Category: Nursing

Evaluating Organizational Change

Description:

This Assignment provides an overview of how to evaluate evidence-based practice quality improvement in a practice change.

Directions:

Introduce an overview of a healthcare system practice guideline, preferably where you work or have worked.

Discuss how different professionals in the healthcare system (nurses, pharmacists, technicians, etc.) are held to this guideline.

Identify the research/reference used by the system to adopt the guideline.

Define the evidence used to define the guideline.

Determine the level of evidence used in the EBP identified.

Provide an opinion on how well this guideline is followed by professionals in the system.

Conclude with a concise overview of the guideline and the discussion in the paper.

Write the paper in 8–10 pages, using APA format.

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment 1 Requirements:

Before finalizing your work, you should:

be sure to 
read the Assignment description carefully
(as displayed above)

consult the Grading Rubric
(under the Course Resources) to make sure you have included everything necessary;

utilize 
spelling
and 
grammar check
 to minimize errors; and

Your writing Assignment should:

follow the conventions of 
Standard American English
(correct grammar, punctuation, etc.);

be 
well ordered
, 
logical,
and 
unified
, as well as 
original and insightful
;

display 
superior content, organization, style, 
and
mechanics
; and;

use 
APA 6th edition
format

How to Submit Assignment 1:

Submit your Assignment to the unit Dropbox before midnight on the last day of the unit.

When you are ready to submit your Assignment, submit to the unit Dropbox. Make sure to save a copy of your work and be sure to confirm that your file uploaded correctly.

Purpose: Conceptual-Theory-Empirical (C-T-E) structure Discussion

Things to remember:

Discussion post is at least 200 words.

Answers all questions with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

3 References, try to find resources that are 5 years or less

No errors with APA format 6thEdition

 

To Discuss:

Discussion
Topic 1: Conceptual-Theory-Empirical

Writing in the voice of your chosen theorist from your
Unit 5 Assignment
, describe the Conceptual-Theory-Empirical (C-T-E) structure process you used in creating your theory?

Researchers often identify the research problem and then go in search of a theory. Discuss the disadvantages of doing this. What does the textbook recommend that researchers do to assure a true fit between theory and designing the study?

Dorothea is one of the leading nursing theorists, and was an important influence in service, practice and education in nursing. In this paper, the focus will not be on who Dorothea was, but on the theory of Self Care and how it was formulated explicated in the professional field. The four main stages of the paper will involve steps in which theorizing occurs, syntax is developed, the theory is tested and lastly evaluation.

Stage One: Theorizing

The self-care theory is development at an early stage of a nurse’s career. When an individual is working at an administrative capacity in state health board, their thinking is most likely aligned to finding a solution to the changing needs of the state’s hospitals (Orem, 1991). The changing needs can be met through proper definition of nursing practice and self-care. The concept is developed in line with what is seen to be important elements of self-care.

Stage Two: Development of Syntax

At this stage, the most important thing that is done is definition of concepts that are very critical to the theory. The most critical question that comes to one’s mind is related to definition of nursing (Taylor, 2006). Orem defined nursing as an act, which involves the process of assisting others in management and provision of self-care to improve the functioning of human at the level of being effective at home.

Another important concept that has to be defined in this case is the self-care. It is described as the practice and performance of certain activities initiated by an individual on their own behalf to ensure that they maintain proper life and health. The concept of nursing and self-care are about the existence of human beings (Orem, 1991). In the case of these theory human beings are defined as those with the ability to use and reflect on the symbols. The human is viewed as a total being that has developmental and universal needs and has the capacity to uphold self-care.

