Category: Nursing

  • The Health Assessment Of Infants

    The Health Assessment Of Infants Topic 1 DQ 1

    Describe the effect of extremely low birth weight babies on the family and community. Consider short-term and long-term impacts, socioeconomic implications, the need for ongoing care, and comorbidities associated with prematurity. Explain how disparities relative to ethnic and cultural groups may contribute to low-birth-weight babies. Identify one support service within your community to assist with preterm infants and their families and explain how the service adequately addresses the needs of the community or a population in your community. Provide the link to the resource in your post.

    Submitted

    Infants that weigh under 2.2 lbs are considered to be of “extremely low weights”. “Preterm infants are born at less than 37 weeks gestational age and low birth weight infants are born with a birth weight below 2.5kg regardless of gestational age.”(WHO2023) Many implications can arise from a considerably low birth weight. For the infant itself, they may require long term medical care physically. This in turn may cause many impairments, psychologically, cognitively, and socially for the family. The family may experience financial disparities. These disparities in turn add great stress to the family. As the infant grows, social concerns develop that affect the community. There exist many factors that contribute to extreme low birth weight in infants. Most factors are correlated with low economic conditions. Minority groups have high rates of infants with extreme low birth weights. During these hard times many families can turn to support groups for resources and guidance. A great organization that offers services is March of dimes. 
    https://www.marchofdimes.org/find-support
    . Here families can find information from planning, to dealing with grief. They also have tools and many links to other support groups according to needs.

     

    References

    World Health Organization 2023 https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/newborn-health/preterm-and-low-birth-weight/

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    REPLY

    Extremely low birth weight (ELBW) babies can have profound effects on the families and community. With the families, extremely low birth weight babies can affect them differently depending on the socioeconomic implications associated with the specific family, but some things are consistent no matter the socioeconomic situation (Subramanian, 2023). One effect extremely low birth weight babies have on families is that families will undergo grieving processes as they adjust to what they originally pictures as a perfect baby to be born. Families will also undergo ongoing care for ELBW babies as care providers attempt to bring the babies up to sufficient health that would be concurrent with normal weight babies. Some comorbidities associated with preterm birth are intraventricular hemmorhage, retinopathy of prematurity and chronic lung disease which often result in mortality or long term disabilities (Mowitz, 2022). In order to get through the journey that a ELBW baby may take you on, support is needed. In the Houston area, there are many services that the Texas Womens Hospital provides for mothers to support them throughout the care process.

    References :

     

    Mowitz, M. E. (2022, December 23). 
    Burden of comorbidities and healthcare resource utilization among Medicaid-enrolled extremely premature infants
    . Journal of health economics and outcomes research. 
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790150/#:~:text=Extremely%20premature%20infants%20are%20at,mortality%20or%20long%2Dterm%20disabilities.

     

    Subramanian, S. (2023, July 7). 
    Extremely low birth weight infant
    . Overview, Morbidity and Mortality, Thermoregulation and Hypoglycemia. 
    https://emedicine.medscape.com/article/979717-overview?form=fpf

     

    REPLY

    Nice post. I understand that having an extremely low birth weight (ELBW) baby can have profound effects on families and communities. It can be a challenging and emotional journey for families as they adjust to unexpected circumstances and potentially face ongoing care for their ELBW baby. One effect that families often experience is a grieving process, as they may need to redefine their expectations for their baby’s health and development (Van de Pol & Allegaert, 2020). Families need permission to grieve and seek support from healthcare professionals, support groups, or counseling services to help them navigate these emotions. Further, ELBW babies may have co-existing medical conditions such as intraventricular hemorrhage, retinopathy of prematurity, and chronic lung disease. These conditions can have long-term consequences and require ongoing medical interventions and therapies. Families may need assistance in understanding and managing these conditions, and healthcare providers must offer comprehensive support and education to families. The Texas Women’s Hospital is a valuable resource for mothers and families in the Houston area. They provide various services to support families throughout the care process, such as specialized neonatal intensive care units, experienced healthcare professionals, and access to support groups or counseling services.

    Reference

    Van de Pol, C., & Allegaert, K. (2020). Growth patterns and body composition in former extremely low birth weight (ELBW) neonates until adulthood: a systematic review. 
    European Journal of Pediatrics
    , 
    179
    , 757-771.

    REPLY

    Hi, I do agree with you on the socioeconomic effect that extremely low birth weight (ELBW) babies can impose on certain families. To add up, emotional factors and the depression associated with the unexpected can also be an influential factor that families may go through with ELBW babies. Community wise, the use of financial resources in the support of these babies care and the general provision of education through various community organized support programs can be so demanding which affects the community financially. Nurses should be knowledgeable in regards to how to provide support and meet the needs of the parents of ELBW babies in order for them to be successful in caring for the babies during discharge. Mothers of LBW babies must be given information by nurses and all other HCPs  through proper health education on routine baby care before discharge, variation in their information sources, and the types of communication. Laid down hospital policies and discharge planning guidelines that consider mothers’ needs are necessary for successful discharge planning (Kristiawati et.al, 2023) The Health Assessment Of Infants.

     

    Reference

    Kristiawati., Yeni, R., Indra, B., & Hariyati, R. T. S. (June, 2023). Mothers’ needs in discharge planning for low birth weight

    babies: A qualitative study. 
    Journal of Neonatal Nursing
    . Volume 29, Issue 3. 
    https://doi.org/10.1016/j.jnn.2022.11.005
    .

     

     

    REPLY

    Hi X. I agree with you that ELBW babies profoundly impact families and communities, regardless of socioeconomic factors. Families undergo a grieving process as they adjust to unexpected outcomes and provide ongoing care to nurture these babies to better health. Preterm birth comorbidities such as intraventricular hemorrhage, retinopathy of prematurity, and chronic lung disease can lead to mortality or long-term disabilities. Despite the challenges, with the right support, families can help ELBW babies thrive(The National Academies Press, 2003).

    References

    The National Academies Press. (2003). The problem of low birth weight. 
    https://nap.nationalacademies.org/read/10841/chapter/8#205

     

    REPLY

    Extremely low birth weight (ELBW) babies indeed bring unique challenges to families, irrespective of their socioeconomic status. These challenges often lead families to undergo a grieving process as they adjust to unexpected outcomes, diverging from their initial visions of a perfect birth. Additionally, families face the demanding task of providing ongoing care for ELBW babies, with the goal of improving their health to levels comparable to normal-weight infants. ELBW babies are at increased risk of comorbidities like intraventricular hemorrhage, retinopathy of prematurity, and chronic lung disease, which can result in mortality or long-term disabilities (Green, 2022). To navigate this challenging journey, families require substantial support. In the Houston area, Texas Women’s Hospital provides valuable services to aid and support mothers throughout the care process, emphasizing the importance of comprehensive care and community resources for families facing the complex journey of ELBW babies.

     

    Reference

    Green, S (2022). Heath assessment of the infant. Grand Canyon University (Ed). Health assessment: Foundations for effective practice. 
    https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/

    REPLY

    Hi X, this is a great and I agree with your post, the effect of extremely low birth weight babies can be very significant and long lasting on the families and the community due to expensive medical care which can place a financial and emotional burden on the families  ( Geddes, 2022 ) The Health Assessment Of Infants. Babies born with extremely low birth weight can be sometimes prone to long-term problems like neurological impairment. Infants of the poor, minority groups, and the poor are at higher risk of low birth weight and premature births ( Geddes, 2022 ), continuous screening and monitoring of the milestones will positively impact the growth and development of the babies.

    Reference:

    Geddes, J. K. (2022, June 7). 
    Low birth weight baby: Causes, risk factors, treatments, and more
    . BabyCenter.

    https://www.babycenter.com/baby/newborn-baby/low-birth-weight_40009602

    REPLY

    Hello

    You mentioned Extremely Low Birth Weight having a profound effect on babies. The Medical Risk factors having a low-birth weight baby include chronic health conditions, infections, and breathing problems such as Respirator Distress Syndrome (March of Dimes, n.d.). RDS is when babies don’t have a protein called Surfactant which keeps small air sacs in a babies lungs from collapsing (March of Dimes, n.d.). Babies with RDS will need continuous supplemental oxygen and transferred to the NICU until the problem has resolved. All this can be emotionally and financially draining on a family so the right education and support is needed.

     

    Reference: 

    March of Dimes. (n.d.). Low birthweight. 
    https://www.marchofdimes.org/find-support/topics/birth/low-birthweight

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    Read

    Extremely low birth baby is defined as a baby that weighs less than 1000g (2.2lbs) at birth (Siva,S. 2023). Effects of extremely low birth weight baby extends beyond the infants, it can impact the family and the community ranges from

    Emotional and psychological impact, parents may experience anxiety , depression, feeling of guilt and inadequacy.

    Financial burden, medical care and intervention needed for the new infant may be expensive.

    Disruption of family dynamic,caring foe ELBW infant may require time and attention , this will in turn affect the family routine and may affect the ability of family members to work or pursue their career.

    Increased health care utilization: ELBW infant may require long term hospitalization and care , this can put additional health care demand on  communities especially the ones with limited access to health care.

    Increased risk of chronic health condition, psychological issues (Apa 2017) sensory impairment, neurodevelopmental challenges, growth and nutritional issues, and some medical complications  ELBW infants has the increased risk of developing most of the above listed and the presence of any of the above conditions will affect the family and community at large,

     

    Disparities in ethnic and cultural groups can contribute to an increased risk of ELBW infant.

    Socioeconomic factors such as poverty, limited access to healthcare , unhealthy living conditions and inadequate prenatal care can increase the risk of ELBW infants.

    Healthcare access and quality: Minority groups may be faced with poor health care access , language barriers , discrimination and cultural belief may affect some health seeking behavior.

    social determinants of health including employment, housing, housing,and community resources can affect pregnancy outcomes.

     

    Support service to to assist with preterm infants and their families at the neonatal intensive care unit will be Family support program. This helps families with emotional support,education and information, parent to parent support , transition support, bereavement support in cases where the preterm infant does not survive.

    https://www.marchofdimes.org/our-work/nicu-family-support

     

    References

     

    American Psychology Association (2017). Low Birth Weight Babies at Higher Risk for Mental Health Problems later in life 0033-2909/17/$12.00 
    http://dx.doi.org/10.1037/bul0000091

     

    Siva, A. (2023) Extremely Low Birth Weight Infant 
    https://emedicine.medscape.com/article/979717-overview

     

     

    REPLY

    Hey

    Great post! You have thoroughly highlighted the multifaceted impact of extremely low birth weight (ELBW) infants on families and communities, emphasizing the emotional, financial, and healthcare challenges. In addition, it is important to consider the potential role of technology in improving care for ELBW infants. Advancements in telemedicine and remote monitoring could offer crucial support, especially in communities with limited healthcare access (Atkinson et al., 2023). Telehealth initiatives can provide continuous medical supervision, advice, and interventions, potentially reducing the need for extended hospitalization and increasing access to specialized care for ELBW infants, which might alleviate the burden on families and communities. Integrating such technological solutions into family support programs, like the neonatal intensive care unit’s Family Support Program, could significantly enhance overall care and support for families of ELBW infants The Health Assessment Of Infants.

    Reference

    Atkinson, J., Hastie, R., Walker, S., Lindquist, A., & Tong, S. (2023). Telehealth in antenatal care: Recent insights and advances. 
    BMC medicine
    , 
    21
    (1), 332. 
    https://doi.org/10.1186/s12916-023-03042-y

    REPLY

    Hello, . It is clear that the
    effects of extremely low birth weight (ELBW) babies extend beyond just the infants themselves
    . The emotional and psychological impact on parents can be significant, leading to anxiety, depression, and feelings of guilt and inadequacy. Additionally, the financial burden of medical care and intervention needed for these infants can be expensive, leading to further stress for families. The care required for ELBW infants can disrupt family dynamics and routines, potentially impacting the ability of family members to work or pursue their careers (Fraiman et al., 2023). This can further compound the financial burden on families. Furthermore, the long-term hospitalization and care required for these infants can put additional strain on healthcare resources, especially in communities with limited access to healthcare. ELBW infants are also at an increased risk of developing chronic health conditions, psychological issues, sensory impairment, neurodevelopmental challenges, and growth and nutritional issues. These conditions not only impact the well-being of the infants but also have ripple effects on their families and communities.

    Reference

    Fraiman, Y. S., Edwards, E. M., Horbar, J. D., Mercier, C. E., Soll, R. F., & Litt, J. S. (2023). Racial Inequity in High-Risk Infant Follow-Up Among Extremely Low Birth Weight Infants. 
    Pediatrics
    , 
    151
    (2), e2022057865.

    REPLY

    Hi , your post is very educative and provides adequate information on the effects of ELBW babies on the babies, families and the community in general. Like you rightly said, issues regarding
    emotional and psychological impact
    such as anxiety, depression, feeling of guilt, and inadequacy coupled with financial instability or burden, medical care and intervention needed for the new infant may be expensive and worrisome. The family systems theory with regards to the impact the new born will have on the other individuals in the family structure can lead to disruption of family dynamic since caring for ELBW infant may require time and attention. Time consumption with the care of these babies will in turn affect the family routine and may affect the ability of family members to work or pursue their career.

    However, nurses should be able to provide adequate education and resources that are directed towards the health promotional needs of both the baby and the mother. Since ELBW babies have low body fats, body  temperature regulation is really important. Hypothermia in LBW babies can cause death. The intervention that can be done is Kangaroo Mother Care (KMC) that has been chosen because is able to increase temperature through a heat transfer and enhance parent-baby bonding (Esme et.al, 2021). In addition, nutritional health and ways of monitoring developmental progress of these babies should be encouraged by nurses and various support groups.

     

    Reference

     

    Esme, A., Evy, N., & Indah, N. (Dec, 2021). The Effectiveness of The Kangaroo Mother

    Care for Low Birth Weight Baby in  Maintaining Thermoregulation Stabilization: a Case Study.  Journal Vol. 7, no.2

    DOI 
    https://doi.org/10.17509/jpki.v7i2.39191
    .

     

     

     

    REPLY

    greetings . I second your idea that the impact of extremely low birth weight (ELBW) babies extends beyond the infants themselves, affecting families and communities in various ways. Families may experience emotional and psychological distress, financial burdens due to expensive medical care, disruptions in family dynamics, and increased healthcare utilization. ELBW infants are at a higher risk of chronic health conditions, sensory impairments, neurodevelopmental challenges, growth and nutritional issues, and other medical complications. Disparities in ethnic and cultural groups, as well as socioeconomic factors like poverty and limited healthcare access, contribute to the increased risk of ELBW infants (WHO, 2018). Support services, such as Family Support Programs in neonatal intensive care units, provide assistance to families dealing with preterm infants, offering emotional support, education, information, and bereavement support when needed. Good luck!

    Reference

    World Health Organization. (2018). Newborns: Reducing mortality.

    REPLY

    Good evening

    Your post on extremely low birth weight babies has a very comprehensive view on the topic and was very informative.

    You are correct that the effect of extremely low birth weight does not only affect the babies themselves, but they affect the families as a whole (Mowitz, 2022). The Health Assessment Of Infants There are many disparities involved when a family has an extremely low birth weight baby, and you provided some great examples of some of the factors that families may have to deal with.

     

    References :

     

    Mowitz, M. E. (2022, December 23). 
    Burden of comorbidities and healthcare resource utilization among Medicaid-enrolled extremely premature infants
    . Journal of health economics and outcomes research. 
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790150/#:~:text=Extremely%20premature%20infants%20are%20at,mortality%20or%20long%2Dterm%20disabilities.

  • Describe the effect of extremely low birth weight babies on the family and community

    NRS-434VN Topic 1 DQ 1

    Describe the effect of extremely low birth weight babies on the family and community. Consider short-term and long-term impacts, socioeconomic implications, the need for ongoing care, and comorbidities associated with prematurity. Explain how disparities relative to ethnic and cultural groups may contribute to low-birth-weight babies. Identify one support service within your community to assist with preterm infants and their families and explain how the service adequately addresses the needs of the community or a population in your community. Provide the link to the resource in your post.

     

    An extremely low birth weight (ELBW) infant is defined as one with a birth weight of less than 1000 g (2 lb, 3 oz). Most extremely low birth weight infants are also the youngest of premature newborns, usually born at 27 weeks’ gestational age or younger. Extremely low birth weight was associated with a negative impact on families.  Financial problems for the family, disruption of planning, disruption of planning, caretaker and family burden are some of the effects by ELBW infants. Parents of infants receiving neonatal intensive care are at increased risk of experiencing adverse mental effects and depressive symptoms. (Holm et al. 2022).

    A baby with low birthweight may be at increased risk for complications. The short-term complications are low oxygen levels at birth, inability to maintain body temperature, difficulty feeding and gaining weight, infection and breathing problems caused by immature lungs. The long-term effects of low birth weights are mental retardation, chronic lung disease, cognitive delays, cerebral palsy, and neurosensory deficits (ie, deafness and blindness).

    Racial disparities in maternal and infant health in the U.S. have persisted for decades. Black, American Indian, and Alaska Native (AIAN), and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares of preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for White women. Differences in health insurance coverage, no prenatal care, Receiving pregnancy-related care late or nit receiving the care  compared to White women are the disparities in maternal and infant health. (Hill et al. 2022).

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    Prenatal care is a key factor in preventing preterm births and low birthweight babies. Many mortalities and morbidity can be prevented by addressing the factors associated with low birth weight. The total health assessment of infants is important. Birth history, history of past and present health concerns, immunization history, developmental history, feeding history, family health history, and insight into the home environment is important.

    Healthy Moms and Babies Connecticut offers resources for mothers and families to promote a healthy start, and information for clinicians.  It is part of the Connecticut Perinatal Quality Collaborative, which supports high quality maternal and newborn care by: (healthy moms and babies, n.d.).

    Working collaboratively with healthcare providers

    Supporting the best care

    Sharing resources

    Gathering data that helps improve care.

     

     

    Healthy moms and babies, n.d. Healthy Moms and Babies. Connecticut. 
    We’re about making moms and babies healthier.
     
    https://healthymomsandbabiesct.org
    .

    Hill L., Artiga S., & Ranji U. 2022. R
    acial Equity and Health Policy
     
    Women’s Health Policy
     
    Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them.

    https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them
    .

