragement but should not pressure the patient into making decisions that don’t align with their wishes.
End-of-life care decisions are rarely easy, but open communication, informed choices, and respect for autonomy can provide a sense of control and peace during a challenging time [5]. By having these conversations beforehand, individuals can ensure their wishes are honored, and families can navigate this difficult journey with clarity and compassion.
References
[1] National Hospice and Palliative Care Organization. (2023, May 10). What is hospice care? NHPC. [hospice care definition]
[2] Aging With Dignity. (2023, May 17). Advance directives. Aging With Dignity. [advance directive ON Aging With Dignity agingwithdignity.org]
[3] The Conversation Project. (2023, May 15). How to start a conversation about end-of-life care. The Conversation Project. [the conversation project ON theconversationproject.org]
[4] American Medical Association. (2020, December 1). Code of Medical Ethics. American Medical Association. [american medical association code of ethics ON ama-assn.org]
[5] Kübler-Ross, E. (1969). On death and dying. Routledge.
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The levels of criminality in women and men significantly differ. Women, in general, are less likely to engage in violent and criminal activities as compared to men. This explains the small percentage of women in prisons. According to most sociologists, this difference in crime can be attributed to gender socialization. Society has assigned different roles and responsibilities across the two genders; therefore, men and women are expected to behave in a certain way per their particular gender roles.
Values such as competitiveness and behavioral patterns such as spending time away from family and home brought about by socialization into male gender roles may promote acts of deviance such as infidelity. On the other hand, role expectations limit womens criminal activities. These role expectations include gentleness, spending time at home, cooking for the family, helping the children with homework, and attending book clubs (Casella, 2020).
Women are also less likely to commit crimes as conviction seems more stigmatizing to them than men, hence influencing their socialization patterns. For instance, they are perceived as doubly deviant in court, and their actions are explained in terms of psychopathology (Heidensohn, 1991). Therefore, women fear such consequences of committing a crime at a higher degree compared to men.
Lastly, the difference in arrests may be attributed to the fact that society closely supervises and strictly disciplines women compared to men; thus, the social control. Subsequently, society ends up with a high percentage of women who conform. According to Sutherland and Cressey, the rates of arrests for females are lowest in such communities and highest in societies where women have great equality with men (Hoffman-Bustamante, 1973).
In conclusion, women make up a small percentage of the total incarcerated population due to differences in role expectations, socialization patterns, and applications of social control, as discussed above. Despite the percentage increase in womens imprisonment over the years, these factors remain viable for explaining the small number of women in prison over the total incarcerated population.
References
Cassella, K. (2020). Social Work and Deviant Behavior. Eastern Gateway Community College.
Heidensohn, F. M. (1991). Women as Perpetrators and Victims of Crime. British Journal of Psychiatry, 158(S10), pp.50-54. <http://sci-hub.se/10.1192/S000712500029199X>
Hoffman-Bustamante, D. (1973). The Nature of Female Criminality. Issues in Criminology, 8(2), pp.117-136. <https://www.jstor.org/stable/42909687>
As of 2015, women made up 10.4% of the incarcerated population in adult prisons and jails. Why do you think women make up such a small percentage of the total incarcerated population?
Women and Crime
(You can support your opinion with outside resources if you wish; just make sure to cite your source[s] at the end ).
Note: Please read Chapter 6 of the attached textbook
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Katie, a Caucasian 8-year-old girl, was brought to the office today by her parents. They were recommended by their primary healthcare provider (PCP). The PCP believed it was best if Katie had a psychiatric evaluation. The parents were given a copy of Conners Teacher Rating Scale-Revised to take to the PMHNP. Katies teacher completed the scale, and it was taken to their PCP. Katies teacher noted that she was easily distracted, inattentive, forgetful, seldomly followed instructions, and never finished school work. The parents are in denial. From a subjective perspective, Katie feels she is okay. She is interested in art. She gets lost momentarily. She loves her parents as they are good and kind to her. Mental examination shows she is well-grown for her age and well-dressed for the weather with clear, coherent, and logical speech. She has no tics, gestures, or noteworthy mannerisms, and her effect is bright. She denies any hallucinations or paranoid thoughts. Her attention and concentration were grossly intact during the interview, and she could count backward from 100 by serial 2s and 5s. She has no suicidal or homicidal ideation. Katie was diagnosed with attention deficit hyperactivity disorder (ADHD) and predominantly inattentive presentation.