Third Stage: Theory Testing

The concept of nursing as defined by Orem has been split into three other important elements that include self-care, self-care deficit and theory of nursing system. Under the theory of self-care there is the understanding of what self-care means. The definition is that activity with is initiated by an individual in performing their own wellbeing and maintenance of life. The human ability to engage in self-care is what has been defined as the self-care agency. Such ability is conditioned through other elements such as state of development, age and life experience on sociocultural orientation and use of resources that are made available. The therapeutic self-care demand means the totality of self-care actions that are carried out for a given period of time to meet the requirements of self-care for a certain period of time and is related to a given set of actions and operations (Taylor, 2006). The self-care requisites make up part of the theory, and it means the actions that are carried out and directed towards giving of self-care.

The development of the theory also does involve making of certain assumptions that are very critical. The main assumption is that people are required to be self-responsible and reliant for their own health care and for the care of their family. In the theory, it is further assumed that the people are distinct individuals (Orem, 1991). Nursing is also defined through a given assumption which looks at the practice as a form of action that involves interaction between more than one individual. Meeting the needs of self-care is an important part of primary care and most importantly looks at prevention of ill health.

Fourth Stage: Evaluation

In the evaluation of the theory is a philosophical debate about how the theory is implemented. In this case the theory is looked at in terms of its strength and weaknesses when applied in nursing practice (George, 2012). The main strength is that it is a theory that offers comprehensive basis under which nursing practice is carried out. It provides utility for professional nursing in form of education, administration in nursing (Whelan, 2014). It is a theory that is contemporary and in line with the contemporary ideas of health maintenance and promotion.

The limitations to the theory also explain a better part of the philosophical application. The main shortcoming is based on the fact that health in most cases is seen as a dynamic and ever-changing concept. It cannot be viewed as a single element but as a whole with several parts. In general view, the theory can be said to be simple but it can be applied to variety of patients (Tomey & Alligood, 2002). It does provide an explanation of what nursing systems entail deficits in self-care and the terms under self-care. The theory is also an indication that patients are in need of taking care of themselves and that they are at a better position of getting better if they perform their personal self-care.

 

 

References

George B. J. (2012). Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.

Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis, MO: Mosby-Year Book Inc.

Taylor, S.G. (2006). Dorthea E. Orem: Self-care deficit theory of nursing. In A.M.

Tomey, A. & Alligood, M. (2002). Significance of theory for nursing as a discipline and profession. Nursing Theorists and their work. Mosby, St. Louis, Missouri, United States of America.

Whelan, E. G. (2014). Analysis and application of Dorothea Orem’s Self-care Practice Model.

While
cognitive behavioral therapy (CBT)
and rational emotive behavioral therapy (REBT) have many similarities, they are distinctly different therapeutic approaches. When assessing clients and selecting one of these therapies, you must recognize the importance of not only selecting the one that is best for the client, but also the approach that most aligns to your own skill set. For this Assignment, as you examine the similarities and differences between CBT and REBT, consider which therapeutic approach you might use with your clients.

Rational Emotive Behavioral Theory (REBT) Learning Objectives

Students will:

Compare cognitive behavioral therapy and rational emotive behavioral therapy

Recommend cognitive behavioral therapies for clients

To prepare:

Review the media in this week’s Learning Resources.

Reflect on the various forms of cognitive behavioral therapy.

The Assignment

In a 1- to 2-page paper, address the following:

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.

Explain at least three differences between CBT and Rational Emotive Behavioral Theory (REBT). Include how these differences might impact your practice as a mental health counselor. Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT)

Explain which version of cognitive behavioral therapy you might use with clients and why. Support your approach with evidence-based literature.

Note:
 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.

The Assignment

In a 1- to 2-page paper, address the following:

Briefly describe how cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) are similar.

Explain      at least three differences between CBT and REBT. Include how these      differences might impact your practice as a mental health counselor.