    Holm K.G., Aagaard H., Maastrup R., Dreier S. Brodsgaard A., & Visitor H. 2022. Journal of Pediatric Nursing. 
    How to support fathers of preterm infants in early parenthood – An integrative review.
     
    https://www.pediatricnursing.org/article/S0882-5963(22)00246-9/fulltext
    . 
    https://doi.org/10.1016/j.pedn.2022.10.001

     

    REPLY

    xx great job. I agree with you DQ response. Due to the ongoing treatment and care needs for the ELVW infants its extremely important that we as nurses are educating the families and connecting to the proper resources to help the families through the growth and developmental phases so they understand and are aware. Not meeting these needs can lead to growth and developmental delays and a predisposition to subsequent development of chronic diseases (Green 2022).  We want to minimize complication and risk early, so yes prenatal care is a must for the pregnant women. In California Choc has a NICU Bridge Program The NICU Bridge program helps ease the transition and ensure your baby continues to receive care from familiar team.

     

    Resource:

    NICU Bridge Program. 

    CHOC Home

     

    Reference:

     

    Green, Sue Z. (2022). Health Assessment: Foundations for Effective Practice. 
    Nutrition and Oral Care During the First Year
    . (2nd ed.).

     

    REPLY

    A wonderful post, xx!. Thank you for bringing up the important issue of extremely low birth weight (ELBW) infants and the impact it has on families. It is indeed true that ELBW infants often face numerous challenges and complications, and these can take a toll on the emotional, financial, and overall well-being of their families. The short-term and long-term complications associated with low birth weight are significant, and parents need to be informed and prepared to navigate through them. Healthcare providers must provide support, education, and resources to families of ELBW infants to help them understand and cope with these potential challenges (Gilarska et al., 2019). The racial disparities in maternal and infant health that you mentioned are also a concerning issue. It is essential to address and eliminate these disparities to ensure equitable access to prenatal care and improved outcomes for all women and infants, regardless of their race or ethnicity. Prenatal care plays a vital role in preventing preterm births and low birthweight babies. By providing comprehensive prenatal care, healthcare providers can identify and address risk factors early on, potentially reducing ELBW infants’ incidence and associated complications.

    Reference

    Gilarska, M., Raaijmakers, A., Zhang, Z. Y., Staessen, J. A., Levtchenko, E., Klimek, M., … & Kwinta, P. (2019). Extremely low birth weight predisposes to impaired renal health: a pooled analysis. 
    Kidney and Blood Pressure Research
    , 
    44
    (5), 897-906.

    REPLY

     

    Your post on extremely low birth weight infants provides very insightful information for both individuals interested in the subject and families looking to be educated on the topic. You touched on some disparities that are specific to certain ethnic / cultural populations which is an important consideration due to certain risk factors associated with different ethnic / cultural groups (Mowitz, 2022). You also provided great examples for complications that are associated with extremely low birth weight infants.

     

    References :

     

     

    Mowitz, M. E. (2022, December 23). 
    Burden of comorbidities and healthcare resource utilization among Medicaid-enrolled extremely premature infants
    . Journal of health economics and outcomes research. 
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9790150/#:~:text=Extremely%20premature%20infants%20are%20at,mortality%20or%20long%2Dterm%20disabilities.

     

    REPLY

    Hello XX regarding your post, I agree with you on the definition of extremely low birth weight babies are babies with a weight below 2.2lbs (Siva, S. 2023)They are usually born at 27weeks as you mentioned , they effects of having extremely low birth weight baby does not only affect the baby but also affects the the entire family and might extend to the community. These babies are faced with different problems with breathing, cognitive delays and mental retardation . Family are usually faced with long hospital stays ,financial problems and psychological problems like depression. Disparities in ethnic and cultural groups such a poverty, poor housing, limited access to health  has also contributed to extremely low birth weight baby. Like you said prenatal care is key to prevention of preterm babies.

     

    References

     

    Siva, A. (2023) Extremely Low Birth Weight Infant 
    https://emedicine.medscape.com/article/979717-overview

    REPLY

    Hi  !

    Indeed, extremely low birth weight (ELBW) infants bring about significant challenges for both families and society. As Shea et al. (2021) discussed, these infants not only cause emotional and financial stress on families but also lead to a higher risk of depression among parents. This creates a considerable burden on families. Providing comprehensive prenatal care, as you pointed out, is crucial in reducing the risks of low birth weight. Your reference to Healthy Moms and Babies Connecticut is a valuable community resource for promoting healthy pregnancies and maternal and newborn care.

    Shea, S., & Holschuh, J. (2021). Perinatal Outcomes in Extremely Low Birth Weight Infants. American Journal of Perinatology, 38(10), 1036-1040.

    REPLY

    Health disparities can be associated with the increasing number of children suffering from low birth weight babies. One of these is associated with ethnic groups such as African American mothers, who are likely to be affected by several challenges contributing to an increase in low birth weight babies. The first challenge is unlocking resources within the community related to better nutrition and health education. This is a challenge that contributes to situations where the young ones are affected as a result of poor nutrition options and less information about their babies’ health. Health education is significant because it contributes to improving the situations of affected patients while creating awareness of changes that are required within the community (March of Dimes, 2021).

    Reference

    March of Dimes. (2021). Low birthweight. 
    https://www.marchofdimes.org/complications/low-birthweight.aspx

    REPLY

    Describe the effect of extremely low birth weight babies on the family and community. Consider short-term and long-term impacts, socioeconomic implications, the need for ongoing care, and comorbidities associated with prematurity. Explain how disparities relative to ethnic and cultural groups may contribute to low-birth-weight babies. Identify one support service within your community to assist with preterm infants and their families and explain how the service adequately addresses the needs of the community or a population in your community. Provide the link to the resource in your post.

                         
    Extremely low birth weight babies have an effect on the family and community
    .  Low birth weight babies typically weigh less than 2.2 pounds and can have lasting impacts.  Short-term effects can include emotional and psychological stress for the families.  The parents can feel anxiety or fear for their baby’s survival.   The hospital costs in order to take care of their low birth weight babies can be enormous which may cause additional stress on the families.   The parents need to spend a substantial amount of time in the neonatal intensive care unit which can affect their work and family responsibilities.

    There are also long-term impacts for the babies and families.    “Although higher rates of child abuse and neglect have been reported among preterm infants”  (Strathearn, Gray, O’Callaghan,, & Wood, 2001, p. 146).  There has been a connection between socioeconomic factors such as poverty, lack of education, and single parenthood.  They are also at a higher risk of health issues throughout their lives.  They may experience development delays or chronic health conditions, and this may cause ongoing medical care which again costs a substantial amount of money. There may be academically and socially issues which can impact them being successful in school.  If long-term conditions continue, parents may need to decrease their hours at work which can cause a financial burden on the families’ living situations.  Hospitals who have to take care of the low birth weight babies may have a financial burden of the medical costs until insurance may send payments to them to pay for the nurses, doctors, and the medical care it takes to help them survive.  The community may need to get involved with the increased demand on the hospitals for other future low-weight birth babies.  The medical demands of the babies alone can be devastating.   ELBW babies are more likely to experience complications including respiratory distress since their lungs are not developed yet, sepsis, or other medical issues which ultimately leads to longer hospital stays and increased costs.

    When you examine disparities relating to ethnic and cultural groups, there is a higher rate of ELBW babies.  The reasons include having limited access to healthcare, financial hardships, and other lifestyle factors.  “Significant and persistent disparities in preterm birth and low birthweight exist: some minority populations (in particular, African Americans and Native Americans) and poor women are at far greater risk for these poor birth outcomes” (Fuller, 2000, p. 435).  These disparities have not changed in the past 100 years.  There is a pattern of risk factors for mothers such as lack of maternal education, medical conditions that existed before pregnancy, hypertension, lack of nutrition, poor access to health care, tobacco or alcohol use, and other environmental factors.  These racial disparities can have an unfair impact on specific communities more than others.

    In Palm Beach County, there is a department called, The Maternal Child Health Division, which provides home visits to pregnant women and their infants.   They also give support and education to the entire family.  The end goal is to improve the birth outcomes by registered nurses who are their case managers.   The programs are called Health Beginnings, Nurse Family Partnership, and Women’s Health Initiative.  Their goals are to reduce low birth weights, increase parenting skills, help organize immunizations for children, offer family support, and breastfeeding education, and a host of other services.   They also offer support and education in different languages to eliminate any barriers that may exist.

     

    https://palmbeach.floridahealth.gov/programs-and-services/clinical-and-nutrition-services/maternal-child-health/index.html

     

    Fuller, K. E. (2000). Low birth-weight infants: the continuing ethnic disparity and the interaction of biology and environment. 
    Ethnicity & disease
    , 
    10
    (3), 432-445.

     

    Strathearn, L., Gray, P. H., O’Callaghan, F. M. J., & Wood, D. O. (2001). Childhood neglect and cognitive development in extremely low birth weight infants: A prospective study.                         
    Pediatrics
    , 
    108
    (1), 142-151.

     

    REPLY

    What a nice post! Extremely
    low birth weight babies not only have a significant impact on their families but also the community
    as a whole. The short-term effects on families include emotional and psychological stress, as parents may experience anxiety and fear for their baby’s survival. The financial burden of hospital costs for the care of low birth weight babies can also add to the stress experienced by families. Additionally, the time that parents need to spend in the neonatal intensive care unit can affect their ability to fulfill work and family responsibilities. Low birth weight babies can also have long-term impacts on both the families and the babies themselves. There is a higher risk of child abuse and neglect among preterm infants, which may be linked to socioeconomic factors such as poverty, lack of education, and single parenthood. These babies are also more likely to experience health issues throughout their lives, which can require ongoing medical care and incur substantial costs. Development delays and chronic health conditions can also affect their academic and social success, potentially leading to decreased work hours for parents and further financial burden on the family’s living situation.

    Reference

    Sahoo, T., Anand, P., Verma, A., Saksena, M., Sankar, M. J., Thukral, A., … & Paul, V. K. (2020). Outcome of extremely low birth weight (ELBW) infants from a birth cohort (2013–2018) in a tertiary care unit in North India. 
    Journal of Perinatology
    , 
    40
    (5), 743-749.

     

    REPLY

    class, The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk (USDA, 2020). This is a federally mandated program which support women and children with clinical care as well as supplemental financial support for staples such as groceries. This is and will continue to be a very important program to address those women and children who live at or below poverty level. Please read up on WIC if you have time and are not familiar with this important resource.

    Reference:

    USDA, 2020. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 
    https://www.fns.usda.gov/wic

    REPLY

     

    LS

  • ANP-650-topic 1 dq 1

    ANP-650-topic 1 dq 1 

    Topic 1 DQ 1

    Review the course objectives and consider how you can develop the specified skills and competencies while applying clinical practice guidelines as an AGACNP providing patient care and creating appropriate patient-centered care plans. List three to five clinical objectives and write a 250-word summary of your plan to incorporate the course objectives and clinical practice guidelines for your clinical experience. Include discussion of what you hope to achieve. You will refer back to this information during Topic 16 when you are asked to reflect on your clinical objectives. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.

     

    ANP-650-topic 1 dq 1

    Multiple chronic conditions are a serious health concern that impacts patients and family caregivers with most adults presenting with multiple complex conditions and secondary cascade of interactions that can lead to increasing complexity and disability (Happ et al., 2018). Interactions that include a balance between treating the primary disease, risk and side effects of comorbid conditions, and other subsequent and related mental health effects (Happ et al., 2018). Clinical practice guidelines help healthcare providers to base diagnostic and therapeutic decisions on evidence-based guidelines that create a reference point for a structured approach to care that is cost-effective, appropriate to each patient, and clinical situation (Jameson et al., 2018).

    PLACE YOUR ORDER HERE

    Perform complete and focused physical exams
    .

    As an
    AGACNP
    student, one of the primary goals of medicine is to prevent disease or have early recognition through effective diagnosing and evidence-based treatment (Jameson et al., 2018). A primary way I plan to achieve this is by forming a trusting relationship with each patient by uniting a patient driven methodical review of systems with contributing social, spiritual, and familial factors with a thorough and complete head to toe physical examination that can correlate the physical signs of disease with the patient centered narrative prior to pursuing any diagnostic studies (Jameson et al., 2018). By forming a trusted relationship, I can receive additional information that can help to unite the pathophysiology and natural history of diseases, clinical skills, and evidence-based guidelines to establish a list of differential diagnosis that can direct meaningful use of diagnostic laboratory and imaging tests (Jameson et al., 2018).

    Order laboratory and imaging tests and analyze results for subacute and complex chronic patient

    One way to develop skills in ordering laboratory and imaging tests and analyzing results is to mentor with my preceptor and specialists either in face to face or by phone consultation to establish clear communication and thoughtful planning to judiciously use diagnostic studies based on whether the results will alter the management of care and truly benefit the patient (Jameson et al., 2018). By interprofessional collaboration I can unite the specialist and preceptors’ recommendations, patient narrative, and focused physical exam with evidence-based practice guidelines for laboratory and imaging tests to form clinical decision-making skills regarding whether to treat or watch a condition (Jameson et al., 2018) ANP-650-topic 1 dq 1.

    Exhibit professional behaviors within scope of practice in interactions with patients and the interdisciplinary team

    To maintain professional behaviors within the
    scope of practice
    interactions with the patient and interdisciplinary team I plan to maintain a humanistic approach to care by ensuring a patient-centered approach that focuses on the culture, lifestyle, attitudes, and values of the patient regardless of correlation with personal or evidence-based guidelines and ensure that I am available to my patients, showing genuine concern, compassion, integrity, and empathy during all interactions including end of life discussions (Jameson et al., 2018). Another way to support professional behavior is by creating cohesive guidance through an illness as the primary provider of care and valuing each member of the team including each allied health professional and primary care team members, and supporting teamwork, effective communication, and effective balanced use of electronic communications and in-personal visits that can support the patients quality of life (Jameson et al., 2018). I plan to remain a perpetual student who is always investigating evidence-based theories and research for health promotion and disease prevention across the lifespan based on the patients overall psychosocial and spiritual needs (Jameson et al., 2018).

    References

    Happ, M. B., Mion, L. C., & Duffy, S. (2018). The challenge of multiple complex chronic conditions. 
    Geriatric Nursing
    , 
    39
    (2), 244–246. https://doi-org.lopes.idm.oclc.org/10.1016/j.gerinurse.2018.02.009

    Jameson, J. L., Kasper, D. L., Longo, D. L., Fauci, A. S., Hauser, S. L., & Loscalzo, J. (Eds.). (2018). 
    Harrison’s principles of internal medicine
     (Vols. 1-2) (20th ed.). McGraw-Hill Education. ISBN-13: 9781259644030 ANP-650-topic 1 dq 1

     

     

    ANP-650-topic 1 dq 1 sample 2

    As an acute care nurse practitioner, there is a lot of responsibility to deliver optimal care to critically ill patients. Utilizing evidence-based theory and research integrates the best available evidence with healthcare expertise to create an effective plan of care (Brunt & Morris, 2023). Working in a technologically advanced environment provides research from many different areas. As NPs, it is important to categorize and rank evidence in literature to confirm we are using safe and reliable information. There are seven accepted levels of evidence based on the methodological quality of the design, validity, and application to patient care (Brunt & Morris, 2023). The highest level is Level I, which is evidence gathered from a systematic review or meta-analysis of randomized controlled trials (RCTs) or based on systematic reviews of RCTs. Level II is evidenced gathered from at least on well created RCT. Level III is evidence gathered from controlled trials without randomization. The other four level grades are ranked based off cohort studies, systematic review of descriptive and qualitative studies, single studies, and lastly opinions of authorities/expert committees. The use of evidence-based theory intertwines with the synthesis of data from a variety of health resources to treat patients. The NPD scope and standards of practice states that NPs should promote inquiry and assists with generating new knowledge (Brunt & Morris, 2023) ANP-650-topic 1 dq 1. As a NP, I will be open to new research that will allow me to provide the most effective and efficient care to my patients. There are many medical advances occurring everyday and I will be following the latest studies to learn from their outcomes. Analyzing common acute care problems to develop differential diagnosis, create clinical judgement, and recommend treatment to patients is an important objective. Diagnostic reasoning is an essential competency to provide safe and effective care (Smith et al., 2022). Using the patient’s chief compliant and medical history, I would order appropriate labs and diagnostic imaging. Based on the results I would create a care plan that would treat their condition while taking into consideration any potential side effects. I would educate the patient on the risks and benefits of any treatments to get informed consent. Once treatment is initiated, I would follow the patient to confirm there are improvements and to answer any questions that arise throughout the care. Discharge education is important to avoid readmissions and confirm that patients understand the importance of compliance with treatment. All of these things would be beneficial to NPs to create the optimal plan of care ANP-650-topic 1 dq 1.

    References:

    Brunt, B. A., & Morris, M. M. (2023). 
    Nursing professional development evidence-based practice. National Library of Medicine.
     Retrieved from 
    https://www.ncbi.nlm.nih.gov/books/NBK589676/

    Smith, S. K., Benbenek, M. M., Bakker, C. J., & Bockwoldt, D. (2022). 
    Scoping review: diagnostic reasoning as a component of clincial reasoning in the U.S. primary care nurse practitioner education
    . Journal of Advanced Nursing.  
    https://doi.org/10.1111%2Fjan.15414 
     ANP-650-topic 1 dq 1

  • AGACNP – ANP 650 topic 1 dq 1

    AGACNP – ANP 650 topic 1 dq 1

    Document clear and concise SOAP notes for all populations.

    I will admit that transitioning from emergency nursing back to intensive care nursing has been challenging. In the emergency department, we chart by exception, meaning that although we can perform an across-the-room assessment, our documentation focuses on the chief complaint of the patient. As many of you know, the intensive care unit (ICU) is quite different in that it is more comprehensive. I am grateful for that. My role in continues to allow me to create new neural pathways which will be beneficial in my future role as a provider. In my clinical experience, my plan is to request and receive feedback on my SOAP notes and supporting documentation. I hope to learn to be thorough in my notes with documentation that supports decisions made and provides an accurate depiction of the status of patients I will be seeing.

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    Recommend options for treatment and management of care for patients according to evidence-based guidelines.