Decision #1
My first choice of medication for Katie is Wellbutrin (Bupropion) XL, whereby she will take a total of 150mg orally daily. The decision to use Wellbutrin (Bupropion) XL 150mg as the first line for ADHD is because the selected medication is an atypical antidepressant that has been found to have higher efficacy in the management of ADHD in children and adolescents (Mucci et al., 2021). The bupropion mechanism of action, although not clear, includes weakly blocking the reuptake of norepinephrine and dopamine (Huecker et al., 2022). These neurotransmitters are responsible for attention and motivation, which leads to a reduction of ADHD symptoms within two weeks of use.
The other available options were not selected over Wellbutrin (Bupropion) XL due to concerns over the efficacy and risks of side effects. Wellbutrin (Bupropion) XL has a reduced risk of serious side effects as well as developing a dependency (Huecker et al., 2022). The provided options have lower efficacy in managing ADHD symptoms or have an increased risk of developing major side effects in long-term use as well as developing addictions.
The selection of Wellbutrin (Bupropion) XL as the first line for treating Katies symptoms was to reduce the ADHD symptoms as well as improve her ability to perform her daily activities such as learning. Wellbutrin (Bupropion) XL is linked to improved outcomes and can also help manage other comorbid psychiatric disorders not yet diagnosed in ADHD patients (Mucci et al., 2021).
The major ethical considerations include the patients autonomy, confidentiality, and maintaining her dignity. In this case, as Katie is too young to make her own decisions on treatment, her parents will be the main decision-makers. They will be informed of all available treatment options, efficacy, and risks to help them decide on the treatment plan that is best for Katie.
Decision #2
The second medication decision for Katie is Intuniv 1mg, to be taken orally at bedtime. I selected Intuniv based on the symptoms Katie presented. Intuniv (Guanfacine) is an FDA-approved alpha-2 adrenergic agonist for the management of ADHD symptoms in children between the ages of 6 and 17 years (FDA, n.d.). Intuniv is effective as it works by stimulating the alpha-2A receptors in the prefrontal cortex (Arnsten, 2020). The stimulated alpha-2A receptors in the prefrontal cortex result in an improved ability to recall things, better attention, and impulse control.
I did not select the other available options for the management of similar symptoms for various reasons. Firstly, although the other options are approved for the management of ADHD, they have a reduced efficacy. This means the benefits of the medications are felt several weeks after administration. Additionally, the other options also have a higher risk of serious side effects, such as seizures and fatigue, compared to Intuniv. The issue of the efficacy of the drug in reducing ADHD symptoms after administration is of concern in selecting medications, as some take longer to be effective (Mucci et al., 2021).
I decided to use Intuniv 1mg orally at bedtime as it improves prefrontal cortex functioning and, hence, higher cognitive function (Arnsten, 2020). This will help improve attention and motivation to learn as well as work on other major ADHD symptoms. Low doses at night will reduce the impact of side effects such as sleepiness.
Ethical considerations that may impact the treatment plan and communication with patients include the decisions to use the new drug and obtaining informed consent from Katies parents to include the new drug in the treatment plan. The parents must be provided with fully understandable information on the drugs efficiency and associated risks.
Decision #3
The third decision is to use Ritalin Methylphenidate 10mg orally in the morning. It is the last option to give to Katie. The medication belongs to a group of psychostimulants that works by inhibiting the reuptake of dopamine and norepinephrine, increasing their concentration levels in the brain (Briars & Todd, 2016). The medication is a first-line medication in the management of ADHD in children. However, in the case of Katie, it is the last option due to its stimulant nature (Faraone, 2018).