Explain      which version of cognitive behavioral therapy you might use with clients      and why. Support your approach with evidence-based literature. (Please use APA formanting Introduction, summary References, )

Introduction

Cognitive behavioral therapy (CBT) and rational emotive behavioral therapy (REBT) present psychological approaches to the management of mental health. The application of each treatment option depends on the skill sets of the psychiatrist as well as how best they suit the client’s situation. The two psychotherapeutic approaches are often perceived to be similar. However, even though they share some significant similarities, they also have notable differences. This paper seeks to examine the similarities and differences of cognitive behavioral therapy and rational emotive behavioral therapy (REBT) and recommends the best version of cognitive behavioral therapy to employ on the management of clients mental disorders.

Cognitive behavioral therapy describes a talking therapy that was developed by Aaron Beck to improve mental disturbances by enforcing changes in behavior and thought (Ellis, 2017). It is also employed in the management of physical, anxiety and depressive problems. CBT breaks down problems into small manageable pieces which can be handled effectively. Often, this approach deals with current situations rather than the past as employed in other interventions. The main aim of CBT therapy is to improve the quality of life of an individual as well as the state of mind in practical ways. In this case, it is a goal-oriented, short-term psychotherapeutic approach that employs practical strategies in the resolution of mental and physical problems. Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT).

Rational emotive behavioral therapy (REBT) describes a psychotherapeutic approach that assists in the identification of self-defeating feelings and thoughts, challenges their rationality and replaces them with productive and healthier beliefs (Turner, 2016). It was developed in the 1950s by Dr. Albert Ellis as the pioneer form of cognitive behavioral therapy (Ellis, 2015). Often, the intervention is applied to current situations to create awareness on the effects of negative emotions and beliefs on one’s wellbeing. After identification of these unhealthy behaviors and actions, it provides a suitable change approach to induce and build productive and positive habits. This facilitates the development of successful professional and personal relationships. As such, it is an action-oriented technique for management of behavioral, emotional and cognitive disturbances.

Similarities between CBT and REBT

CBT and REBT are both structured mental therapy approaches. REBT employs ABC‘s method which is characterized by activation of events, beliefs about the events and the consequences of the event, disputing interventions, effective responses, and new feelings. Similarly, the cognitive behavioral therapy applies a structured approach that entails psychological assessment, reconceptualization, acquisition, consolidation, and application of skills and training, generalization and maintenance and post-treatment evaluation follow-up.

Moreover, both approaches collect evidence regarding the client’s thoughts. This is achieved through professional interactions which help in behavioral observation as well as sharing of experiences, feelings, and activities. The result of both techniques is the effective resolution of problems through the acquisition of evidence regarding thoughts and provision of guidance to patients. They both rely on homework assignments whereby the completion of the assigned tasks creates therapeutic alliances. These assignments help an individual to condition themselves towards the development of healthier habits using self-management behavioral procedures.

They were also developed by trained and practicing psychoanalysts whose ideas came from their uncertainty of the effectiveness of the psychoanalysis and the roles of cognitive processes in emotional disturbances (Ellis, 2017). Rational emotive behavioral therapy is considered to be the pioneer of cognitive behavior therapy which means that their development focused on similar concepts including emotions, thought and behavioral modifications (Ellis, 2015). They are also action-oriented therapeutic approaches that seek to improve the quality of life and wellbeing of clients. Additionally, their notions affirm that human habits and emotions are triggered by thoughts, attitudes, beliefs and ideas and not by events.

Differences

Rational Emotive Behavior Therapy’s psychotherapeutic approach is highly confronting, persuasive and directive. Mental psychiatrists engage in extensive talks, providing dictations and instructions regarding the concept of rationality (Ellis, 2017). They also demonstrate irrational actions and explain why they are irrational since clients seek to understand why they behave in a particular manner. On the contrary, Cognitive Behavior Therapy emphasizes self-discovery whereby, reflective questioning is employed to identify an individual’s misconceptions. Mental psychiatrists ask questions which trigger the clients thinking on what they do and why they do those activities. This helps in discovering their irrational beliefs as well as their feelings. The client’s own words are used to resolve their problems through self-expression.