    Designing evidence-based treatments for patients comes with so much responsibility that we in this class may have never had to deal with. Our training, however, along with our experience as registered nurses, may prove to be beneficial not only to us, but to the facilities in which we will work. One study by Kleinpell et al. (2019) noted increased use of clinical practice guidelines, improved patient outcomes, reduced complications, and improved patient care management with advanced practice providers in the ICU setting. As RN’s we naturally want what is best for our patients and sometimes must deal with many barriers to achieving our goals. As Adult-Gerontology Acute Care Nurse Practitioner (AGANCP) students, we can learn from our faculty and preceptors the many ways we can manage and treat our patients to achieve the best possible outcomes. Evidence-based medicine uses the most up-to-date, relevant clinical research that can assist with determining if a medical intervention alters the disease process and improves quality of life, or if it does not (Jameson et al., p. 20). We must ask the right questions, seek to understand, and when in doubt, ask again. There is zero room for arrogance and/or complacency. My goal is to provide care that is necessary, accurate, evidence-based, and cost efficient AGACNP – ANP 650 topic 1 dq 1 .

    Exhibit professional behaviors within scope of practice in interactions with patients and the interdisciplinary team.

    This will take some adjustment, but not in the way one would automatically think. Moving from a staff role to a provider role will have its challenges. For me as a staff nurse, I am a helper. If I see someone needing assistance, I am the first to volunteer. As a provider, it will be challenging to remain in a provider role and not assist with cleaning a patient. I imagine it will be awkward, especially on my current unit. I will be seeking guidance from my preceptors on how to handle those situations. My goal is to move my mind from staff RN to provider by this time next year.

    Order laboratory and imaging tests and analyze results for subacute and complex chronic patients.

     
    According to Jameson et al. (2018, p. 16), clinicians can be more efficient users of diagnostic data if we understand the nature of test information. I truly hope to become more proficient at not only ordering the necessary labs and imaging needed to support my diagnosis and decision-making, but thoroughly understanding what the information means for my patients. My fear is that I will try to order more than what is necessary and cloud my judgement with too much information. My goal is to leverage my preceptors’ knowledge to help me navigate this new (to me) concept and learn the “who”, “what”, “when”, “where”, “how”, and “why” for each diagnostic for each patient case I can participate in.

    References:

    Jameson, J., Fauci, A., Kasper, D., Hauser, S., Longo, D., & Loscalzo, J. (2018). 
    Harrison’s principals of internal medicine 
    (20th ed.). McGraw-Hill Education.

    Kleinpell, R. M., Grabenkort, W. R., Kapu, A. N., Constantine, R., & Sicoutris, C. (2019). Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018. 
    Critical care medicine
    , 
    47
    (10), 1442–1449. 
    https://doi.org/10.1097/CCM.0000000000003925

     

     

    AGACNP – ANP 650 topic 1 dq 1  sample 2

    As I read through the course objectives there were many different topics to consider that are all important and beneficial as AGACNP students in providing patient care and learning how to be NPs in a clinical setting. Clinical practice guidelines (CPGs) help to support various interrelationships among critical contributors to clinical decision-making. There is no one-size-fits-all approach when it comes to patient care, so CPGs can elevate the decisions a clinician makes by describing and appraising the evidence and reasoning behind certain recommendations which allow for them to show relevance to each patient at the individual level (U.S. Department of Health and Human Services, n.d.). I have selected three objectives that I feel are of great value for me personally in that I want to expand my current knowledge of them.

    The first objective I will incorporate into my clinical rotations is clinical documentation and how it affects patient care, patient outcomes, and reimbursement. I know that documentation on the provider level is much different than that of an RN and what I am used to doing daily so learning and mastering this is something I feel is valuable and I would like to establish this skill early on in my clinical rotations so that I can build on it with each additional rotation and course. Documentation for the patient at the inpatient level should follow the general principles of Professional Billing and Coding, according to our textbook, as it is considered a record of the patient’s clinical experience. The documentation must follow certain regulatory requirements to ensure adequate and full reimbursement for services rendered (McKean et al., 2016).

    The second objective I feel is important and I will be incorporating is the use of diagnostic testing and interpretation of these tests to properly diagnose, treat, and manage the conditions of the patients I will be caring for. I am familiar with diagnostic testing in diagnosing patients with various conditions. However, I am no expert and have much to still learn as I know this is a vital aspect of any provider’s ability to properly care for their patients. I hope to gain more knowledge and experience in this area to be confident at what I am ordering for a patient is the right test or study and not wasting time or money in ordering them AGACNP – ANP 650 topic 1 dq 1 . This also can be related to the clinical documentation discussed above as what I am ordering and why will need to be put in my documentation for the patient so that it is understood and supported as to what decisions are made.

    The third objective I will be incorporating in my rotations is the use of clinical judgment with evidence-based medicine guidelines supporting this judgment. Our text discusses this at length and discusses that clinical judgment and expertise are vital in the practice of EBM (McKean et al., 2016). As a learner in this field, I am hoping to gain insight from my preceptor and others I will work with to be able to learn and better my clinical judgment skills. What I know now will only grow with each clinical rotation and I hope to improve my clinical judgment skills more and more each day.

    References:

    McKean, S. C., Ross, J. J., Dressler, D. D., & Scheurer, D. (2016). Principles and practice of hospital medicine, (2nd ed.). 
    McGraw Hill LLC.

    U.S. Department of Health and Human Services. (n.d.). 
    Clinical practice guidelines
    . National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/providers/clinicalpractice AGACNP – ANP 650 topic 1 dq 1

  • NRNP-6645 Week 3: Assignment ANALYZING GROUP TECHNIQUES

    NRNP-6645 Week 3: Assignment ANALYZING GROUP TECHNIQUES

    ANALYZING GROUP TECHNIQUES

    Group therapy can alleviate feelings of isolation and foster a supportive and collaborative environment for sharing difficult feelings in order to facilitate healing. For many people, being part of a group that has a shared understanding of a struggle provides a unique opportunity to gain understanding of their own experiences.

    As you examine one of the group therapy demonstrations from this week’s Learning Resources, consider the role and efficacy of the leader and the reasons that specific therapeutic techniques were selected.

    RESOURCES

     

    Be sure to review the Learning Resources before completing this activity.

    Click the weekly resources link to access the resources.

    NRNP-6645 Week 3: Assignment ANALYZING GROUP TECHNIQUES

    WEEKLY RESOURCES

    To prepare:

    Select one of the group therapy video demonstrations from this week’s required media Learning Resources.

    THE ASSIGNMENT

    In a 3- to 4-page paper, identify the video you selected and address the following:

    What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?

    What evidence from the literature supports the techniques demonstrated?

    What did you notice that the therapist did well?

    Explain something that you would have handled differently.

    What is an insight that you gained from watching the therapist handle the group therapy?

    Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?

    Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

    BY DAY 7

    Submit
     your Assignment.

    Reminde
    r
    Links to an external site.
     The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

     

    Analyzing Group Techniques

    Group therapy may help patients overcome their worries and concerns by providing a safe and supportive setting in which they can open up and share their feelings with their therapist and peers. Group therapy gives advantages like interacting with others by utilizing therapeutic strategies and ways to aid patients in discovering different approaches to lessen symptoms such as despair, melancholy, and stress. During any group therapy session, the group therapist is required to be a proactive leader and player in order to help participants in understanding their own personal and social difficulties. In an ideal situation, the discourse would center on current issues affecting a person and other members. “Psychotherapy for schizophrenia” is the video chosen for this paper. The purpose of this paper is to examine the group therapy techniques demonstrated in the video, as well as the crucial role performed by the therapist.

    GET A PLAGIARISM-FREE ESSAY NOW

    Cognitive-behavioral therapy (CBT) is one of the group strategies used in this video. The strategies were effectively applied by the facilitators, who asked clients to voice their fears and describe how they overcame the worry they were experiencing. Research indicates that cognitive-behavioral therapy has a significant impact on lowering the need for hospital admissions and boosting patient satisfaction (Carr et al., 2018). NRNP-6645 Week 3: Assignment ANALYZING GROUP TECHNIQUES

    The benefits of cognitive-behavioral therapy (CBT) have long been established in the scientific community, with patients gaining a better knowledge and ability to control their mental health as a result of the treatment (Lecomte et al., 2018). What went well is that it was a good idea for the group facilitators to introduce themselves, go through the session schedule and guidelines, and then make follow-up phone calls.

    A little change I would make would be to spread the patients out further in a circular pattern and somewhat away from one other. Overstimulated clients often grow uncomfortable when seated so close together; the layout was unusual, not a perfect circle as it seemed from the outside. I am m not sure whether there was a problem with space, but a little circle might be more appealing. One insight I gained from watching the video was the importance of going through the schedule, guidelines, and following up after the session was over. The inpatient groups that I have been guiding have made me really apprehensive. Finding subjects to talk about has become a lot better for me. Understanding how to validate and appreciate client responses was much easier after watching the video. On a regular basis, I will go through a subject with the group and offer open-ended questions so that anybody may contribute. However, this does not always work. Not everybody contributes because certain patients dominate the discourse while others do not offer their thoughts. I also got an insight into the many approaches of reviewing a subject and asking clients individually across the group so that everybody gets a chance to speak out and express their perspectives.

    The facilitation of groups with problematic clients or temperaments has happened to me on a few occasions. I feel that it is entirely dependent on the client, the group, and their impressions of what is going on. One time, I had a delusional and manic patient who was engaging, but not disruptively so, but also not beneficially so. Repeated redirection of the patient by me was necessary. Another example is a young patient who had been in the facility for a month. It is sometimes difficult to gain and maintain the concentration of this age group. After redirecting the client to a leader of the group, I ended up removing the client from the group, which resulted in the group running more efficiently. Group members that are disruptive and indecent should be removed from the group since they are causing other clients to be distressed.

    I regularly bring up the subject and ask every participant in the group questions or suggestions about what they have found to be effective in dealing with their problems, for instance, what they do to reduce their stress levels. The use of games in groups with children and adolescents has shown to be quite effective since they increase interaction significantly NRNP-6645 Week 3: Assignment ANALYZING GROUP TECHNIQUES. What would one expect to discover throughout the various stages of group therapy?

    Members of the group therapy go through phases in which they learn to recognize their own perspectives while also learning from the points of view of their fellows. Openness, understanding, respect, and appreciation for what others have to say and contribute are some of the positives of group therapy. Sharing one’s experiences allows one to obtain new views while also aiding in rehabilitation. The learning and application of alternative strategies to alleviate symptoms of sadness and worry in daily life may be beneficial (Li et al., 2020).

    In a nutshell, group therapy can be an extremely valuable approach in allowing individuals to connect and benefit from others who may be going through comparable situations. It may be beneficial for clinicians to encourage group therapy as a way to acquire different coping mechanisms while also emphasizing that medicine is not a panacea
    NRNP-6645 Week 3: Assignment
    ANALYZING GROUP TECHNIQUES.

     

    References

    Carr, E. R., McKernan, L. C., Hillbrand, M., & Hamlett, N. (2018). Expanding traditional paradigms: An integrative approach to the psychotherapeutic treatment of psychosis. Journal of Psychotherapy Integration, 28(2), 154-170.
    https://doi.org/10.1037/int0000083

    Lecomte, T., Samson, C., Naeem, F., Schachte, L., & Farhall, J. (2018). Implementing cognitive behavioral therapy for psychosis: An international survey of clinicians’ attitudes and obstacles. Psychiatric Rehabilitation Journal, 41(2), 141-148.
    https://doi.org/10.1037/prj0000292

    Li, X., Kivlighan, D. M., Paquin, J. D., & Gold, P. B. (2020). What was that session like? An empirically-derived typology of group therapy sessions. Group Dynamics: Theory, Research, and Practice.
    https://doi.org/10.1037/gdn0000139
      NRNP-6645 Week 3: Assignment ANALYZING GROUP TECHNIQUES

  • ANALYZING GROUP TECHNIQUES

    THE ANALYZING GROUP TECHNIQUES ASSIGNMENT

    In a 3- to 4-page paper, identify the video you selected and address the following:

    What group therapy techniques were demonstrated? How well do you believe these techniques were demonstrated?

    What evidence from the literature supports the techniques demonstrated?

    What did you notice that the therapist did well?

    Explain something that you would have handled differently.

    What is an insight that you gained from watching the therapist handle the group therapy?

    Now imagine you are leading your own group session. How would you go about handling a difficult situation with a disruptive group member? How would you elicit participation in your group? What would you anticipate finding in the different phases of group therapy? What do you see as the benefits and challenges of group therapy?

    Support your reasoning with at least three peer-reviewed, evidence-based sources, and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

    Analyzing Group Techniques

    Introduction

    Interpersonal psychotherapy (IPT) is a time-limited psychotherapeutic approach that has three phases namely; beginning, middle, and end. The collective approach requires a therapist to be able to identify an individual’s target diagnosis and the interpersonal context in which it presents. IPT puts much emphasis on stressful events of life transitions, deficits linked to the onset, perpetuation or exacerbation of present symptoms interpersonal disputes, and grief while assisting patients to connect with social supports and improve the nature and quality of their relations (Cuijpers et al., 2016). The initial phase includes the formation of a therapeutic alliance, in the middle phase, a therapist applies interpersonal problem-focused therapeutic guidelines and in the ending phase, both the client and therapist consolidate gains, review contingency plans, and adaptive interpersonal strategies. Although IPT was initially noted to be effective in the management of depression, today, evidence from currently existing research indicates that it is effective in the management of other mental health issues such as anxiety disorders, eating disorders, and substance abuse disorders.

    BUY A PLAGIARISM-FREE PAPER HERE

    In a group setup, IPT is effective in helping people to address the relationship and personal issues by focusing on their interpersonal relations. The primary purpose of group IPT   is to address individual difficulties and encourage the individual development of group members.  Therefore, a therapist will select members for a group that comprises individuals who can collectively benefit from IPT therapy as well as contribute to the personal development of other group members. In this paper, the author analyzes the group techniques used during an IPT group therapy session for a client named Jimmy who had a substance use disorder. The author discusses and demonstrates the group techniques illustrated during the session with evidence from supporting literature, what the therapist did well, what the author would have handled differently, and insights gained from watching how the therapist handled the group therapy session.

    Group Therapy Techniques, How They Were Demonstrated With Literature Support

    An important group technique that was demonstrated during the session is that of releasing tension in the beginning stage. Before the session began, Jimmy was in a lot of discomforts to share his deepest feelings, thoughts, and secrets with group members. However, when he first spoke, all group members who had realized the tension tried to make the environment more comfortable. For instance, one member of the group thanked Jimmy for sharing and another acknowledged that everyone has secrets. To add on, other group members shared their secrets. One member admits how she had done huge stuff on a project; another member shared how he used his grandfather’s pension money when he was sent to get it from the post office. Another group member admitted that he used to steal from his family although under totally different circumstances. According to Hauber, Boon & Vermeiren (2019), sharing does not only promotes universality and comfort but also increased cohesiveness and released tension amongst group members.

    Another group therapy technique that was demonstrated was that of catharsis which helped to build trust, confidence and to promote disclosure. In the beginning stage of the IPT session, Jimmy was not ready to disclose much of his secrets, thoughts, feelings, and issues. This group technique was demonstrated by group members who were ready to disclose very shameful aspects of their lives that played a major role in relieving guilt, pain, or stress. By people being ready to disclose aspects of individual lives, it left a clear message of trust that brought members together by permitting them to take risks and make further disclosures. This had a positive impact on Jimmy and the group. As other group members demonstrated to identify with Jimmy, they also took risks to expose their vulnerability. This interaction took the group to a higher level of interpersonal sensitivity which is another group therapy technique.  Interpersonal sensitivity was demonstrated through Mark when he shared an experience that was similar to that of Jimmy while historically focusing on the details of the disclosure. Hauber, Boon & Vermeiren (2019) highlight that, disclosure can only happen in a group when there is individual readiness and cohesiveness to disclose Analyzing Group Techniques. It is for this reason that the therapist did not force disclosure despite powerful agents of change.

    The technique of interpersonal learning was also demonstrated through the active interaction of group members. After group members obtained a deeper understanding of themselves through a genuine emotional interpersonal experience, the therapist took time to illuminate the process and provide feedback to group members. Interpersonal learning began when   Jimmy shared his problematic behavior of stealing his mum’s medication. After sharing, he observed the feedback and reaction from other group members to determine the validity of the feedback. According to Hauber, Boon & Vermeiren (2019), this approach influenced Jimmy to reflect and accept responsibility for the outcomes of his problematic behavior with a resolution to change the ineffective behavior.

    The last group technique that was evident was that of instilling hope. This was possible since group members were in different stages of the psychotherapy process. This technique was demonstrated when Jimmy admitted to having continued feelings of shame. To help him overcome these feelings, Tim offered him a classic intervention disclosure that provided further meta-disclosure by questioning Jimmy of what he was afraid would happen if he shared his feelings, thoughts, and issues. Through Tim’s intervention, Jimmy opened up and expressed the likelihood of people disrespecting and rejecting him as the root of his fears. On the contrary, his fear did not occur. Instead, group members instilled hope in him by acknowledging how they respected and admired his courage and honesty to share rather than focusing on his past actions.  This approach demonstrated that, in IPT, when an individual realizes that they are not judged based on the historical actions that they individually judge themselves, they can play a major role in helping another person to give up their self-judgment and let go of past events (Hauber, Boon & Vermeiren, 2019).

    What the Therapist Did Well

    It was impressive that the therapist used a directive approach to lead the group during the entire IPT session. Although it is commendable for therapists to combine both the directive and non-directive approach, the latter can make group members feel completely lost during therapy. On the other hand, by using a directive psychotherapeutic approach, the therapist was able to ensure that the process was directly relevant. A directive therapist usually assumes a more active role that includes providing feedback, interpretations, expressing opinions, making suggestions and recommendations.

    The therapist also demonstrated traits of an effective leader and enabler through active listening and allowing turn-taking with the aim of modeling behaviors of group members. She talked less but listened more, a trait that revealed her as less dominating and controlling. As a result, every member of the group was able to share their feelings, experiences, and thoughts. Apart from creating a sense of universality, solidarity, and cohesiveness in IPT, turn-taking increases a therapist’s responsiveness and strengthens the sense of group members. On the other hand, active listening is a significant skill that therapists explore to develop healthy and positive interactions with clients (Jones, Bodie & Hughes, 2019). It also promotes a therapists’ ability to recall the most vital feelings, events, and issues conveyed by a client.

    The therapist was empathetic. She demonstrated a perfect understanding of Jimmy’s experiences even though Jimmy had not explicitly described his feelings or thoughts to her in the beginning stage of the IPT session. The empathy demonstrated by the therapist made Jimmy feel that his values and past behaviors will not be judged especially if they conflicted with the therapist’s values.

