Week 7 Assignment 1 Captain of the Ship Obsessive Compulsive Kamp University Nurs 4582: PMHNP Role II Dr. Hohn Doe March 18, 2016 Obsessive Compulsive Disorder (OCD) is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions (Sadock, Sadock, & Ruiz, 2014). These recurring obsessions or compulsions cause severe distress to the person. An obsession is a recurrent and intrusive thought while a compulsion is a conscious, standardized, recurrent behavior. The purpose of this paper is to explore management strategies of OCD in adult clients. As the PMHNP, I will discuss a case and recommend treatment modalities, medical management, follow-up plan and collaboration in the care of a client with OCD. History of present illness (HPI) and Clinical Impression HPI: K. K. a 22 yo CF referred for a psychiatric evaluation by her PCP. Karen reports a complaint of “I need help, I can’t keep a job because of these rituals I have.” She reports that she cannot maintain a job because of her rituals of checking locks. Karen has recurrent thoughts that she had left the door of her apartment and car unlocked. She reports leaving work several times daily to check the locks on both her car and apartment. Additionally, because she often had the thought that she had not locked the door to the car, it was difficult for her to leave the car or apartment until she had repeatedly checked that it was secured causing her to be late for work. She has been fired several times for tardiness and poor attendance however checking the locks decreases her anxiety about security. Karen denies any medical issues and is not currently taking any medications. She also denies the use of any alcohol, tobacco or illicit drugs. Reports a family history of depression in both maternal and paternal grandmothers. Karen recognizes that she is needs help and is eager to begin treatment. Assessment: A healthy, well-groomed 22yo CF in no acute distress. A, A&Ox4, pleasant and appropriately dressed. Makes good eye contact however mood is depressed with a flat affect; recent and remoter memory are intact. Karen’s thoughts are circumstantial and preoccupied with obsessions and compulsions. Her insight and judgment are fair. Denies SI/HI/AVH. Clinical Impression: Based on the diagnostic criteria in APA (2013), a diagnosis of OCD is made. Psychopharmacology If the patient’s symptoms cause a significant impairment in function or distress, treatment is recommended (Fenske and Petersen, 2015). Based on Karen’s report of losing several jobs because of tardiness and attendance, there is a significant impairment in social and home functionality. Karen also reports that her rituals cause her significant distress. The standard approach is to start treatment with an SSRI or clomipramine and then move to other pharmacological strategies if the SSRI is not effective (Sadock, Sadock, & Ruiz, 2014). I will initiate Prozac 40mg oral daily as it is Food and Drug Administration (FDA) approved for treatment of OCD (Stahl, 2014). I will have the patient return to clinic in week to assess for tolerability and increase to the suggested 80mg oral daily. Higher dosages have often been necessary for a beneficial effect (Stahl, 2014). I prefer to initiate with an SSRI (Prozac) as opposed to tricyclic (Clomipramine) for the less troubling adverse effects associated with Clomipramine. Karen will be informed that she might experience sleep disturbances, nausea, diarrhea, headache and anxiety which are all adverse effects of SSRIs. The desired outcome of pharmacotherapy is to reduce the patient’s intrusive thoughts that cause the compulsions that interfere with her home and work life. Well controlled studies have found that pharmacotherapy, behavior therapy, or combination of both is effective in significantly reducing the symptoms of patients with OCD (Fenske and Petersen, 2015). Psychotherapy Some studies indicate that behavior therapy is as effective as pharmacotherapies in OCD and some indicate that the beneficial effects are longer lasting with behavior therapy (Sadock, Sadock, & Ruiz, 2014). Many clinicians consider behavior therapy the treatment of choice for OCD and also because it can be conducted in both outpatient and inpatient settings. With the prinicpal behavioral approaches being exposure and response prevention, patients must be committed to improvement as Karen is. Behavior therapy will be initiated the same week as pharmacotherapy. The goal of therapy is to change the client’s behavior to reduce dysfunction and to improve her quality of life. A psychotherapist will be consulted to intiate and manage therapy sessions. Medical Management I will consult with Karen’s PCP for updates and additional concerns. Since she has been with her PCP for more than 5 years, he has good insight into her life. We will discuss baseline labs such as CBC, CMP, TSH, hepatic panel. Since with SSRIs, nausea, headache dry mouth and diarrhea are common side effects, monitoring the patient’s electrolytes is important. I would also recommend an EKG for baseline and follow up after medication initiation as SSRIs can lengthen the OT interval in otherwise health people (Sadock, Sadock, & Ruiz, 2014). Community resources such as the local chapter of the OCD Foundation will be provided to Karen for support services. Follow -up Plan and Collaboration Karen was instructed to follow up in 1 week to monitor tolerability and compliance of medicaiton and dose adjustment. Subsequently, she will return every 4 weeks for medication management. She is also instructed to begin behavior therapy the same week as medication are initiated and to follow up weekly for therapy sessions. I will consult with the therapist weekly for updates and any concerns or questions. I will reiterate and reinforce to both the PCP and therapist the importance of monitoring for suicidal ideations as the patient is taking an antidepressant and abuptly stopping will increase risk of suicide. About one-third of patients with OCD have major depressive disorder, and suicide is a risk for all patients with OCD (Sadock, Sadock, & Ruiz, 2014). Conclusion A poor prognosis is indicated by Karen yielding to rather than resisting compulsion or the need for hospitalization. A good prognosis for Karen is indicated by good home, social and occupational adjustment. The importance of an interdisciplinary team including PCP, therapist and other ancillaries will benefit the client for a better quality of life. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Fenske, N. & Petersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management. American Family Physician, 92(10): 896-903. Retrieved from http://www.aafp.org.afp /2015/1115/p896.html Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Post a philosophy statement for Mountain View Health Center, at least one goal, and at least one related objective. Offer insights you have gained about the process of developing a philosophy statement, as well as the significance of and distinctions between organizational goals and objectives.