I would select Ritalin (methylphenidate) over the other two options as the last option if they failed to achieve the desired outcomes regarding the ADHD symptoms presented by Katie. A stimulant medication is more potent in managing ADHD in children aged 6 years and older due to its selective inhibition of the reuptake of neurotransmitters, especially dopamine and norepinephrine, leading to better ADHD symptom management (Faraone, 2018).
By deciding to use Ritalin (methylphenidate), I intend to improve the efficacy of the treatment and effectively manage to reduce the major symptoms of ADHD manifested by Katie. As earlier noted, methylphenidate increases the concentration of dopamine and norepinephrine in the brain, improving attention duration and moods (Faraone, 2018).
In this case, the ethical considerations that would impact the communication with the patient and the treatment plan would be considerations to use a psychostimulant on a child. The parents, as decision-makers, must be well informed about the drugs potency and efficiency in managing ADHD as well as other comorbidities and the associated side effects, including the risk of addiction. This would help introduce the medication to the treatment plan with informed patient consent.
Conclusion
Katie has been diagnosed with ADHD and predominantly inattentive presentation. ADHD in children can is a neurodevelopmental disorder that affects children and adolescents, leading to increased inattention, hyperactivity, disruptive behavior, and impulsivity (Mucci et al., 2021). The management of ADHD in children requires starting treatment with medications with a low risk of side effects and addiction. Although some medications, such as Ritalin (methylphenidate), have the highest efficacy levels and are recommended as first-line medications for managing ADHD in children, they have a higher potential for side effects and the development of dependency (Faraone, 2018). Regardless of the efficacy of a drug if added to a treatment plan, it is important to have an ethically collaborative partnership with the patient or other legal decision-makers before deciding on adding medications to the treatment plan. Collaborative and ethical relationships improve patient outcomes as well as their experiences during the entire care period.
References
Arnsten, A. F. T. (2020). Guanfacines mechanism of action in treating prefrontal cortical disorders: Successful translation across species. Neurobiology of Learning and Memory, 176, 107327. https://doi.org/10.1016/J.NLM.2020.107327
Briars, L., & Todd, T. (2016). A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. The Journal of Pediatric Pharmacology and Therapeutics?: JPPT, 21(3), 192. https://doi.org/10.5863/1551-6776-21.3.192
Faraone, S. V. (2018). The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neuroscience and Biobehavioral Reviews, 87, 255270. https://doi.org/10.1016/J.NEUBIOREV.2018.02.001
FDA. (n.d.). Clinical Pharmacological Review. Retrieved April 25, 2023, from https://www.fda.gov/media/80233/download
Huecker, M. R., Smiley, A., & Saadabadi, A. (2022). Bupropion. XPharm: The Comprehensive Pharmacology Reference, 14. https://doi.org/10.1016/B978-008055232-3.64054-1
Mucci, F., Carpita, B., Pagni, G., Vecchia, A. Della, Bjedov, S., Pozza, A., & Marazziti, D. (2021). Lifetime evolution of ADHD treatment. Journal of Neural Transmission 2021 128:7, 128(7), 10851098. https://doi.org/10.1007/S00702-021-02336-W
BACKGROUND
Katie is an 8-year-old Caucasian female who was brought to your office today by her mother & father. They report that they were referred to you by their primary care provider after seeking her advice because Katies teacher suggested that she may have ADHD. Katies parents reported that their PCP felt that she should be evaluated by psychiatry to determine whether or not she has this condition.
Treatment for ADHD
The parents give the PMHNP a copy of a form titled Conners Teacher Rating Scale-Revised. This scale was filled out by Katies teacher and sent home to the parents so that they could share it with their familys primary care provider. According to the scoring provided by her teacher, Katie is inattentive, easily distracted, forgets things she has already learned and is poor in spelling, reading, and arithmetic. Her attention span is short, and she is noted to only pay attention to things she is interested in. The teacher opined that she lacks interest in schoolwork and is easily distracted. Katie is also noted to start things but never finish them, seldom follows through on instructions, and fails to finish her school work.