Rational Emotive Behavior Therapy addresses both emotional disturbances and distorted cognitions whereas the cognitive behavior therapy addresses distorted cognitions philosophic basis. REBT entails unconditional acceptance towards profound solution whereby, the client is guided on how to accept themselves, their imperfections and flaws as well as those of other people. Moreover, this therapy encourages unconditional acceptance of life regardless of the unfairness, hassles, and discomforts it brings (Losada et al.,2 015). On the other hand, CBT philosophical basis provides limited approaches to situations following their dismissal of mind-reading.

Consequently, Rational Emotive Behavior Therapy improves an individual’s self-esteem through unconditional self-acceptance (Losada et al., 2 015). This helps the client to understand and accept themselves through self-assessment. However, Cognitive Behavior Therapists reinforces the positive characteristics and habits of the client to boost their self-esteem. The CBT approach attracts pitfalls since the client could be easily discouraged by their failures in areas they believed in a good performance. Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT). Eventually, the CBT approach to self-esteem could limit risk-taking and increase fear of failure. On the contrary, REBT self-esteem approach encourages self-acceptance including in failed situations and thus encourages risk-taking, preoccupation with proving and smug-complacency which facilitate the enjoyment of tasks by the client.

The differences between rational emotive behavioral therapy and cognitive behavioral therapy pose several impacts on mental health counseling practice. This means that psychiatrists should explore the client’s condition in depth to understand the most effective approach to employ in their treatment. Moreover, these differences limit the application of each intervention to specific cases and with the incorporation of particular skills. For instance, patients with self-esteem issues could be effectively treated using the rational emotive behavioral therapy rather than cognitive behavioral therapy following the role of REBT in fostering unconditional self-acceptance and unconditional acceptance instead of majoring on the client’s strength.

A version
of cognitive behavioral therapy I might use with clients

Cognitive behavior therapy improves mental health modification of attitudes, beliefs, and thoughts. It incorporates both the cognitive and behavioral philosophies, and therefore, it is essential in improving mental health. Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT). Diverse cognitive behavior therapy versions exist in psychiatric nursing practice. These include the stress inoculation training, unified protocol, Mindfulness-based cognitive behavioral hypnotherapy, Moral reconation therapy, structured cognitive behavioral training, Cognitive emotional behavioral therapy as well as Brief cognitive behavioral therapy (BCBT) (Hofmann, & Otto, 2017).

Among these versions, I would prefer the application of structured cognitive behavioral training with my clients. This is because; this approach heavily draws its philosophies from CBT and it asserts that emotions, thoughts and beliefs influence the behaviors of an individual. It also incorporates the psychological and behavior health modalities including those of rational emotive behavior therapy which makes it useful in addressing multiple problems. SCBT is time conscious and seeks to produce positive patient outcomes within a specific period and is therefore helpful in managing addictions associated with food and substances. It is also crucial in the management of anxieties, stress and diabetes conditions which pose significant health concerns in the contemporary health systems. Its application in the reduction of recidivism in criminal psychology makes it more useful in eradicating crime. As such, SCBT is the most appropriate approach to use in clients since it provides a basis for resolving multiple problems.

Conclusion

Cognitive behavior therapy and rational emotive behavioral therapy are psychological approaches to the management of mental and physical conditions. These techniques share several similarities and differences which provide criteria for differential applications. The psychiatrist skills together with the type of situation presented by the client influence the choice of therapeutic approach to employ. Cognitive behavioral therapies are most commonly used in the 21
st
century following their increased success in the treatment of multiple conditions. Several versions of this intervention exist in healthcare. However, structured cognitive behavioral training provides a basis for the management of numerous health problems promptly. It also incorporates several modalities and draws heavily on the cognitive behavior therapy philosophies making it more efficient and effective to use. Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT).

 

References

Ellis, A. (2015, January). The Evolution of Rational-Emotive Therapy (RET) and Cognitive Behavior Therapy. In 
Evolution Of Psychotherapy……….: The 1st Conference
 (p. 107). Routledge.