    What to Handle Differently

    The author would neither introduce individual reactions nor well-intended comments during the IPT group therapy session. This is in particular to the therapist’s comment ‘I was wondering if you answered my question though?”. In psychotherapy, when a therapist demonstrates individual reactions or well-intended comments, it can negatively impact the therapeutic alliance with clients since each client interprets reactions differently. In most cases, clients tend to misinterpret the therapist’s reactions or comments. When this happens, it can either result in non-disclosure, non-compliance with psychotherapy, and in worse cases, termination of psychotherapy.

    Insights Gained

    The major insight gained in watching the therapist was the significance of being an effective leader and enabler in an IPT group and the need to listen more but talk less during group therapy sessions.  According to Jones, Bodie & Hughes (2019), talking less and listening more is a characteristic of an active listener and active listening helped members of the group to feel appreciated, worthy and respected. Effective leadership was demonstrated through a directive approach to lead the session. As a result, the group members responded positively by interacting on a higher and deeper level through personal disclosures, it promoted continuous engagement, positive and open communication among group members Analyzing Group Techniques.

    How to handle A difficult Group Member

    If the author was conducting a group therapy session, I would handle a difficult group member first by determining the readiness stage of the client, giving the client choices, and focusing on his/her strengths. Determining the client’s change would help to determine the need for therapy to move them from their readiness stage to the next rather than influencing individual change. Giving the client choices is a strategic approach towards giving him/her the chance to make an informed decision while actively engaging them in the process. On the other hand, focusing on the client’s strengths would help to increase optimism and attachment.

    Explain Why Each of Your Supporting Sources Is Considered Scholarly

    The studies by Cuijpers et al., (2016), Hauber, Boon & Vermeiren (2019), and Jones, Bodie, & Hughes (2019) are all scholarly sources since they have long and specific titles with more than a single author for each article. Just below the title, each of these articles has an abstract which is a summary of an entire article. Besides, the body of each of these sources is clearly structured   in   the following sections, background/introduction, methods, discussion and the conclusion. The authors have used tables as visuals to present statistical findings and concluded with a reference list.

    Conclusion

    IPT is a form of the time-limited psychotherapeutic approach used to manage mood disorders, substance abuse disorders, and eating disorders. This form of psychotherapy is based on the following two major principles; that interpersonal relations have a significant impact on people’s mental health, and the aforementioned disorders are manageable by focusing on building stronger and healthier interpersonal skills. Its major goals are; to resolve an individual’s issues and improve social skills. In this paper, the author discussed the group techniques used during an IPT group therapy session for a client named Jimmy who had a substance use disorder. The group techniques demonstrated included; interpersonal sensitivity, interpersonal learning, catharsis, altruism, releasing the tension, and universality.  What the therapist did well include; directive approach to lead the group during the entire IPT session, active listening and, allowing turn-taking and being empathetic.

     

    References

    CATS CATS (29th September 2016).
    Interpersonal Group Therapy for Addiction Recovery Demonstration.
    Available at

    . Watched on  21
    st
    March 2021

    Cuijpers, P., Donker, T., Weissman, M. M., Ravitz, P., & Cristea, I. A. (2016). Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis. 
    American Journal of Psychiatry
    , 
    173
    (7), 680-687.

    Hauber, K., Boon, A. E., & Vermeiren, R. (2019). Therapeutic factors that promote recovery in high-risk adolescents intensive group psychotherapeutic MBT program.
    Child and adolescent psychiatry and mental health
    , 
    13
    , 2.
    https://doi.org/10.1186/s13034-019-0263-6

    Jones, S. M., Bodie, G. D., & Hughes, S. D. (2019). The impact of mindfulness on empathy, active listening, and perceived provisions of emotional support. 
    Communication Research
    , 
    46
    (6), 838-865 Analyzing Group Techniques.

  • NRS-425 Community Teaching Project: Teaching Acknowledgment Form

    NRS-425 Community Teaching Project: Teaching Acknowledgment Form

    This form acknowledges that the teaching presentation has been completed. Students must submit this form in the digital classroom in Topic 5.

    Student Name:

    Course Section and Faculty Name:

    Date of Presentation:

    ORDER A PAPER HERE

    Representative Information

    Representative Name :

     

     

     

     

    Last

    First

    M.I.

    Credentials:

     

    Title:

     

     

    (i.e., MS, RN)

    Organization:

     

    Phone Number:

     

    Email Address:

     

    Student Presentation Information

    Type of Presentation:

    PowerPoint presentation

    Pamphlet presentation

    Poster presentation

    Infographic presentation

     Provider Acknowledgement

    I ___________________________ acknowledge that ____________________________

     

    (Representative’s Name)

    (Student’s Name)

    has participated in a community teaching experience at the organization listed on this form. The organization/agency does not endorse the university or the student; however, the teaching plan developed by the student is considered appropriate and of benefit to the community of interest. 
    NRS-425-RS-T5-TeachingAcknowledgmentForm

     

     

     

    Representative’s Signature (must be handwritten)

     

    Date Signed

  • Mother and Daughter: A Cultural Tale video

    Mother and Daughter: A Cultural Tale video

    FAMILY ASSESSMENT

    Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.

    To prepare:

    Review this week’s Learning Resources and reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.

    Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.

    View the 
    Mother and Daughter: A Cultural Tale
     video in the Learning Resources and consider how you might assess the family in the case study.

    THE ASSIGNMENT

    Document the following for the family in the video, using the Comprehensive Evaluation Note Template:

    Chief complaint

    History of present illness

    Past psychiatric history

    Substance use history

    Family psychiatric/substance use history

    Psychosocial history/Developmental history

    Medical history

    Review of systems (ROS)

    Physical assessment (if applicable)

    Mental status exam

    Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with 
    DSM-5-TR
     diagnostic criteria

    Case formulation and treatment plan

    Include a psychotherapy genogram for the family

    Note:
     For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.

     

    Psychotherapy with Multiple Modalities WK2 Assignment 

     
    Subjective:

    CC
    (chief complaint):

    The mother reports that she is experiencing a lot of pain, and she feels nobody is helping her manage the pain. Her daughter Sharleen indicates that she desires to make her mother peaceful and wants her to lower expectations and accept that life has changed. She adds that she has a feeling that her mother is holding her back from all she could be doing. The mother wants her daughters to always spend time with her and sometimes gets depressed when she is lonely. Sharleen admits that she hates spending time with her mother in the house since her mother has two dogs, which she does not like. She does not like touching the dogs or having their hair on her body. She adds that she cannot have a meal at her mother’s house since eevryting there smells like the dogs, making her uncomfortable. Sharleen complains that her mother is too quick to take action due to her high expectations. There is also a complaint that one of the siblings was raped by her biological father, which has affected her mental health. As the complaints are presented, it is noted that Patti and Sharleen are not always in common agreement, and Gonzalo Baciga is even worried about the mother and daughter.

    PLACE YOUR ORDER HERE

    HPI
    :

    The said patient is a female from Iran-America and is 40-year-old. She wants to be examined for complicated family dynamics problems regarding her children and her. Her 23-year-old daughter discussed the various issues concerning her relationship with her mother and family. They want to be evaluated for trauma-related concerns related to domestic violence caused by their father Mother and Daughter: A Cultural Tale video. The lady admits that apart from the violence, their mother is adjusting to America’s norms, an adjustment disorder.

    They admit that there is a lot of family conflict, especially with their father, who once raped one of her daughters. The significant problem is that the mother is falling ill and has undergone several surgeries on her foot. A second issue relates to the rape case by the father. The third issue is the difference in beliefs and traditions as the mother wants her children to look after her, while the children prefer employing a nursng facilty to care. Generally, the issues are unresolved and cause depression and trauma. Fumbling and enthusiasm were two visible symptoms observed during the assessments. Other signs noted include; impulsivity, hyperactivity, often repeating words, and irritability. There is no evidence of an inability to focus, possessing a short memory, or paying attention.

    Past Psychiatric History
    :

    The mother described depressing moments in this case but did not indicate psychiatric illnesses such as depression. They disputed thoughts of suicide. Additionally, they denied having ever used illegal substances, suffering from a significant mental illness, or having insanity.

    Hospitalizations:
    No previous reports mentioned acute admissions for mental illness.

    Psychotherapy or Previous Psychiatric Diagnosis:

    There is no recorded current mental diagnosis or psychotherapeutic treatment for the patient. However, it was earlier indicated that the mother becomes depressed whenever she is lonely. Additionally, they did not mention any medicine for depression.

    Substance Current Use and History:
    No reported abuse of substances at the moment.

    Family Psychiatric/Substance Use History:
    No substance use or psychiatric is reported.

    Psychosocial History:

    The daughter and mother are both struggling to adjust to a new way of life. They have visited the institution for mental assessment diagnosis of any trauma disorder and adjustment disorder. Their current psychiatrist was presented, too, and participated in answering some questions related to the patients’ past issues. The mother, who is living on disability, was brought by her daughter, a school-going girl. There were no details about the girl’s school that were collected. No information was revealed concerning the daughter thought it might be important if she could report any. Unnikrishnan et al. (2021) indicate that patient information is necessary for creating a full treatment plan. The family denied both current and medical history. The assessment only revealed the mother’s surgery without mentioning its reason. It would be imperative to ask questions that would help dig deep into patients’ health histories.

    Medical History:

    Current Medications
    : None mentioned

    Allergies
    : Not known

    Reproductive Hx
    : Not known for the children, but the mother has six children

    Objective:

    Review of systems (ROS)

    Skin
    -reported no issue

    Respiratory system
    – no shortness of breath, cough, or sneezing.

    Cardiovascular
    system- no chest pains reported

    Gastrointestina
    l-no constipation, abdominal pains, or diarrhea

    Hematologic
    – no easy bleeding or anemia

    Genitourinary
    -no hematuria or flank pain

    Neurological
    – no dizziness, headaches, ataxia, or paralysis

    Endocrine system
    – no polyuria, diabetes, polyphagia, or polydipsia.

    Assessment:

    Mental Status Examination:

    The mother is an Iranian female aged 40 years, and her Americanized Iranian daughter is aged 23. Due to early and abusive marriage stress, the mother looks older than she should. The daughter looks at the mother’s stated age and seems not concerned. They are cooperating with the examiner. They are cleanly dressed, and there is no abnormal mental activity. However, they are both restless, anxious, and irritated. They deny any auditory or visual hallucinations or delusions. They have clear and loud speeches though the volume and tones are normal (Mitchell et al., 2021). Their thought process is logical, and their goals are driven.

    Some evidence of fidgeting, impulsivity, excitability, and annoyance are visible, including an aggressive tone with some repetitions. When spoken to, they looked present-minded. Cognitively, they have remote and recent memories intact, normal concentration, average insight, and all attention, judgment, and abstraction unbroken (Watkins et al., 2018).

    Differential Diagnoses:

    POST-TRAUMATIC STRESS DISORDER- PTSD; ICD-10 CODE: F.43

    The post-traumatic disorder can follow a traumatic experience such as a physical assault or military combat. Although stress always follows trauma, PSTD victims relieve trauma with their minds and start distancing themselves from friends and family. They also may begin experiencing prolonged anger. Individuals that have faced or experienced life-threatening events form the majority of these victims. There is no specific or fixed prevalence for the condition, for it affects both men and women, young and aged. Traumatic stress lead to physiopathological and psychoemotional consequences. PTSD is psychologically correlated with general physical impairments that alter daily life and the mind. The condition is common to those who face terror or get exposed to environmental toxins (Mitchell et al., 2021) Mother and Daughter: A Cultural Tale video.

    People who have experienced scary, shocking, and other dangerous occurrences have too fearful scars to forget the trauma they went through. Notably, 95% of individuals experience different reactions after life-threatening trauma, although most recover fully. Those who continue experiencing the trauma are diagnosed with PSTD to avoid feeling stressed or uncomfortable even when there is no danger around. Some signs of this disorder include extreme anger, fear, guilt, shame, or negative emotional thoughts.

    Reflections:

    From the look of this topic’s assignment, PSTD is a disorder most folks have incorrectly related. Sustainability and formation of PSTD are re-associated with many neurotransmitters. Dopamine contributes a lot to this class. Given that patients with PTSD are predisposed to obesity, these patients must understand the dangers of being overweight, which predisposes them to be chronic and acute illnesses such as diabetes, obstructive sleep apnea, hyperlipidemia, cardiovascular disease, chronic obstructive pulmonary disease, rheumatoid arthritis, and so on. “PTSD is related to an elevated incidence of type II diabetes mellitus,” according to the study (Watkins et al., 2018).

    There is a link between PTSD and severe health difficulties throughout the lifespan. Including activities that, regardless of their results, can trigger high-risk behavior. Substance misuse, binge eating, obesity, and inappropriate/unsafe sexual conduct are all highly risky behaviors that may be engaged as a result of PTSD. It is consequently critical to teach these patients about the need for modern contraception, healthy eating habits, and physical activity (Watkins et al., 2018). Clinicians and their clients may discuss healthy patient behaviors, healthy meals, and exercises to maintain good health and prevent illnesses and consequences.

    Case Formulation Treatment Plan;

    PSTD victims are treated with psychotherapy, medications, or both because everyone is unique and people are affected differently; these people should be assigned an experienced manager with enough knowledge about the condition. Some victims are required to try different medications and therefore require the attention of a professional nurse practitioner. The condition tends to reoccur and needs to be treated from its root cause. The mother exhibits symptoms and signs of social skills and is aware of her worsening depressive issues.

    20mg Prozac daily

    15mg BID Buspar

    Management of stress

    Nutrition and diet specialist

    Side effects of medications and their overall expectations.

     

    References

    Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., … & Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025-1033.

    Unnikrishnan, R., Radha, V., & Mohan, V. (2021). Challenges Involved in Incorporating Personalised Treatment Plan as Routine Care of Patients with Diabetes. Pharmacogenomics and personalized medicine, 14, 327.

    Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258.

    Mother and Daughter: A Cultural Tale video Transcript

    00:00:00
    TRANSCRIPT OF VIDEO FILE: 

    00:00:00
    _____________________________________________________________________ 

    00:00:00
    BEGIN TRANSCRIPT: 

    00:00:00
    [music] 

    00:00:35
    A MOTHER and A DAUGHTER: 

    00:00:35
    A CULTURAL TALE 

    00:00:35
    AN INTERVIEW WITH 

    00:00:35
    GONZALO BACIGALUPE, PhD 

    00:00:35
    Produced by 

    00:00:35
    Andrews & Clark 

    00:00:35
    Explorations, Inc. 

    00:00:35
    copyright 2003 

    00:00:35
    GONZALO BACIGALUPE 
    When I’m asked to do a consultation, one 
    of the first things I ask is, what will be the most benefit for the 
    client and the therapist and in the case that you’re going to see 
    I’m basically asked to have a reflecting 
    team and what we did was first have an interview with the 
    therapist and the family and ask them what they will find 
    useful for the interview and basically to ask them about the 
    history of the therapy and the history of what are the kinds of things that 
    they have been working on. I ask the reflecting team 
    to come in and I instructed them to think of themselves as so let the 
    god mothers of the therapist, who in a way, put them, himself, or in this case 
    herself at risk in front of her peers and 
    another people. So, I wanted them, the reflecting team to address the 
    therapeutic system as a whole not just to address the family, I 
    wanted them to talk also about the therapist and to be protective 
    of them. I also ask the reflecting team not to 
    be too much of clinician, but to really react on a more 
    personal level around the family. I sometimes reflected on what they were saying 
    to clarify or to expand the idea or how I understood it 
    to give voice to other possibilities, but respecting the personal 
    peace, and then, I ask I ask the family to come back to, in a 
    classical way, to respond to those comments what strike them. 
    In the case that we watch, it seems that the family 
    was dealing with sort of like two forms of trauma and/or 
    three forms of trauma; one is, history of battering the 
    domestic violence, child sexual abuse, a history of 
    immigration that in some ways we lay it to that trauma 
    getting away from it and basically the mother of five children 
    deciding that they need to move out of the home, 
    but in the process leaving one behind who is later on 
    sexually, I mean, raped by the father. And then 
    at the present moment mother dealing with a 
    fairly traumatic illness that have her, very disable, unable 
    to walk and to work. So, it’s sort of like the 
    interview trying to address this different forms of trauma 
    and the way in which 
    the young adults are trying to make sense 
    of their bicultural life and 
    how the whole family is trying to make sense of being bicultural 
    and being immigrants. The session 
    doesn’t end with a need or incredible intervention of 
    my part because I feel that this is the part of the therapist 
    to try to decide, this is the family that’s been working this therapist for year and half. Therefore, they 
    have a relationship I feel that I need to respect and so 
    those are the basic 
    intercomments. So tell me how is it that you came out with the 
    idea of having this interview with 
    me? 

    00:04:30
    Sharleen 

    00:04:30
    Patti 

    00:04:30
    SANDI 
    Okay. I’m going to go back 
    when Patti came in for the first time. She came in because 
    they were chaos at her 
    household. 

    00:04:45
    Sandi – their therapist 

    00:04:45
    SANDI 
    She came to this country twelve years ago 
    with her four children and one was left behind, her 
    daughter who was 10 years old at that time, eight years old at that time, was 
    left behind. Just two years back, 
    finally they were able to get her visa and she 
    brought her to United States. So ever since she came here 
    chaos was created inside the 
    household. 

    00:05:20
    GONZALO BACIGALUPE 
    So I’m clear, Sharleen you 
    are? 

    00:05:25
    SHARLEEN 
    Her daughter. 

    00:05:25
    GONZALO BACIGALUPE 
    Her daughter. And how old are you? 

    00:05:25
    SHARLEEN 
    I’m 23. 

    00:05:25
    GONZALO BACIGALUPE 
    23, and 
    how old are your siblings? 

    00:05:30
    SHARLEEN 
    24. 

    00:05:30
    GONZALO BACIGALUPE 
    And that’s 
    sister or brother? 

    00:05:35
    PATTI 
    Sister. 

    00:05:35
    SHARLEEN 
    And then 21-year old 
    sister and 18-year old brother 
    and a 15-year old 
    brother. 

    00:05:50
    GONZALO BACIGALUPE 
    Okay, and which one is the one that stayed there. 

    00:05:50
    SHARLEEN 
    21. 

    00:05:50
    SANDI 
    21. 

    00:05:50
    GONZALO BACIGALUPE 
    21. 
    Okay. All right. Okay. Go ahead, sorry. 

    00:05:55
    SANDI 
    And 
    I met with the entire family for two 
    couple of sessions and she really interested and wanted to be in therapy 
    21, so. 

    00:06:10
    GONZALO BACIGALUPE 
    What’s her name? 