Katies parents actively deny that Katie has ADHD. She would be running around like a wild person if she had ADHD reports her mother. She is never defiant or has temper outbursts adds her father.
SUBJECTIVE
Katie reported that she didnt know what the big deal was. She states that school is OK- her favorite subjects are art and recess. She states that she finds her other subjects boring, and sometimes hard because she feels lost. She admits that her mind does wander during class to things that she thinks of as more fun. Sometimes Katie reports I will just be thinking about nothing and the teacher will call my name and I dont know what they were talking about.
Katie reported that her home life was just fine. She reports that she loves her parents and that they are very good and kind to her. Denies any abuse or bullying at school. Offers no other concerns at this time.
MENTAL STATUS EXAM
The client is an 8-year-old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. The effect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Attention and concentration are grossly intact based on Katies attendance to the clinical interview and her ability to count backward from 100 by serial 2s and 5s. Insight and judgment appear age-appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
Examine Case Study: A Young Caucasian Girl with ADHD. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patients pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for this patient.
Decision #1 (1 page) Wellbutrin (Bupropion) XL 150mg orally daily
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page) Intuniv 1mg orally at bedtime
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page) Ritalin Methylphenidate 10mg PO in the morning
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
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Nursing is an important profession in the healthcare sector that supports peoples health and ensures wellness. With the progressive advancements in the profession, nursing has begun conceptualizing spiritual importance and associating it with bodily health. Spirituality is regarded as an integral part of a patients well-being (Hawthorne & Gordon, 2019). When providing holistic care to patients, nurses are expected to take care of their physical, emotional, mental, and spiritual needs. Currently, the nurses are not only expected to diagnose and dispense medication but also to nourish the patients spiritual aspects. However, spirituality is culturally based, as individuals have different faiths and beliefs. It is, therefore, essential to understand the cultural beliefs of individuals before providing any spiritual nourishment to the patients. Nurses need to uphold spiritual standards in healthcare and determine the patients who may find receiving spiritual care fulfilling. Nurses must undoubtedly comprehend and regard spirituality in the care process (Timmins, 2017). The nurses are expected to assess the spirituality of the patients. Multiple tools can be used to evaluate the spirituality of the patients.
One of the tools that are utilized to assess spirituality is the Spirituality Scale. This tool is important in assessing the level of spirituality in nurses and how they can channel these beliefs into providing spiritual care to their patients while providing them with holistic care (Timmins, 2017). The tool has three sections with various questions that can be used to determine the nurses spirituality. Some of the open-ended questions are used to ask the nurses about their beliefs.
The other tool that is commonly used to assess spirituality is Open Invite. Open Invite is focused on the patient and encourages the need for spiritual dialogue between the nurses and the patients. The patients who are not spiritual can decide not to engage in a dialogue with the nurses, but the spiritual ones can decide to engage in further spiritual dialogues with the nurses (Timmins, 2017). Such spiritual dialogues provide them with comfort and hope for quick recovery. The conversational questions are used to determine whether the patients are spiritual.
The other important tool used to gauge spirituality in nursing is the spirituality scale test. It consists of true and false questions that can be used to assess the spirituality of the patients and the nurses (Timmins, 2017). The tool has various questions that the nurses can use to determine if they should offer spiritual care to the patients. These tools have proved to be significant in determining whether to provide spiritual care to patients or not.
References
Hawthorne, D. M., & Gordon, S. C. (2019). The Invisibility of Spiritual Nursing Care in Clinical Practice. Journal of Holistic Nursing, 38(1), 147155. https://doi.org/10.1177/0898010119889704
Timmins, F. (2017). Assessing the spiritual needs of patients. Rcni.com. https://journals.rcni.com/nursing-standard/assessing-the-spiritual-needs-of-patients- ns.2017.e10312
The use of spirituality in nursing practice is not new. However, it is more studied and utilized in a more structured format in nursing. Identify and discuss tools used to evaluate spirituality.
Spirituality In Nursing
Please include 400 words in your initial post with two scholarly articles no later than 5 years old.
No Plagiarism
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