Ellis, A. (2017). The place of meditation in cognitive-behavior therapy and rational-emotive therapy. In 
Meditation
 (pp. 671-673). Routledge.

Hofmann, S. G., & Otto, M. W. (2017). 
Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder-specific treatment techniques
. Routledge.

Losada, A., Márquez-González, M., Romero-Moreno, R., Mausbach, B. T., López, J., Fernández-Fernández, V., & Nogales-González, C. (2015). Cognitive–behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: Results of a randomized clinical trial. 
Journal of Consulting and Clinical Psychology
, 
83
(4), 760.

Turner, M. J. (2016). Rational emotive behavior therapy (REBT), irrational and rational beliefs, and the mental health of athletes. 
Frontiers in psychology
, 
7
, 1423 Cognitive Behavioral Theory (CBT) Versus Rational Emotive Behavioral Theory (REBT)

Outline for Strategic Plan for Change Paper

Write a structured outline of your paper including the references you plan for each section.

1. Introduction and Statement of the Problem

1.1. What is the problem?

1.2. Why is it important enough to warrant a change?

1.2.1. Scholarly Reference #1

1.2.2. Scholarly Reference #2

1.2.3. Scholarly Reference #3

*Outline for Strategic Plan for Change Paper References in this section support the importance (2-3 is adequate to establish that the problem is significant). These may be peer reviewed journal articles and may or may not, be original research. 

2. 
Review of Literature

2.1. Research Reference #1

2.2. Research Reference #2

2.3. Research Reference #3

2.4. Research Reference #4

PLACE YOUR ORDER FOR A ZERO-PLAGIARISM PAPER HERE

2.5. Research Reference #5

The review of literature section requires at least five current scholarly peer reviewed articles. 
Research articles are required for this section!
 Include a short synopsis of the studies, the population studied, and indicate if the research is Qualitative or Quantitative. The purpose of a literature review is to identify strategies for change to address the problem. This is not a place for articles establishing the problem (that is in the introduction/background). Example of Research Reference:

MacKusick, C. I., & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. 
Medsurg Nursing
, 
19
(6), 335-340.

Mackusick and Minick (2010) conducted an interpretive, qualitative study to identify reasons influencing the decisions of RNs to leave clinical practice.

3. 
Synthesis of the Evidence

3.1. Provide a clear, concise, summary of potential actions derived from your evidence review.

3.2. Compare and contrast recommendations to improve on the problem.

3.3. Determine the best action for your organization and make a succinct statement of your recommended plan.

4. 
Suggested Courses of Action

4.1. Restate the action you want to occur

4.2. Outline how you will implement the change

4.3. Use and identify a Change theory or Leadership strategy to guide the change process.

4.4. Who, what, when, and where?

5.
Outline for Strategic Plan for Change Paper or Conclusion 

5.1. Summarize the main ideas and arguments, pulling everything together to help clarify the thesis of the paper.

Cognitive Behavioral Therapy (CBT)

When first introduced, cognitive behavioral therapy (CBT) was unlike any other therapeutic approach. For years, psychotherapeutic techniques were driven by psychoanalytic theories. These techniques were time consuming, leaving many therapists frustrated with the length of time involved in helping their clients achieve a sense of relief. With the development of CBT, however, therapists were able to help their clients heal more quickly. This poses the questions: If CBT is more efficient than other techniques, why isn’t it used with all clients? How do you know when CBT is an appropriate therapeutic approach?

This week, as you examine cognitive behavioral therapy and its appropriateness for clients, you compare it to rational emotive behavioral therapy. You also develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients.

Photo Credit: Clayton Rohner/Creatas Video/Getty Images

Learning Resources

Cognitive Behavioral Therapy (CBT) Required Readings

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice
(2nd ed.). New York, NY: Springer Publishing Company.