    00:06:10
    SANDI 
    Shireen. 

    00:06:15
    Shireen – the 21 year old sister 

    00:06:15
    emigrated from Iran 2 years ago 

    00:06:15
    GONZALO BACIGALUPE 
    Okay. 

    00:06:15
    SANDI 
    She 
    just felt that she needed the money more than coming to therapy and 
    she refused the entire time and mom tried to 
    she ask her, if she doesn’t feel comfortable with me. 
    She said she has had all appointments with other 
    therapists at this clinic, still she refused to come in, but they kept 
    on seeing Patti and the oldest daughter 
    Sheela for about a year and a half now. 
    Ever since then, we started working 
    on the chaos in the household, what is it that creating 
    chaos and I found out that Patti 
    lives with traditional ways of living, 
    their daughters are trying to detach 
    herself from Patti and grow on their own and find their own individuality. 
    So would ask where they have been working on 
    and every since then she had two surgeries. 

    00:07:30
    Patti had surgery on both feet. 

    00:07:30
    SANDI 
    Every thing is 
    started. 

    00:07:35
    GONZALO BACIGALUPE 
    Who had two surgeries? 

    00:07:35
    SANDI 
    Patti had two surgeries 
    on her feet. 

    00:07:40
    Surgery failed – she is disabled. 

    00:07:40
    SANDI 
    And that created more tension, 
    anxiety in the 
    family. 

    00:07:50
    She is in constant pain. 

    00:07:50
    SANDI 
    So — and I have been seeing her 
    after her surgery and she has been referred to a psychiatrist 
    for medication because a lot of time she feels 
    hopeless, helpless, she feels her children are out of control, 
    she can’t be in charge, they no need her anymore. 
    So those are the 
    major. 

    00:08:20
    GONZALO BACIGALUPE 
    If you were to describe 
    an accomplishment and you have accomplishment with the therapists during this time. 
    Is there something that you will say, it’s an important 
    accomplishment? 

    00:08:35
    SANDI 
    Awareness of the difference between 
    individualist ways of living and collectivistic ways of living 
    and awareness that how they 
    to respect and understand the children are growing 
    in this country and they are going to try to detach themselves 
    from Patti to be able to grow on their own. 

    00:09:00
    GONZALO BACIGALUPE 
    What has been for 
    you this work with Sandi? 

    00:09:05
    PATTI 
    She helped 
    me to understand the kids grow up and left the house and they have been 
    not to depend on them so many times and try to live my life 
    alone and then to take care of my things, my problem in the life 
    and respect them and give them their 
    freedom. 

    00:09:30
    GONZALO BACIGALUPE 
    Do you have a sense that that is sort word that has been accomplished that is more to be 
    done. 

    00:09:35
    PATTI 
    I think I need more to be done, 
    I’m not done. No. 

    00:09:40
    GONZALO BACIGALUPE 
    Do you have of 
    sense of what is that you would like to do? 

    00:09:45
    PATTI 
    Yeah, I’d like to learn 
    to lead my life alone and depend on the kids 
    a lot because in our custom when the parents get old and especially 
    when they are in my situation they can’t walk or take care of theirself, the kids are always 
    there for parents, but over here no, they have their own life. And 
    I expect them to be there all of the time for me and they can’t, matter of fact, I 
    had a big argument with her last night about that, I had a very bad back 
    for few days I was done and last night, I called her and I said come and spend a night with me and she said no, I 
    can’t. I said, you should and you have to and we got into a big 
    argument. 

    00:10:30
    GONZALO BACIGALUPE 
    So, you are on your own right now, you’re living in your own and each of the kids 
    have their own place or? 

    00:10:35
    PATTI 
    Three of them, two of the boys lived with me 18 and 
    15 years old, but the 15 years old was with her for three four days and 
    I was with 18 years old a lot. 
    I feel like they doesn’t do enough for me. 

    00:10:50
    SHARLEEN 
    She makes her own plans for me, she expects me to 
    like to go with her and spend time with her because she is bored. I have too much to do, I can’t 
    unwind your boredness, find something else to do, but I have plans, I’m 24 
    and my world around me is happening and I need to be there, I accomplish things. 
    I can’t sit down and like chitchat for a whole 
    day. 

    00:11:15
    PATTI 
    And I feel I’m depressed I cannot move, I need them to come 
    and visit me, spend a night with me. 

    00:11:20
    SHARLEEN 
    I spend, I — out of the seven days, I saw 
    her for six days, I make sure, I saw her for six days out of that week. 
    I spent a day with a friend and I got some stuff done and she felt like I owe her something because I 
    didn’t spend that time with her. And she did a nice job raising us, she was a wonderful 
    mother, we all suffered through the good and the bad in the family like every family does, 
    but we have all grown up, we can’t stay in the nest 
    forever. I’m trying to experience life and my own good or bad, whether you 
    approve it or not, it’s my life. 

    00:11:55
    GONZALO BACIGALUPE 
    Sharleen, is this something that you have had a discussion, 
    the three of you, I mean this particular or this is not like? 

    00:12:00
    SHARLEEN 
    I think, I have mentioned to her, but she takes it personal, she 
    doesn’t hear me out. 

    00:12:05
    GONZALO BACIGALUPE 
    Is this something that you have had conversations 
    with the family? 

    00:12:10
    SANDI 
    Over and over, yes. Especially with the 
    oldest daughter Sheela, she also, being the oldest, 
    she feels that she has been the parentified child all 
    her life, she has played a role of a man for — in 
    her mother’s life and then the entire, I’ve seen 
    her for about four times right, four, five times and 
    she used to cry the entire time in the session. 

    00:12:40
    GONZALO BACIGALUPE 
    And I realize that you’re being very 
    touched by this, I mean this is not something that. 

    00:12:45
    SHARLEEN 
    Yeah, it’s something that I 
    strive so hard to accomplish and as soon as I feel like I got her on the right 
    step, there she goes falling depart again asking for like, I give her 
    what I can and she keeps on asking for more and more and that’s not how my life 
    works. 

    00:13:05
    GONZALO BACIGALUPE 
    What do you right now? Are you working, studying? 

    00:13:05
    SHARLEEN 
    Yeah, I 
    work and I’m trying to get my license. I’m trying to get accomplish things 
    from now. 

    00:13:15
    GONZALO BACIGALUPE 
    What kind of work are you are doing right now? 

    00:13:15
    SHARLEEN 
    I just — I find promotional jobs 
    and then, I’m trying to get my real estate 
    license. 

    00:13:25
    GONZALO BACIGALUPE 
    And your 
    sister? 

    00:13:30
    SHARLEEN 
    Sheela? 

    00:13:30
    GONZALO BACIGALUPE 
    Sheela, is she also on her own? 

    00:13:30
    SHARLEEN 
    Yeah. 

    00:13:30
    GONZALO BACIGALUPE 
    She is also working, 
    studying? And the 18-year old, what is he doing? 

    00:13:35
    PATTI 
    He is a 
    student. 

    00:13:40
    GONZALO BACIGALUPE 
    In high school? 

    00:13:40
    PATTI 
    Yes. 

    00:13:40
    GONZALO BACIGALUPE 
    So, he is finishing high school right now? 

    00:13:40
    PATTI 
    Yes, this 
    year. 

    00:13:45
    GONZALO BACIGALUPE 
    And is he talking also about leaving home after finishing the high school or 
    what are his plans? 

    00:13:50
    SHARLEEN 
    He is not sure yet, depends on how the family situation is 
    going, you know, everybody looks for happiness and peace of mind, depends like 
    how he feels around the home. 

    00:14:00
    GONZALO BACIGALUPE 
    How about the 15-year old? 

    00:14:00
    PATTI 
    I 
    have lots of problems with him, I don’t get long with him at all. 

    00:14:05
    SHARLEEN 
    She has no patience. 
    And she takes it out on other people. 

    00:14:10
    PATTI 
    Because I 
    can’t do anything, I walk fewer step and that’s it, I have a horrible pain 
    after fewer step. And I have to sit and wait for them to come and give me a glass 
    of water. 

    00:14:25
    SHARLEEN 
    Well, the thing is I want her not to wait for us, I want her to be on her own, I want 
    her to learn how to like, you know there is a — you know superman lost his both feet 
    and he sits on a wheel chair, but he is still going on with 
    life. 

    00:14:40
    PATTI 
    But Superman has money, somebody take care of him all of the time. 

    00:14:40
    SHARLEEN 
    You have to learn how to ease your own 
    mind and not depend on other people. She is forty years old, if 
    she was 60, poor dying lady, I would be more sympathetic, just 40 years 
    old, there is much more for her to experience. It’s not time for her to start depending on 
    her children yet. We’re only in our 20s, let me live life, let me experience 
    and do what you can, while you can. Give it your 
    best. 

    00:15:10
    GONZALO BACIGALUPE 
    Sharleen, how is that you decided to come today, I mean what’s it? 

    00:15:10
    SHARLEEN 
    Because 
    I was with her last week and they asked me to, they invited me to, so I thought maybe 
    you would like help as much as this is helping you. 

    00:15:20
    GONZALO BACIGALUPE 
    Do you have a sense that you are sort of being 
    representative of the other of your siblings that you are coming as a representative for all of them 
    in some way? 

    00:15:30
    SHARLEEN 
    We are all trying to get her to be more positive and feel like 
    do a little step at a day, but try your best to be better, 
    to do a better in life. Every time I try to push her to be more 
    independent and not as much like do that all stuff with her that she could do on her 
    own, she keeps like she has a broken wing that she wants to buoy on us, after a while, it gets heavy. 
    You just want it off because I want to breathe and I want to experience my life. I cannot 
    live like a 20-year old from Iran. I have different things to experience than to sit 
    at home. And the thing is like I don’t feel like I can 
    accomplish with her when I’m at home because she is either watching TV or on the phone, which 
    is just like sad people around and I can’t hang out like 
    that. 

    00:16:20
    GONZALO BACIGALUPE 
    Besides the — your five kids and yourself, is there 
    anybody else in the family here who immigrated with you guys or –? 

    00:16:25
    PATTI 
    I have a 
    cousin, but they live LA and I don’t even talk to 
    them. 

    00:16:35
    GONZALO BACIGALUPE 
    And so, in a way, when you 
    need something, basically the only thing that you feel like you can go for your 
    kids? When you — we’re talking about chaos, 
    there have been — there were some chaos about a year and half ago when we start through the work and 
    can you tell me little bit about what the chaos was about or what — how you define 
    that? 

    00:17:00
    SANDI 
    Okay. I just want to mention something about 
    before her surgery Patti has been a very independent women 
    as far as working hard, single mother, raising all her 
    children and they are all proud of her in many ways. 
    When they came she did not have the health problem as far as the 
    pain in her feet, constant pain and feeling hopeless 
    and helpless. They came for a different reason was for Shireen, 
    because Shireen came form Iran and two weeks everything was 
    wonderful, they all re-united, they enjoyed, celebrated 
    for two weeks, and then, she started telling him about 
    the stories that her father abused her sexually, physically and 
    she was abandoned in their house. 
    So, that’s where the explosion, the chaos started. 
    Before that — 

    00:18:05
    GONZALO BACIGALUPE 
    When you say that the chaos started, what started to happen? 

    00:18:05
    SANDI 
    They were 
    fighting, constant fighting, screaming, yelling and cursing 
    each other. Before that, my understanding was that 
    kind of was a very peaceful way of living, am I correct in 
    this? 

    00:18:25
    GONZALO BACIGALUPE 
    Okay. All right, so the tension has really sky rocketed 
    after Sheela came back, I mean, two weeks after one, and then, he came out of that — there’s been 
    this –? 

    00:18:35
    PATTI 
    As she came back, she was blaming me, why did you left me back home with my dad 
    there, he did all of those things to me. And my husband used 
    to tell her, you was a rotten fruit and she didn’t take you, you are a rotten one. 
    She took the good ones and left you behind for me. 
    And she was blaming me for everything. 

    00:18:55
    GONZALO BACIGALUPE 
    When you left, you had separated from your 
    husband? 

    00:19:00
    PATTI 
    No, we were living together my daughter had a medical problem, Sheela 
    and matter of fact, her, and they give me a medical visa to come here and 
    Sheela and Sharleen born here many years ago. 
    And when I went to get a Visa, they told me two of them are American 
    citizen, you have to take them, we cannot say no. And my boys were 
    four years old then 18 months old and Shireen was eight and they said, they decide 
    Shireen should be stayed home and make it sure I’ll will be go back. But 
    after I came here, my daughter didn’t have any problem any more and they were find and 
    I used to stay here and I decided to live here. And my husband was 
    keep telling me don’t come, don’t come, stay there, I will come some day and he never sent me any 
    money, he never did anything for us at all except sending the letter 10 pages 
    every single day, what to do, how to leave and how to raise the kids 
    and I throw them all in the trash because I didn’t had a time to read them and I didn’t had 
    time to practice anything he said and I ignored everything until like 
    six, seven years later, he just wrote a letter, I want you to be back home, you 
    are my wife, I order you to back home and I said, forget about you, I have my life here. 
    And who wants to go back to that life. And I was thrown all of the 
    time to bring Shireen and I couldn’t until three years ago. 
    Finally, she came and for couple of days, weeks everything was fine until she 
    started talking about every problem she had back home and 
    for any little mistakes she made, my husband used to beat her up and keep her outside 
    the house for all night and many, many things, the things he used to do to me. 
    And I know what she talking about and what she had to go 
    through, but I couldn’t do anything about it. I didn’t have the choice. When I came 
    here few week after, few months after I was here I called my dad and I said, 
    I’m worried about Shireen, I afraid to beat her and 
    I’m not there to protect them because I was all this over to protect the kids. 
    Each time he wants to beat them, I was right ahead of them and say, beat me, don’t touch 
    my kids, do whatever you want with me. And my dad said you 
    should imagine your house was in the fire, you took four of them off the fire, you left one 
    behind, leave her behind and take care of those four you have and I thought about it, I 
    thought, he is very right, absolutely right, I should take care of the four I have over here. 
    Why should I go back there. He would be — make 
    everybody miserable. I didn’t have a very good life but like she 
    said, we all worked together and take care of each other and like I was out 
    all of the time and like Sheela said, she was father of the kid, take care of the kids, 
    take care of the bank account, his groceries, everything. And I used to be 
    a care giver and save it all this and Sheela and Sharleen would stay home and take 
    care of the kids, two younger brother and each other. And everything was okay until 
    Shireen came. And then, after few months, 
    for a couple of years, we had a problem until, thanks god, last May she got married with somebody 
    behind our back. 

    00:22:25
    GONZALO BACIGALUPE 
    Who got married? 

    00:22:25
    PATTI 
    Shireen, 
    we were on the camping three when she ran away with one of my friend’s son and got married and 
    she moved out the house and my house is so quiet and I enjoy 
    the life so much except I get so depressed because I feel hopeless and I have so 
    much pain and they can’t do anything about my pain, I’m always in 
    pain. 

    00:22:50
    GONZALO BACIGALUPE 
    As you must have seen, when — do you work on how they make sense 
    of what happen to Shireen, I mean, in Iran during the time 
    that she was alone, was that workout with the whole family, they were some sort of 
    a conversation in therapy? 

    00:23:05
    SANDI 
    Yes, I met, as I 
    remember, I met with all of them and they expressed their feelings and 
    shouting, yelling, everything was going on in our session. And they were 
    expressing, Shireen was constantly blaming the mother for all 
    her pain and what happened to her to lead on and a mother tried to 
    explain her situation, the sisters also, brothers also. 
    So, we had few sessions like that. 

    00:23:35
    GONZALO BACIGALUPE 
    What was 
    your sense of how it can — that there were some sort a resolution around that that 
    people were able to make sense that Patti and the kids were able to make sense 
    of this or? 

    00:23:50
    SANDI 
    I was hoping for that, that was my really aim to 
    discover, explore their meanings of the situation 
    and. 

    00:24:00
    PATTI 
    They got in fight, we couldn’t keep coming 
    back, I couldn’t make them to go back as a family. 

    00:24:05
    GONZALO BACIGALUPE 
    Is it still something that is very hard to 
    talk about or not? 

    00:24:10
    PATTI 
    About the rape you mean? 

    00:24:10
    GONZALO BACIGALUPE 
    Yeah? 

    00:24:10
    PATTI 
    What 
    do you think? 

    00:24:15
    SHARLEEN 
    Well, I’m not very worried about, I mean, it’s affecting 
    her life and I feel sorry for her, but I try not to think about 
    it. 

    00:24:25
    GONZALO BACIGALUPE 
    And do you have the sense that that’s what anybody else in the 
    family tries to do that tries hard so they doesn’t affect? 

    00:24:30
    SHARLEEN 
    Because we already did 
    our crying over it and I’m over it, I’m ready to move on 
    about it. 

    00:24:40
    PATTI 
    It’s like when somebody die, you grieve for it. 
    When I heard about it, I was crying and crying and crying for months and months, and then later 
    on, it’s something you can’t do any thing about this, something happened, what am I going to do about it. 
    I tried to take her to counseling, I take her to Iranian psychologist, 200 dollars an hour. 
    And she would then go back, then what can I 
    do. And I think I’m 
    over with it, I feel sorry for her, but what can I do. My older son 
    doesn’t want to talk to this, his dad, nobody wants to contact him or have any 
    relationship or any thing to — 

    00:25:20
    GONZALO BACIGALUPE 
    Has he acknowledged that he 
    did rape her? 

    00:25:25
    PATTI 
    I told him once, and he will start cursing at me and I hang up. I said, I 
    pay a dollar fifty a minute, I don’t want to hear your cursing. I want to see what’s going on, what 
    happened and you tell me if it happened or not and will start cursing and 
    I hang up. And after that, I never called back, and he is remarried, he married 
    to Iris after Shireen came, during the three years, he got married twice 
    and he has moved on with his 
    life. 

    00:25:55
    GONZALO BACIGALUPE 
    Is there any, I mean, is there 
    a way in which you think, I mean you, Sharleen 
    and maybe some of your siblings, but just from your perspective, is 
    there where you think about how the relationship with your mom should be, is it — do 
    you have a dream for how? 

    00:26:15
    SHARLEEN 
    Yeah, I just wanted her to be more peaceful. I want her to 
    lower her expectations and to accept a lot of things about 
    life. 

    00:26:25
    GONZALO BACIGALUPE 
    What do you mean lower expectations, what? 

    00:26:25
    SHARLEEN 
    Not to expect so much from 
    people, not to — I think what she does is, she thinks of an idea and she reacts on it so 
    so quick without she calming herself down before she like takes the 
    reaction. 

    00:26:40
    GONZALO BACIGALUPE 
    Do you have a sense that your mom thinks that you can do more than 
    what you can actually do? 

    00:26:45
    SHARLEEN 
    I have a sense that she is holding me back from doing all that I could be doing 
    and as soon as I could get excited about her, every time I give her little bit of hope, 
    there she goes back expecting more, and then, getting angry at. She has some thoughts 
    then she is so hang up that these thoughts are like so true and she gets 
    angry about them and she hold on to them, then she accuses people and all they are 
    her thoughts in her mind. And I just ask her to leave them alone, let people be and 
    everything is going to — just then it’s going to take its course. 

    00:27:15
    GONZALO BACIGALUPE 
    Am I trying to tell you, if 
    you were to think about how your ambition, how you see it in the future, the relation 
    how do you see it? I mean, if you were to move 
    in a way the direction that you want it to move, how many times do you see yourself 
    beside in her or interacting with her? 

    00:27:35
    SHARLEEN 
    I speak to her every 
    day, I mean almost everyday. 

    00:27:40
    GONZALO BACIGALUPE 
    But again, I’m asking you more about — 

    00:27:40
    SHARLEEN 
    Like in the 
    future, yeah, I just want her to like be more calm about 
    like life so that I could like through her better. So that when I do spend time with 
    her that I could enjoy it better instead of her frightening my other siblings or telling me about how 
    so and so, this and that and this and that. I just want her to be more calm 
    so we could just enjoy the moment when we hang out, rather than like. 

    00:28:05
    GONZALO BACIGALUPE 
    What kinds of things do you enjoy 
    with her in the moment? 

    00:28:10
    SHARLEEN 
    I try to tell her about my ideas, how she is 
    like be more relaxed and not — you know same things. 

    00:28:15
    GONZALO BACIGALUPE 
    Patti, how do 
    you ambition the relationship with your daughter? 

    00:28:20
    PATTI 
    I saw her on Sunday, Sunday night 
    and Sunday night, I went to visit my older daughter and she was aware that I took 
    the dinner for them. And after I laid down fully at my daughter, 
    older daughter house, I couldn’t get up, they pulled me and took me to the car and I came home. 
    I didn’t see her until yesterday afternoon and I said, I have been done with my bag. 
    I just want them to spend time with me. I’m lonely, I get depressed when I’m lonely. 
    If she had a job, if she was working like the other people, I would understand 
    she is working everyday like my older daughter, she go to her school, she work, I understand she doesn’t 
    have a time, but I know she has time and I expect her to come and spend the time. And I 
    said, I gave you whatever you want, whatever I have in the house like furniture, this 
    and that, anything she said, mom can I have this? Sure, honey, doesn’t matter you 
    or me, you can have it. And when I’m like that with you, I expect you to do 
    something for me too. 

    00:29:20
    GONZALO BACIGALUPE 
    Patti, I understand how 
    also you are feeling upset about this, about 
    and I know that the question I’m asking is hard, I mean, how do 
    ambition the relationship with Sharleen? What will you like to happen 
    in the future? 

    00:29:40
    PATTI 
    Between me and her? I want her to 
    just spend time with me whenever she can. 

    00:29:45
    GONZALO BACIGALUPE 
    What kind of time for instance would you like to –? 

    00:29:45
    PATTI 
    She 
    come and stay at my house because she knows I cannot live with two boys and go to her house. 
    She most of the time ask me to come and stay at my house, but when I go to her house 
    and I spend over there, I’m worried about 18 years old I have at 
    home. 

    00:30:05
    GONZALO BACIGALUPE 
    And do you have a sense of how many times, 
    how many nights that you would like her to spend with you in your home? 

    00:30:10
    PATTI 
    Once a week is good 
    if she come and stay the day or night, once a week with me is fine, but 
    when she come like one hour, half hour, she is for example, going to go see so and so 
    to keep a board work, she will stop at my house to have a drink the water or say, hi mother, how 
    are you? 

    00:30:30
    SHARLEEN 
    Two, three hours? 

    00:30:30
    PATTI 
    That’s not a visit for me, I wanted to come with me and 
    spend the time with me and stay with me that day. 

    00:30:35
    SHARLEEN 
    When I go over there, she is either on the phone or she is 
    watching TV, I’m very, very uncomfortable in her house like 
    to where I cannot stand sitting down because she has two dogs around and I don’t like those 
    things. I don’t like the hair on my body. When I touch an animal, I wash my hands before I eat. 
    She has two dogs, there is dog here on the couch, dog here on the floor, dog here on 
    the chairs, there is dogs all around. I don’t want to eat anything because the dishes smell like dogs, 
    I’m not comfortable. I don’t enjoy that, it’s not pleasant to me. I 
    could only do it so much at a time. I express that to her, you have dogs, I can’t 
    eat either your dishes. That’s my culture, that’s how I was brought up and I thought 
    that’s how she was brought up. So, she surprises me when she does these things, she makes the family 
    unhappy because nobody wants to see dogs, it smells like dogs in her house. 

    00:31:25
    PATTI 
    How come you don’t 
    do the other things, you grow up and have a cold chill like, that’s just the only 
    thing you know. 

    00:31:35
    SHARLEEN 
    I don’t — I cannot stand it, I cannot stand it. 

    00:31:35
    PATTI 
    And they give me so much happiness, they make me so happy, 
    I love them so much. 

    00:31:40
    SHARLEEN 
    I don’t like it. 

    00:31:40
    PATTI 
    And I never ever going to get rid of 
    them. 

    00:31:45
    SHARLEEN 
    I don’t like it, don’t ask me to sleep in the pillow, it’s that the dogs stinks. 

    00:31:45
    PATTI 
    Actually, you know 
    we have a guest room, the dogs doesn’t in that room. 

    00:31:50
    SHARLEEN 
    I cannot sleep in motels, I cannot use 
    other people’s bed, I cannot sleep with dogs, I cannot do these things. 

    00:31:55
    PATTI 
    You know that bed 
    brand new and you know the sheets and everything brand new in the guest room and you know that that door is 
    closed. 

    00:32:05
    SHARLEEN 
    I’m not enjoying it, I cannot eat breakfast, when I’m thirsty I can’t drink water there. 

    00:32:05
    GONZALO BACIGALUPE 
    Let me ask you, is this the kind of 
    sometimes the — where the discussions go? 

    00:32:10
    SHARLEEN 
    Yeah. 

    00:32:10
    GONZALO BACIGA 
    And if I were 
    to let you go over the discussion where will it end, one of you will leave the room 
    or –? 

    00:32:20
    SHARLEEN 
    I will start screaming. 

    00:32:20
    PATTI 
    Screaming, yeah. 

    00:32:20
    SHARLEEN 
    And disrespecting and calling 
    names. 

    00:32:25
    PATTI 
    I do. 

    00:32:25
    SHARLEEN 
    At this stage, I don’t — 

    00:32:25
    GONZALO BACIGALUPE 
    And you would be like, I don’t want to see you, I don’t want to talk to you 
    anymore. 

    00:32:30
    SHARLEEN 
    I’m trying to become a woman, I’m trying to became a lady. 
    And when I go to her house, she treats me disrespectfully like that about her dogs, she would curse 
    me out and I just feel, oh, what a mother. 

    00:32:40
    GONZALO BACIGALUPE 
    Would you say both of 
    you that you would like that not to happen that you will not get into this. 

    00:32:45
    PATTI 
    Of course 
    I love them. 

    00:32:50
    GONZALO BACIGALUPE 
    Do you sometimes dream with, been able to relate 
    to each other without having to get into this. 

    00:32:55
    SHARLEEN 
    Of course, I 
    do. 

    00:33:00
    PATTI 
    I feel even we argue, we still love each other and I feel 
    like, they are my kids, they will be still here for me if I need 
    them really. And they have been until sometimes lately. 

    00:33:10
    SHARLEEN 
    I 
    just want her to appreciate and not to expect and expect just like take what 
    people give you and just be happy. 

    00:33:20
    GONZALO BACIGALUPE 
    We’re going to stop a little bit 
    now. 

    00:33:25
    Reflecting Team Enters 

    00:33:25
    Isaac 

    00:33:25
    ISAAC 
    I’m Isaac and 
    I really resonated with Sharleen. 
    I come from, well my parents emigrated 
    here. 

    00:33:40
    GONZALO BACIGALUPE 
    Where your parents came from? 

    00:33:40
    ISAAC 
    Korea, and I was 
    born in the States, but there are still this cultural tension 
    that we experienced within our family. And so when she was talking 
    about the difference of cultures and who she is 
    and there was a little bit of disparity between 
    her Iranian culture and the American cultures in her life and I 
    experienced that in my life too. So, I really understood that and I thought, you know 
    what? I’m not the only one that went through that. And if I’m not the only one then she is not the only 
    one either, so something that I guess happens in a 
    culture of people when they immigrate into 
    another country. 

    00:34:30
    GONZALO BACIGALUPE 
    How old were you when you immigrated? 

    00:34:30
    ISAAC 
    I was born here. 

    00:34:30
    GONZALO BACIGALUPE 
    You were born 
    here, but still — 

    00:34:35
    ISAAC 
    My parents, my parents moved here. When they were 
    in their mid-20s, they moved here. And then I was born and 
    shortly after they moved here. And so there was a been influence 
    there. 

    00:34:50
    GONZALO BACIGALUPE 
    All right, cool. 

    00:34:50
    Roberta 

    00:34:50
    ROBERTA 
    My name is Roberta and these things 
    really struck out with me because I have seen Patti before. I have been on 
    the reflecting team. And I’m amazed at the difference in her, how much younger she looks 
    and more vibrant than the last month I had seen her. So, I was very impressed 
    by her change. Another thing that just really struck out from me was 
    when Sharleen was talking about what she didn’t want to do, and then, Patti 
    talked about when her husband had sent her the letters and said, come home 
    and Patti didn’t want to go home and it was almost like it was the same conversation, only held with different 
    people. And I thought that was rather interesting that they are both having the same 
    things happen in their life at different times, but they both wanted their independence. 
    And I saw that realistic out from me, so that was very 
    interesting. 

    00:35:45
    GONZALO BACIGALUPE 
    Yeah, it’s interesting, I was — I don’t know if it’s the same you are saying, but 
    how can you have your independence, but at the same time, still 
    stay connected? It’s a hard one. 

    00:35:55
    ROBERTA 
    And they are fighting to 
    stay connected. 

    00:36:00
    Dorothy 

    00:36:00
    DOROTHY 
    First of all, I’m really impressed 
    with Sandi, the therapist and working with this family and having the care and the 
    love that it concerns between all of them, including Sandi 
    as a therapist. And I really 
    relate it to Patti because I have six children and I watched them one leave one at a time and so I know 
    what that feels like. 

    00:36:25
    GONZALO BACIGALUPE 
    What it feels like? 

    00:36:25
    DOROTHY 
    Well, it is — it feels 
    like a tragedy really each time. There 
    is always, there’s something to deal with because it’s a grieving, you are letting go. 
    You are letting go and I really relate it to her on that level, 
    completely, but I didn’t have the kind of real 
    tragedies to deal with that Patti has had to deal with, in addition to 
    this letting go, okay. She has had the, well, the disability 
    to deal with in the pain, the constant pain that she deals with 
    and also then the tragedy in her daughter’s life and what must come up for 
    a mother in dealing with that. I mean, unavoidable in the situation, of course, but still 
    she was dealing with that. At the same time, with all of this other 
    emotional stuff that I know about. So, I just have a lot of respect 
    for her and I noticed that she has done a good 
    job with her children. How wise Sharleen is 
    for a age, very wise, so. 

    00:37:35
    GONZALO BACIGALUPE 
    In a way, 
    Roberta? 

    00:37:40
    DOROTHY 
    Dorothy. 

    00:37:40
    GONZALO BACIGALUPE 
    Dorothy, in a way it is if it’s 
    Sharleen’s need for independence is in a way due to 
    her mom’s wanting her to be independent to 
    and sort of like I mean she has to get it from somewhere right? 

    00:37:55
    DOROTHY 
    Yes. 

    00:37:55
    GONZALO BACIGALUPE 
    Yeah. 

    00:37:55
    Amber 

    00:37:55
    AMBER 
    Yeah 
    that was a kind of a question I had. Well, what were Patti’s dreams for her children in 
    making this enormous transition from Iran, right. 

    00:38:05
    GONZALO BACIGALUPE 
    Yeah. 

    00:38:05
    AMBER 
    To 
    the States, this huge transition, I mean, there must have been a dream, some purpose that was bringing 
    her over here, and I was really curious what her thoughts back, I guess, 20 years 
    ago or something like that. And I loved Sharleen’s metaphor 
    of the birds, the wings feeling, really weighing her down right 
    now. 

    00:38:30
    GONZALO BACIGALUPE 
    And at the same the time, the wings are supposed to be as somewhat 
    you fly on. Yeah. 

    00:38:35
    AMBER 
    Yeah. And so at that kind tied into my thoughts about what were Patti’s 
    dreams for her — duckling in a way. I 
    do not just kind of rambling thoughts about duckling is calling around and the infant 
    their mom and their mind they follow her around forever even when they grow up, but they do 
    eventually gained some distance more than they 
    had. 

    00:39:00
    GONZALO BACIGALUPE 
    Maybe one comment, so maybe you want to say something else, I mean, maybe there is a couple of 
    burning comments that people want to — 

    00:39:05
    ISAAC 
    I know the 
    family really loves each other. 
    Even if they argue, you see that there is a sense of care 
    and compassion there for each other and I don’t think that. 

    00:39:20
    GONZALO BACIGALUPE 
    And in that sense, it must be very 
    frustrating to get into this stuff, it’s like. 

    00:39:25
    ISAAC 
    Oh yeah, absolutely. 

    00:39:25
    AMBER 
    Yeah 
    Patti made that comment. Even when we are fighting, I know we love each other. 

    00:39:30
    ISAAC 
    I said they’re 
    going, you know, that’s exactly right, when she said that and 
    even though, Sharleen is — it seems like it’s little 
    bit tough love going on, on behalf — from Sharleen’s part of she representing 
    all the kids, from kids towards their mom, and saying, mom, they love you, but 
    we want you to be able to function on your own 
    and I don’t know how that kind of fits in with everybody. 

    00:40:00
    GONZALO BACIGALUPE 
    Yeah. 
    I was wondering what it is for a kid even if it’s an adult, I 
    mean and clearly these are — kids were becoming adults 
    I mean, Sharleen put it very well. But it must be really hard 
    to see your mom becoming a little bit, you know sometimes like 
    a kid to, I mean, that they need to take care of so soon. 

    00:40:25
    ISAAC 
    Yeah. 

    00:40:25
    ROBERTA 
    And 
    she made that comment if she was older it would be different, but she is younger. 
    And I don’t think they expected, I imagine she is torn 
    with wanting to live her own life and wanting to take care of her mom, I’m sure she is struggling 
    deeply. 

    00:40:45
    GONZALO BACIGALUPE 
    Any of you thinking as a therapist, putting yourself in 
    Sandi’s shoes and anything that 
    you may think that Sandi is having to deal with or some dilemma that she may be 
    struggling with? 

    00:41:00
    ROBERTA 
    What I felt for Sandi, because I think this must be 
    very difficult for her also to, because the families seems 
    even though they have said they have grown and they have made changes that they are almost stuck on that 
    and I imagine Sandi is probably having a hard time getting over that 
    stuckness, and so that’s what I see Sandi probably struggling with. 
    It’s just being stuck and where do I go from here, where do I take the family from 
    here? 

    00:41:30
    GONZALO BACIGALUPE 
    I was wondering, I mean, and the reason I guess I had a self-interest in asking because I was 
    wondering and wanted to check with you guys, I mean, since she’s also from Iran 
    I mean, people might think that she is more of an expert on this family. And 
    of course, there are things that have to do with being from Iran. Also, the things that probably have to do 
    with being an immigrant, but also there is some tragic things that have happened in this family and 
    that you know, so I wonder how she at 
    sometimes might feel like not necessary knowing what to do and 
    while at the same time, feeling very well connected with this family. 

    00:42:05
    AMBER 
    Oh I think she 
    is. 

    00:42:10
    ROBERTA 
    She shows she’s well connected with that. 

    00:42:10
    DOROTHY 
    Oh yeah. And it must be very frustrating 
    because how do you improve the quality of life 
    for Patti, especially for the family in general, I mean, it must be very frustrating. 
    I mean, what concrete steps do to 
    take. 

    00:42:30
    GONZALO BACIGALUPE 
    Okay. Alright. Thank 
    you. 

    00:42:35
    Family & Sandi Return 

    00:42:35
    GONZALO BACIGALUPE 
    I generally ask after this, we call this 
    is a reflecting team, if you had any reactions, any thoughts 
    or — and you don’t need to address everything that was — I mean, 
    anything that strike you? 

    00:42:50
    SANDI 
    For me, I really 
    felt that 
    they hit — they touched the right sensitive part as 
    far as being stuck, I’m always thinking okay, what else, what 
    can I do to really — what can I, I 
    come with ideas of goal setting, achieving goals, and 
    trying to figure out what else can I do, so the family 
    can — 

    00:43:25
    GONZALO BACIGALUPE 
    Move forward. 

    00:43:25
    SANDI 
    Move forward. 

    00:43:25
    GONZALO BACIGALUPE 
    Patti, did you, of 
    what, all what you heard, there was something that struck you something new 
    or interesting or –? 

    00:43:35
    PATTI 
    Nothing, 
    they just talk about discipline on this — think you were asking me about Shireen, how 
    do I feel and I told you I have been grieved and it’s over, but I was 
    thinking about, it’s always in my head. 
    I don’t think I never going to forget it. It’s always 
    in my head and sometimes I feel like, maybe 
    if I was there, it wouldn’t happen and then I think about 
    rest of them, what could have happened to the rest of them, maybe if I’d take them all, what would be happened 
    to all of them. 
    So, I don’t know. 

    00:44:20
    GONZALO BACIGALUPE 
    Do you move back and forth between that. Sharleen 
    how about you, anything that strike you as? 

    00:44:25
    SHARLEEN 
    Oh pretty much everything 
    everybody said was really interesting to hear about. 

    00:44:30
    GONZALO BACIGALUPE 
    Anything in particular 
    that? 

    00:44:35
    SHARLEEN 
    I don’t think so. 