Chapter 8, “Cognitive Behavioral Therapy” (pp. 313–346)

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.

 

Note:
You will access this text from the Walden Library databases.

Required Media

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013).
Counseling and psychotherapy theories in context and practice
[Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
For this week, view Behavior Therapy and Cognitive-Behavioral Therapy only. You will access this media from the Walden Library databases.

Beck, A. (1994).
Aaron Beck on cognitive therapy
[Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
You will access this Cognitive Behavioral Therapy (CBT) media from the Walden Library databases. The approximate length of this media piece is 50 minutes

Eysenck, H. (n.d.).
Hans Eysenck on behavior therapy
[Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
You will access this media from the Walden Library databases. The approximate length of this media piece is 50 minutes.

Optional Resources

Ellis, A. (2012).
Albert Ellis on REBT
[Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
You will access this Cognitive Behavioral Therapy (CBT) media from the Walden Library databases. The approximate length of this media piece is 50 minutes.

Health Care Policy Discussion Question

Students may select one of the chapters included in this week’s readings and answer the following questions:

What interested you most about this chapter and why did you select it?

How does it relate to what you understand or have learned so far about the role of nurses and advanced practice nurses in policy and politics?

How does it relate to your current clinical practice? Give at least one specific example.

How does it relate to what you hope to accomplish as an advanced practice nurse?

All discussion posts must be minimum 250 words, references must be cited in APA format, and must include minimum of 2 scholarly resources published within the past 5-7 years.

Attached are the board rubric grading.

Health Care Policy Discussion Board Rubric

Proficient

Novice

Introduction and quality of discussion’s Argument

 

 

 

 

 

 

 

1 point

It is consistent with application in research related to its context. Clarity of ideas.

0.5 point

The topic has a partially weak association to clarity of ideas and related topic.

 

Objectivity of Tone, overall quality & Review of Literature in APA 6
th
format within past 7 years

1 point

Tone is consistent, addressed professionally and objectively.

Evidence in literature supports arguments.

 

0.5 point

The tone is not consistently objective. Partially poor evidence in review of literature.

Quality of Reply posts

1 point

Consistent clarity and supported by research evidence.

 

0.5 point

Partially lack of clarity or lack of support with research evidence.

Consider how the paradigm of a healing hospital might influence your philosophy of caregiving and write an essay of 500-750 words that addresses the following:

Describe the components of a healing hospital and their relationship to spirituality.

What are the challenges of creating a healing environment in light of the barriers and complexities of the hospital environment?

Include biblical aspects that support the concept of a healing hospital.

Medical Education and the Changing Practice of Medicine

Answer the following questions:

The Flexner Report of 1910 is described by the authors as “an accurate and searing description of abuses in the medical schools.” Describe some of the major shortcomings of medical education cited by the Flexner report and the corrective measures that resulted.

Academic medical centers were formed by the union of medical schools through affiliations with hospitals that provided clinical experience for medical students. These affiliations were later broadened into academic health centers. Describe the components of the academic health centers and their significance to the evolution of the university-based health professional education complex.

The health care delivery system now with ACA mandates, places increased emphasis on maintaining wellness and on promoting disease avoidance through healthy behaviors and lifestyles. What are some challenges this new orientation poses for our existing system of medical education and training?

In what ways did physicians’ relationships with hospitals change as a result of health care industry reforms? Discuss the consequences of these changes for physicians’ roles and responsibilities in relationship to hospitals.

The dispute over exposing the comparative performance of physicians on a wide spectrum of variables has been resolved in favor of the consumers of health care with requirements such as “Physician Compare.”  A number of states have passed legislation that gives the public access to physician information, including disciplinary records, malpractice actions, and whether a physician has lost hospital privileges. Are these fair and balanced bases on which consumers should make decisions about their choice of physicians?

Given the new role of hospitalists in patient care, identify some issues raised by this new brand of physician for the primary physician and patient.