    00:44:35
    GONZALO BACIGALUPE 
    You don’t think so. 
    Is there a 
    movement and this is something that it’s like you 
    have been working for a year and a half, you have been going through 
    some very difficult stuff. 
    Do you see yourselves and 
    maybe you can imagine your siblings thinking about this. 
    Having other, so like very difficult conversations 
    therapy, I mean do you see yourselves having to 
    deal with tough issues? Or will you say that this is the worst 
    so to speak? 

    00:45:25
    PATTI 
    This is the worst. Just argue 
    with them because I love them and I don’t want to argue with them. I want them to have 
    a good life and get married and move on with their life and I see them happy in their 
    life. 

    00:45:40
    SHARLEEN 
    And sometimes she wants to choose our happiness 
    for us, and that’s not going to work out here. 

    00:45:45
    GONZALO BACIGALUPE 
    Tell me how that works, I mean, you guys are — 

    00:45:45
    SHARLEEN 
    She wants 
    to like choose our friends or choose where I hang out or boyfriends 
    or husbands. 

    00:45:55
    GONZALO BACIGALUPE 
    And she probably gave up already. 

    00:45:55
    SHARLEEN 
    No, no. 
    That’s the thing. 

    00:46:00
    GONZALO BACIGALUPE 
    You really think that’s not the — 

    00:46:00
    SHARLEEN 
    No, that’s the thing, she hasn’t given up. 

    00:46:00
    PATTI 
    I was 
    supposed to. 

    00:46:05
    GONZALO BACIGALUPE 
    She hasn’t given up? 

    00:46:05
    SHARLEEN 
    No. 

    00:46:05
    PATTI 
    I was 14 when my parents chose my husband for me and 
    I got married. And he was a nightmare, he was a man from hell, I think, sometimes. 
    But I hate to say that especially in front of the boys, but 
    he was. But the thing is sometimes I think is not fair what happened 
    to me, I do it to them, but sometimes, I feel like if I don’t get involved they don’t 
    know what to do. 

    00:46:30
    SHARLEEN 
    She doesn’t leave things alone like if the water is all calm, she 
    has to drop a rock. She doesn’t let things be. 

    00:46:35
    PATTI 
    I see 
    there are good looking guys, I keep telling them, look at him, he is cute, look at him, get 
    close to him or something like that, I want them to get 
    married. 

    00:46:50
    GONZALO BACIGALUPE 
    But in a way you gave up the notion that you’re going to have to choose. 

    00:46:50
    PATTI 
    Not they 
    choose, yes. 

    00:46:55
    GONZALO BACIGALUPE 
    A boy I mean, for them? 

    00:46:55
    PATTI 
    Choose, yes, I don’t want to choose her husband. 

    00:46:55
    SHARLEEN 
    Sometimes 
    I feel like she suffocates us with her opinions 
    and her thoughts and her beliefs. 

    00:47:05
    GONZALO BACIGALUPE 
    Tell me about an opinion lately. 

    00:47:05
    SHARLEEN 
    I mean, they 
    are nice, but. 

    00:47:10
    GONZALO BACIGALUPE 
    Some of the opinion that really — 

    00:47:10
    SHARLEEN 
    They make sense, but they make sense to you, not everybody has to go along 
    with what you thing is the best way to do things. And she feels like, if 
    you want to be a winner, you have to do it her way. 

    00:47:20
    GONZALO BACIGALUPE 
    Who is the more opinionated 
    at home? I mean, she has a strong opinion, but who 
    else? 

    00:47:30
    SHARLEEN 
    I think we all are that’s why we don’t get along. Everybody has an input. 

    00:47:30
    GONZALO BACIGALUPE 
    And 
    do you have a strong opinion of how your mom should behave, do you 
    see –? 

    00:47:40
    SHARLEEN 
    Yeah, I just wish she should be more calm, and what just she acts, so. 

    00:47:40
    GONZALO BACIGALUPE 
    Is 
    there any space in this, which I mean, you did say that before that you have the dream that 
    things were, that you were more calm, so that you could relate with her in a different level. 
    Is there some space for her not be so calm? 

    00:47:55
    SHARLEEN 
    I 
    mean, her house is what she creates for herself, to be calm or not be calm right. 

    00:48:00
    PATTI 
    Sharleen, and most 
    of the time you guys come over there even with my bad fit dinner is ready, lunch is 
    is ready. 

    00:48:10
    SHARLEEN 
    Yeah. 

    00:48:10
    PATTI 
    We sit, talk and have fun, but sometimes like 
    well, yesterday when I asked you to spend time with me you said, not it was an argument. 

    00:48:15
    SHARLEEN 
    I can’t, I had 
    plans. 

    00:48:20
    PATTI 
    And most of the time they come over there and they have fun. 

    00:48:20
    GONZALO BACIGALUPE 
    But aren’t you — 

    00:48:20
    PATTI 
    It’s 
    not always fun. 

    00:48:25
    SHARLEEN 
    Of course. 

    00:48:25
    GONZALO BACIGALUPE 
    Are you willing to 
    allow for your kids to sometimes not to respond to your demand 
    of what you want, I mean, is there sometimes some voice in you says, 
    you know, maybe I know I will like that, but it doesn’t make sense again. 

    00:48:40
    PATTI 
    I do. 
    You should have seen me before. 

    00:48:45
    GONZALO BACIGALUPE 
    Tell me about that. 

    00:48:45
    PATTI 
    No, honest, I used to want them to be there all 
    of the time, but not now. 

    00:48:50
    GONZALO BACIGALUPE 
    I like your sense of humor actually. 

    00:48:50
    PATTI 
    Thank you. 
    No, honest I used to be to be want them to be there all of the time. 

    00:48:55
    GONZALO BACIGALUPE 
    Ah, ha. So, now you want them 
    sometimes, not all the time. 

    00:49:00
    PATTI 
    Like when they moved out, the first one moved out, I want her 
    to call every. 

    00:49:05
    GONZALO BACIGALUPE 
    You were crazy. 

    00:49:05
    PATTI 
    Every hour, every hour, tell me what is going on, where is she going, what’s 
    she doing and everything. Now, I changed a lot. Thanks 
    to Sandi, I give them lots of freedom and space and I let them to choose what they 
    should do and give them lots of freedom, don’t I? 

    00:49:20
    GONZALO BACIGALUPE 
    Have you been looking for boys for 
    her. 

    00:49:25
    SHARLEEN 
    Nobody remind her 
    too. 

    00:49:30
    GONZALO BACIGALUPE 
    Won’t you remind her to look for boys for you. 

    00:49:30
    SHARLEEN 
    Yeah, too much. 

    00:49:30
    GONZALO BACIGALUPE 
    So 
    sometimes, I mean, in a way you’re seeing the changes, but sometimes you get as obnoxious 
    about it. 

    00:49:40
    SHARLEEN 
    No, sometimes I just give up on her because I feel like, I don’t know how to get through 
    her. 

    00:49:45
    GONZALO BACIGALUPE 
    Patti, let me switch a little a bit, because she said something that you probably guys can 
    sort of like talk and addressing therapy. If you were not 
    having this pain and you were not having this serious difficulty to walk, 
    which is in a way sort of like a new member in the family, I mean, is a new 
    situation I guess for you, it was not there. How — what 
    would you be doing? 

    00:50:10
    PATTI 
    I was working first of all. 

    00:50:10
    GONZALO BACIGALUPE 
    What were you doing? 

    00:50:10
    PATTI 
    I was 
    caregiver and I have told you. And — 

    00:50:15
    GONZALO BACIGALUPE 
    Oh I’m sorry. 

    00:50:15
    PATTI 
    I was a caregiver and 
    I would be working 8, 12 hours a day and sometimes when I was 
    off during the weekend I was shopping at the mall. When I go to a store I see, for example, meat are on sale 
    I buy them all meats whatever it’s out there like, call her, I bought 
    you meat, it’s awesome, it was all sometime I get it. Do things for them all. 

    00:50:35
    SHARLEEN 
    And that’s not 
    right, because she is not letting us grow up and have responsibility, she wants to do things, these things for us and 
    she — 

    00:50:45
    PATTI 
    Who said it is not right? 

    00:50:45
    SHARLEEN 
    She doesn’t understand. 

    00:50:45
    PATTI 
    Even if I don’t call and still you come and take it from the freezer. 

    00:50:45
    SHARLEEN 
    Mom, the thing 
    I’m trying to — she cooks everyday as she delivers it to my sister’s food — house everyday. 
    I tell her let her learn on her own, you do things for yourself, go for — don’t 
    meat stuff, go for a massage, go for this and that, clean your room if you are bored. 
    Learn how to read and write if you are bored, do something else, stop involving 
    your plans so much around your children, find other hobbies, find other things to entertain your 
    life with. 

    00:51:15
    GONZALO BACIGALUPE 
    What other things that she does for you or your siblings 
    you will like her to continue 
    doing? 

    00:51:25
    SHARLEEN 
    Be the same mother that she has always been, but just not expect so much because she gives, and 
    then, she expects so much back in return, her expectations are 
    too high. 

    00:51:35
    GONZALO BACIGALUPE 
    So you will like her to continue cooking and doing the things? 

    00:51:35
    SHARLEEN 
    Once in a while. 
    Once in — don’t make it like, it’s a family ritual every week. Let 
    it — let us — treat us like we have grown up and are out and doing 
    our own life because that’s how it actually is. It’s just too much sometimes. 
    I feel like, if it wasn’t because of my involvement with — so 
    much of my energy involved with her, I would have probably take off to Europe 
    for six months, work out there, do something, I would have a free mind to decide for myself, what 
    to do for like a summer time. 

    00:52:10
    GONZALO BACIGALUPE 
    Do you have a sense that your mom 
    may think that if she doesn’t do those things, that she would be thinking that she is sort of like 
    neglecting with you guys? 

    00:52:20
    SHARLEEN 
    Yeah, she would feel like she has left us alone, that’s just her habit or how 
    she grew up, her mom probably that these things. 

    00:52:25
    GONZALO BACIGALUPE 
    The time I will report her to 
    child protector servants and doing the stuff. 

    00:52:30
    SHARLEEN 
    I don’t know about it, but she feels like 
    she’s being the best mom. 

    00:52:35
    GONZALO BACIGALUPE 
    Are you ever thought about reporting her for, I mean for — 

    00:52:35
    SANDI 
    For 
    great mom. 

    00:52:40
    GONZALO BACIGALUPE 
    For actually, no, for letting them be their — do their 
    things. 

    00:52:45
    SANDI 
    On their own. 

    00:52:45
    GONZALO BACIGALUPE 
    Yeah. And have you thought about you could be reported, if you let them to be more independent 
    or–? 

    00:52:50
    PATTI 
    No, not. 

    00:52:50
    GONZALO BACIGALUPE 
    I mean I never thought that in 
    a way, I mean, negligence can be different. 

    00:52:55
    PATTI 
    I’d tell they love that. 

    00:52:55
    GONZALO BACIGALUPE 
    I was wondering if what 
    it seems to bother you is not so much what she may do or what she may 
    expect after she does it? 

    00:53:05
    SHARLEEN 
    I feel like I give her an inch and then she expects a mile. 
    I give her like, I try to please her and please her let’s say, three days in a row, and she gets overexcited, then 
    she thinks like it’s a shopping for everyday. 

    00:53:15
    GONZALO BACIGALUPE 
    What are you thinking Patti when you hear that? 
    I mean, you are not getting angry at this point, you were so like maybe she has a 
    point. 

    00:53:25
    PATTI 
    No, I will call her and I leave her home, but no. 

    00:53:25
    SHARLEEN 
    It’s really that’s how she things then, then I try to — 

    00:53:25
    PATTI 
    I swear to god, I will not call her. 

    00:53:25
    SHARLEEN 
    See, 
    that’s — 

    00:53:30
    PATTI 
    I will not contact her and just leave her alone from now. 

    00:53:30
    SHARLEEN 
    She’s. I try to explain a point to 
    her. 

    00:53:35
    PATTI 
    No that’s not the point., 

    00:53:35
    SHARLEEN 
    Then she feels this way, I’m here to like, you know I feel. 

    00:53:35
    PATTI 
    I will give you the space as much 
    as you want. 

    00:53:40
    SHARLEEN 
    That’s how she feels and I feel like sometimes she’s like so in her zoom 
    box that she’s not willing to like let them down. 

    00:53:45
    PATTI 
    As a mother, how old your kids get 
    then you see them like they are catching the fire, you want to grab them and not let them 
    burn theirself. 

    00:53:55
    GONZALO BACIGALUPE 
    Your kids are going to be your kids. 

    00:53:55
    SHARLEEN 
    Yeah, but you can’t interfere. 

    00:53:55
    PATTI 
    It doesn’t matter how old they get, I want 
    to go take them, especially because I had that abuser husband, I don’t want she 
    marry somebody abuser. 

    00:54:05
    GONZALO BACIGALUPE 
    Let me — we are going to have to stop very soon and I was wondering 
    Sandi, do you sometimes, in the sessions struggle with helping them 
    to feed out how to negotiate these things. 

    00:54:15
    SANDI 
    I do 
    constantly. 

    00:54:20
    GONZALO BACIGALUPE 
    And do you have a sense that that 
    is sort of like that the struggle is that you know the man for mom 
    to be more balanced, less the man they know or 
    whatever, or controlling or intuitive or whatever the way 
    the kids may see it, or the way Patti see it as, you know, this is the way 
    I understand being a mother and this is the way I do things and this is when I want to take care of them. 
    How each put the other one in sort of 
    like a paradox, it’s like, love me, don’t 
    love me kind of thing, you know. 

    00:55:00
    SANDI 
    Right, exactly. 

    00:55:00
    GONZALO BACIGALUPE 
    It’s care for me, but don’t care for me. 
    It’s how to find that. 

    00:55:05
    SANDI 
    Right. 

    00:55:05
    GONZALO BACIGALUPE 
    That balance I guess. 

    00:55:05
    SANDI 
    Exactly. 
    I have been focusing on more 
    negotiation between them, and how they can 
    compromise as far as what makes 
    Patti happy and what makes the children happy. As for one big issue 
    with Patti is the way they cloth also, the way they 
    choose their clothing, that is another big issue. She is not 
    happy with some of this stuff that you be talked 
    about this before. So constantly I’m trying to balance 
    between our way of living back home and our way 
    of living over here, and by negotiation and 
    compromise. 

    00:56:00
    PATTI 
    It’s mostly Shireen, the way she cloth, I don’t like it at all, I cannot even 
    stand to look at her. I will have to steal it and throw it 
    into trash can. 

    00:56:10
    GONZALO BACIGALUPE 
    Although, you know here you — it’s interesting because in a 
    way here, you know in the stage you might seem like very conservative around it, but if you were to be Iran 
    with all of the kids, you’ll be considered sort of like the revolutionary and almost hang you for allowing 
    your kids to wear the clothing they are wearing right? 

    00:56:25
    SANDI 
    Exactly. 

    00:56:25
    GONZALO BACIGALUPE 
    And that’s 
    that although, I don’t know how — although you are here, 
    you saw you feel like you are there in some way, I mean, you carry your culture around 
    is about you. 

    00:56:40
    PATTI 
    What do you suggest for 
    me? 

    00:56:45
    GONZALO BACIGALUPE 
    What do I suggest for you? I don’t know. 

    00:56:45
    PATTI 
    Leave them 
    alone. 

    00:56:50
    GONZALO BACIGALUPE 
    You cannot leave them alone. Right. 
    But let me — I don’t think that you can leave them alone. 

    00:56:55
    PATTI 
    I’ll try it. 

    00:56:55
    GONZALO BACIGALUPE 
    But at the same time, I 
    think that you need to add another something that you need to do, 
    I mean, I don’t think that you can leave them. 

    00:57:05
    SHARLEEN 
    Yeah, find something to do. 

    00:57:05
    GONZALO BACIGALUPE 
    I don’t know. 

    00:57:05
    SHARLEEN 
    For real, find something to 
    do. 

    00:57:10
    GONZALO BACIGALUPE 
    I don’t think that you can leave them alone. I think that you’re still going to be concerned about them. 
    I mean it’s impossible for you, what impress me and this is something that coming to terms 
    with what is happening to you and your body, it’s not an easy task, I 
    mean, definitely it’s — it must be really, really, really hard, and how to have 
    other people who can be a resource. I mean, you were having that conversation right now, how 
    you can have other people who can be resourced 
    to help you with that, I mean, that’s something that I think that should really be having conversation, the two of 
    you. 

    00:57:45
    SANDI 
    Yeah. 

    00:57:45
    GONZALO BACIGALUPE 
    About what kinds of resources you can use besides 
    you know, getting some help from your kids. I mean, because there are some things that your kids not able to do 
    to help you with dealing with this pain and you know you were talking about your 
    weight and how to heal this and on and on. 
    I mean, this is sort of like a new adjustment. And before you were dealing something to happen 
    in the past that came to visit during the present, you were happy a year and a half, you have always 
    that sort of suddenly you were faced with this very traumatic 
    event, series of events I, mean, what happened to you before you came here from what I understand 
    was very traumatic. And sort of like now you are 
    face something that is very traumatic. I mean, how do you deal with this 
    excruciating pain, difficulty, I mean, how can you be able to walk in your own 
    and having to — I mean, that’s — I find it very dramatic. 
    It’s sort of like given up something, and you cannot just run away to another culture 
    to run away from this pain. I mean, and clearly, you’re going to have to join something to 
    be able to be aware, I mean, join, I don’t know exactly what, because 
    that’s something that you probably know more about. 

    00:59:00
    SANDI 
    We’ve been exploring different options 
    as far as resources. Patti came up and you came up with weight watchers 
    idea. And she said, that’s some place I can join 
    and it makes me feel good and I said, okay, then you are benefiting 
    so many ways, your health, your weight and also the 
    psychologically you are benefiting from that. 

    00:59:25
    GONZALO BACIGALUPE 
    Hope this was somehow helpful. 
    And we don’t have more time. I’m really 
    privileged for having you coming to the interview with someone you do not know 
    anything about. I’m going to still thinking about this as I watch the video tape and I watch 
    where we and I also would feel that there are things that maybe I didn’t ask, but 
    that you would have asked and I would just share them with you. Alright, because I think that you guys 
    said so much and shared so much with us. Alright. So, thank you. 

    00:59:55
    SANDI 
    Thank you. 

    00:59:55
    GONZALO BACIGALUPE 
    Thank 
    you. 

    01:00:00
    SANDI 
    Thank you. 

    01:00:00
    Family & Sandi Return 

    01:00:00
    Epilogue 

    01:00:00
    & 

    01:00:00
    Afterthoughts 

    01:00:00
    GONZALO BACIGALUPE 
    I’m going 
    to comment on some themes that had 
    to with the interview per se with the family, the reflecting 
    team for some conceptual ideas that I think that maybe important for people to 
    know, and also to reflect on my own thinking 
    as I was doing the interview and also about some of the things that I may have missed 
    after having done the interview and having seen watch the video tape a couple of 
    times. One of the things that I did not is in the case, 
    in the Sandi’s case is 
    how difficult it is for the reflecting team 
    to react personally sometimes, but unknowingly to a family 
    but to react to the overall therapeutic system although I may have emphasized that 
    I find that sometimes it’s hard for therapists to think about the therapy 
    system and not just the family. We are trying to observe 
    the family and not to observe as interacting with the family 
    and because it’s so compelling sometimes the story of the client, but 
    I find that it is helpful to think about the relationship between the 
    therapist and the family and some of the isomorphisms that happened there to understand what is happening 
    in the family. In this case, one of the things that we 
    find is that trauma occurs, I mean, at various levels. On the 
    one side, you have the survival story, which is also at the same time a traumatic story. 
    That is the husband, the father and 
    the husband in this family will seem to have been very abusive 
    towards his wife and the mother and towards the children. 
    And that isn’t itself fairly traumatic. And 
    then the survival story is leaving him and coming to the United States. 
    And then, the second peace of this traumatic story is 
    for the children to come to terms and for the mother to come to terms with having left 
    one of the children in the home country. 
    The other peace of the trauma is in itself the story of survival 
    becomes — could become story of trauma as this family come 
    and immigrate the United States. In the interview, we didn’t explore 
    in detail the immigration story, we have enough time, because in some way, the 
    conflict between the 
    children and the mother, particularly one child and the mother, adult child 
    takes over in terms of the interview, in terms of what becomes figure. 
    And so, and then, as we — as that conversation moves along 
    we’re moving to knowing little bit about acknowledging the trauma 
    of coming to terms with the illness for mother. 
    One of the things I did, I do in first interview of course, is 
    to know who is in the family and try to build a basic genogram and 
    that’s what I find myself doing in the first part of the interview. And also 
    talking about how is it that they decide to come for a consultation. 
    Conceptually a theme that I saw was interesting in this interview is the idea of leaving home, 
    how is that this girl is struggling with 
    independence, how mother is struggling with this independence. And how 
    they are both in some ways struggling with the idea of dependence 
    and independence and basically struggling with different notions of what it 
    means to be independent or be dependent. And I would add 
    that a lot of this course that is struggling with is that this course of 
    how our society tends to see the kids 
    leaving home, and tends to in some way, see independence 
    as more important than dependence and work a lot around those polarities 
    between dependents and independence rather think in terms of interdependence. 
    And particularly now that they have to negotiate how 
    mother is going to taking care by the children since she is getting ill. 
    One of the things that I didn’t address in the interview is how the therapist define 
    this process as detachment and I never addressed 
    this idea of detachment, which is in itself, part of the process 
    thinking about independence as separation rather than as joining. 
    And it could have been, I think, I saw there was a last opportunity to talk about 
    the therapist understanding of this process, since she understood it as 
    detachment. One of the things that I 
    also found myself doing a lot of was listening to the mother’s situation to the facts 
    and the daughter, while they were showing some of the tension that existed 
    between the two of them. And at the same 
    time, as the competition evolve, I do acknowledge the emotional climate 
    and how is it that in particular, the daughter is feeling 
    in the session and at certain moment, she is very upset and sad and angry. 
    And I knowledge that and maybe I too have acknowledged a little bit more 
    mother’s emotional stands. 
    One of the things that I didn’t also 
    address that that doesn’t seem that the therapists could address later on 
    is, how is that the daughter seems to know more about what’s going on with the siblings and 
    to really validate her concern for the family in that way 
    that in someway, she is being very protective of her mother as she takes 
    care of the siblings. Another concern of mine and 
    I think that I might have done that during the interview, was to 
    always bring forth the voices of those who are present and 
    those who are being represented in this case how, she, the 
    daughter will represent the voices of the siblings. 
    And another aspect of the interview includes how is it that I ask about 
    social support and where is the family, what are the connections 
    they have, and at the beginning, I ask about, is there is anybody else 
    who immigrated with them and — or who is his close by as a 
    relative. And at the end of the interview, I again suggest the possibility 
    of thinking about social support, thinking of friends or other professionals 
    or paraprofessionals who might provide support in particular around the new needs 
    that mother, that the adult have right now 
    in terms of the illness. The peace that was present in the session 
    is this notion of agency. Although someone might have 
    gone through a very traumatic period, I 
    try to highlight the process of survival of overcoming 
    that particular period and to think in terms of the future. 
    And then think in terms of ambition and different kind of relationship 
    and a couple of times in the interview I ask 
    the mother and daughter to ambition how do they ambition in different 
    kind of relationship. In the interviews, you can observe, and this is 
    I think, basic in the collaborative approach, I often 
    ask how — I mean, I check with the therapist 
    and the clients around issues of how is this conversation 
    moving, if this conversation were to continue 
    this way, where will they go, and I ask the therapist 
    to hypothesize what would happen if they were to continue talking 
    in a particular way. During the reflecting theme, the 
    basic conversation was around the dependence, 
    independence and interdependence. And what I found very 
    interesting is, how is it that the different 
    place in the reflecting theme we’re able to understand the immigrant experience and the big cultural 
    aspects of this family. And 
    another piece that I saw that was important is to sort of like understand 
    what it is to 
    become more independent of your own parent while at the same time, coming to term with the notion 
    that they would have — you would have to take care of your own parent, although this is in a very — at a 
    early time, earlier than the usual. During the reflecting 
    time, I thought to myself, I was reminded 
    of how being close 
    to the family coming from the same background, 
    in this case, the therapist being also of some of from Iran may not necessarily 
    ensure your success from a multi-cultural perspective. 
    Although the relationship with the client maybe a very positive one and may not necessarily 
    ensure the success and 
    in that sense, the value of bringing the reflecting with very different 
    voices. The peace that viewers 
    may find interesting is, how I use words, in this case, the 
    therapists, some are from Iran, I am also a non-English 
    Irish speaker and how I use this an opportunity to play with words 
    and to use humor with the family and the therapist, 
    which I do often during the session. One 
    of the questions I ask them and it will have 
    different configuration with different families, I ask them who is more opinionated, who 
    has a strong opinion, which in some way, is basically 
    bringing — reflecting on something that could — we get 
    them into trouble, something that will be seen as problematic, but at the same time, it maybe 
    seen as validating. And 
    when I ask who is more opinionated, a typical kind of secret questions 
    I guess is, I’m basically, assuming that they are both 
    opinionated that in a way they cheer some similarities, in fact, that with people are in conflict, often 
    there’s, because they are seeing themselves as two different. And 
    towards the end of the interview, I term on 
    that I like her sense of humor and her daughter smile 
    and I see how important it is to always validate 
    both, any member, all the members of the family attending the 
    session, so that the other one — so that the other one 
    can feel okay about criticizing the other members of the family, but 
    not having the therapist sort of like completely in coalition 
    with that same statement. That is, if I can see 
    and I can validate each members of the family, the other ones may also see 
    that particular validation. Often 
    in a consultation, I will mention that there’s themes 
    that can be talked in therapy later and I may say 
    maybe we can, I could have same, maybe, we can think about this idea between 
    now and then if I were to be alone as a therapist. 
    Often in a consolidation, I may say, this is something that maybe 
    helpful to talk about in the future in a therapy session. I may say something of that sort in a reflective 
    way. Another aspect that I noticed in this session like in many other sessions is, how 
    expectations about the others, are they 
    ones that may — high expectations about another member of the family might 
    bring a lot of conflict. In terms of assimilation and I — towards 
    the end I term on that she’d always be concerned 
    about the children. And that there might be 
    other ways, in which you can get resources. 
    I also try to reframe 
    some of the difficulties using multi-cultural framework, 
    for instance, by saying that there is some things that you might be thinking here, that here 
    it could be conservative, but in home country couldn’t because couldn’t be considered 
    very radical and very different. 
    And I also try to help them 
    to think about this different transitions they are going through, including — and 
    this different traumas they are dealing with in the past, in the present and in the future. 

    01:14:10
    [music] 

    01:15:45
    Visit our website 

    01:15:45
    for monthly specials: 

    01:15:45
    WWW.masterswork.com 

    01:15:45
    for info or catalogue, call: 

    01:15:45
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    01:15:45
    END TRANSCRIPT 

    Mother and Daughter: A Cultural Tale video NRNP_6645_Week2_Assignment_Rubric

    NRNP_6645_Week2_Assignment_Rubric

    Criteria

    Ratings

    Pts

    This criterion is linked to a Learning Outcome
    Document the following for the family in the video, using the Comprehensive Evaluation Note Template: • Chief complaint• History of present illness• Past psychiatric history• Substance use history• Family psychiatric/substance use history• Psychosocial history/Developmental history• Medical history• Review of systems (ROS) • Physical assessment (if applicable)

    20
     
    to >
    17.0
     pts

    Excellent 90%–100%

    The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family’s situation and culture.

    17
     
    to >
    15.0
     pts

    Good 80%–89%

    The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family.

    15
     
    to >
    13.0
     pts

    Fair 70%–79%

    The assignment includes a description of the subjective and objective information for the client family but is somewhat general or contains small inaccuracies.

    13
     
    to >
    0
     pts

    Poor 0%–69%

    The assignment includes a description of the subjective and objective information for the client family but is vague or contains many inaccuracies. Or, several of the required elements are missing.

    20
     pts

    This criterion is linked to a Learning Outcome
    • Mental status exam • Differential diagnoses—Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5-TR diagnostic criteria

    20
     
    to >
    17.0
     pts

    Excellent 90%–100%

    The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

    17
     
    to >
    15.0
     pts

    Good 80%–89%

    The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

    15
     
    to >
    13.0
     pts

    Fair 70%–79%

    The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

    13
     
    to >
    0
     pts

    Poor 0%–69%

    The response provides an incomplete or inaccurate description of the results of the mental status exam and/or explanation of the differential diagnoses. Or, assessment documentation is missing.

    20
     pts

    This criterion is linked to a Learning Outcome
    • Case formulation• Treatment plan that includes psychotherapy interventions

    25
     
    to >
    22.0
     pts

    Excellent 90%–100%

    Case formulation is thorough, thoughtful, and demonstrate critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. The response demonstrates thoughtful consideration of the client family’s situation and culture.

    22
     
    to >
    19.0
     pts

    Good 80%–89%

    Case formulation demonstrates critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions.

    19
     
    to >
    17.0
     pts

    Fair 70%–79%

    Case formulation is somewhat general or does not demonstrate critical thinking…. The assignment includes a treatment plan for the client family that includes psychotherapy interventions but is somewhat general or contains small inaccuracies.

    17
     
    to >
    0
     pts

    Poor 0%–69%

    The assignment provides a vague and/or inaccurate description of the case formulation and treatment plan for the client family. Or, many of the required elements are missing.

    25
     pts

    This criterion is linked to a Learning Outcome
    • A psychotherapy genogram for the family

    Mother and Daughter: A Cultural Tale video

    20
     
    to >
    17.0
     pts

    Excellent 90%–100%

    The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided.

    17
     
    to >
    15.0
     pts

    Good 80%–89%

    The assignment includes an accurate genogram of the client family. The documentation style is consistent and a key is provided.

    15
     
    to >
    13.0
     pts

    Fair 70%–79%

    The assignment includes a genogram of the client family but is somewhat limited or contains factual inaccuracies or inconsistencies in documentation style.

    13
     
    to >
    0
     pts

    Poor 0%–69%

    The genogram provided is vague or contains many inaccuracies. Or, the genogram is missing.

    20
     pts

    This criterion is linked to a Learning Outcome
    Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided which delineate all required criteria.

    5
     
    to >
    4.0
     pts

    Excellent 90%–100%

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

    4
     
    to >
    3.0
     pts

    Good 80%–89%

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

    3
     
    to >
    2.0
     pts

    Fair 70%–79%

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

    2
     
    to >
    0
     pts

    Poor 0%–69%

    Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time…. No purpose statement, introduction, or conclusion were provided. 5  pts This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5   to >
    4.0
     pts

    Excellent 90%–100%

    Uses correct grammar, spelling, and punctuation with no errors.

    4
     
    to >
    3.0
     pts

    Good 80%–89%

    Contains 1 or 2 grammar, spelling, and punctuation errors.

    3
     
    to >
    2.0
     pts

    Fair 70%–79%

    Contains 3 or 4 grammar, spelling, and punctuation errors.

    2
     
    to >
    0
     pts

    Poor 0%–69%

    Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

    5
     pts

    This criterion is linked to a Learning Outcome
    Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

    5
     
    to >
    4.0
     pts

    Excellent 90%–100%

    Uses correct APA format with no errors.

    4
     
    to >
    3.0
     pts

    Good 80%–89%

    Contains 1 or 2 APA format errors.

    3
     
    to >
    2.0
     pts

    Fair 70%–79%

    Contains 3 or 4 APA format errors.

    2
     
    to >
    0
     pts

    Poor 0%–69%

    Contains many (≥5) APA format errors.

    5
     pts

    Total Points: 
    100 Mother and Daughter: A Cultural Tale video

  • NRS-425 – Community Teaching Project: Indirect Care Experience Hours

    NRS-425 – Community Teaching Project: Indirect Care Experience Hours

    The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using both direct and indirect care experiences for practicing nurses. This course requires students to complete 25 hours of indirect care experiences involving the development and implementation of a teaching plan at a community/public health location in their local community.

    Complete the table below by indicating the date each required activity was completed and submit it in the digital classroom in Topic 5.

    GET WRITING HELP HERE

    Date Completed

    Hours

    Indirect Care Experiences and Activities

     

    4

    Selection, Research, and Assessment

    ·         Select a setting for a teaching presentation.

    ·         Perform needs assessment that includes assessment of environmental factors, socio-economic/cultural/political disparities, and health literacy.

     

    2

    Community Assessment

    ·         Perform a community assessment of your selected community using secondary sources and a physical appraisal.

     

    4

    Teaching Plan Development

    ·         Research evidence for the chosen teaching topic, including theories and techniques to promote health management.

     

    4

    Interview of Community Representative

    ·         Interview and provide teaching plan to the community representative.

    ·         Obtain feedback from the selected community site representative.

    ·         Complete the summary paper of the interview with the representative.

    ·         Obtain signature from community representative acknowledging interview was completed.

     

    3

    Revising the Teaching Plan

    ·         Revise teaching plan based on additional information gathered, instructor feedback, and community representative feedback.

    ·         Apply knowledge of social cultural factors of the population.

     

    3

    Finalizing Teaching Plan

    ·         Review feedback and adjust the teaching plan accordingly.

    ·         Develop and submit the presentation.

     

    3

    Community Teaching Presentation

    ·         Deliver presentation to the selected community.

    ·         Obtain signature from community representative acknowledging presentation was completed.

     

    2

    Community Teaching Experience Reflection

    ·         Evaluate teaching effectiveness and complete the teaching experience reflection.

    Total

    25

     

    I, _________________________, have completed the indirect care experience hours required to meet the learning objectives of the course.

    Student Signature: __________________________________________ Date: ___________________________________

    NRS-425-RS-IndirectCareExperienceHours

  • NRNP-6645F Week 1: Assignment COURSE ACKNOWLEDGEMENT QUIZ

    NRNP-6645F Week 1: Assignment COURSE ACKNOWLEDGEMENT QUIZ

    Question 1

    0.1
    / 0.1
     pts

    How long does my instructor have to grade my assignments after the due date?

    3 days

     

    5 days

     

    7 days

     

    Correct! 

    10 days

     

    Question 2

    0.1
    / 0.1
     pts

    Where do I find my instructor’s feedback on assignments?

    In the grading comments

     

    In the rubric

     

    Correct!

    Grading comments and the rubric

     

    ORDER AXAM OR QUIZ HELP HERE

    Question 3

    0.1 
    / 0.1
     pts

    How often should I check the announcements, email and doc sharing?

    Correct!

    Every day

     

    Once a week

     

    Twice a week

     

    Three times a week

     

    NRNP-6645F Week 1: Assignment COURSE ACKNOWLEDGEMENT QUIZ Question 4

    0.1 
    / 0.1
     pts

    Who do I contact about a grade I don’t agree with?

    Correct!

    Didactic faculty

     

    Specialty Coordinator

     

    Program Director

     

    President

     

    Question 5

    0.1 
    / 0.1
     pts

    Are assignment re-dos or extra credit allowed in the NP program?

    Yes

     

    Correct!

    No

     

    Question 6

    0.1
    / 0.1
     pts

    I cannot use my textbook as a resource or other patient centered websites such as WebMD.

    Correct!

    True

     

    False

     

    Question 7

    0.1 
    / 0.1
     pts

    I cannot use textbooks, notes, videos, websites, or any other resource when taking the midterm and final exams.

    Correct!

    True

     

    False

     

    Question 8

    0.1 
    / 0.1
     pts

    Are Grand Rounds mandatory to attend?

    Yes

     

    Correct!

    No

     

    NRNP-6645F Week 1: Assignment COURSE ACKNOWLEDGEMENT QUIZ Question 9

    0.1 
    / 0.1
     pts

    Can I watch a recording of Grand Rounds later?

    Correct!

    Yes

     

    No

     

    Question 10

    0.1 
    / 0.1
     pts

    I have read the NP program Practicum Manual and will abide by the requirements to successfully complete this program.

    Correct!

    True

     

    False

     

    Question 11

    0.1 
    / 0.1
     pts

    I am responsible for everything I post on social media.

    Correct!

    True

     

    False

     

    Question 12

    0.1 
    / 0.1
     pts

    I understand the appropriate chain of command in the College of Nursing.

    Correct!

    True

     

    False

     

    Question 13

    1 
    / 1
     pts

    I acknowledge reading the syllabus and understand the course requirements to successfully pass the class.

    Correct!

    True

     

    False

     

    Question 14

    Not yet graded 
    / 0.1
     pts

    By signing below, I acknowledge that I have viewed the course information meeting in its entirety  and / or course materials and will adhere to the policies that have been set forth.

    Type your name and the date below.

    NRNP-6645F Week 1: Assignment COURSE ACKNOWLEDGEMENT QUIZ