Week 3: Philosophy, Goals, and Objectives
Being clear about “why we are here” launches the process of determining the objectives and goals we want to achieve.
— Michele V. Sare and LeAnn Ogilvie, Strategic Planning for Nurses: Change Management in Health Care
In Week 2, you examined mission and vision as the underpinning for strategic planning. As the quote above suggests, drawing from a sound mission and vision allows the strategic planning process to proceed with the articulation of the organization’s philosophy and development of goals and objectives.
This week, you continue to examine the strategic planning process, with a focus on the development of a philosophy statement, goals, and objectives for an organization.
Learning Objectives
Students will:
· Analyze the process of developing philosophy statements
· Analyze the significance of and distinctions between organizational goals and objectives
· Evaluate organizational philosophy statements
· Evaluate organizational goals and objectives
Photo Credit: Attila Barabas/iStock/Getty Images Plus/Getty Images
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Cara, C. M., Nyberg, J. J., & Brousseau, S. (2011). Fostering the coexistence of caring philosophy and economics in today’s health care system. Nursing Administration Quarterly, 35(1), 6–14.
Retrieved from the Walden Library databases.
The article addresses caring as a part of mission and philosophy and the benefits of this for nursing satisfaction and performance, patient satisfaction, quality of care, and cost reduction.
Lorenzi, N. M. (2011). AMIA’s realigned strategic plan. Journal of American Medical Informatics Association, 18(2), 203–208.
Retrieved from the Walden Library databases.
As you read this article, consider the process used to set goals and evaluate the extent to which the identified goals are specific, measureable, attainable, relevant, and time-bound.
Kenny, G. (2012). From the stakeholder viewpoint: Designing measurable objectives. Journal of Business Strategy, 33(6), 40–46.
Retrieved from the Walden Library databases.
Measurable objectives are an important part of the strategic planning process, yet many organizations struggle with formulating good objectives. In this article, the author suggests strategies for developing better objectives, which will then facilitate the planning process.
Urbanski, J., Baskel, M., & Martelli, M. (2011). Strategic planning—A plan for excellence for South Haven Health System. Nursing Administration Quarterly, 35(3), 227–234.
Retrieved from the Walden Library databases.
The article addresses stakeholder involvement as a key component of South Haven Health System’s success in strategic planning and describes how the system develops goals and objectives.
Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., . . . Rosamond, W. D. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic impact goal through 2020 and beyond. Retrieved from http://circ.ahajournals.org/content/121/4/586.full.pdf+html
As you read this report, consider the process used to set goals and evaluate the extent to which the identified goals are specific, measureable, attainable, relevant, and time-bound.
Required Media
Laureate Education (Producer). (2013b). Case study: Mountain View Health Center [Interactive media]. Retrieved from CDN database. (NURS 6241)
This interactive multimedia piece presents a case study of an organization, with information about the types of activities performed there, organizational structure, strategic priorities, and financial allocations. You will use this as a resource for this week’s Discussion.
Optional Resources
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
· Chapter 7, “Strategic and Operational Planning” (pp. 138–161)
Review as needed.
Sare, M., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care.Sudbury, MA: Jones and Bartlett.
· Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action” (pp. 117–143)
Review as needed, focusing on the information about goals and objectives.
Kramer, M., Schmalenberg, C., & Maguire, P. (2010). Nine structures and leadership practices essential for a magnetic (healthy) work environment. Nursing Administration Quarterly, 34(1), 4–17.
Retrieved from the Walden Library databases.
The authors discuss the clinical environment of nursing and the leadership practices needed to promote quality patient care outcomes.
Discussion: Developing a Philosophy, Goals, and Objectives
As addressed in this week’s Learning Resources, an organization’s philosophy statement derives from its mission and indicates the values and beliefs that steer decision making. An organization’s philosophy statement should be used to develop goals and objectives that lead to assured action.
As effective organizations recognize, “setting specific goals in a clear and compelling way—and insisting that people work together to achieve them—is the best way to get results” (Ashkenas, 2012, para. 9).
This Discussion builds on the Week 2 Discussion 2, as you create a philosophy statement, goals, and objectives for Mountain View Health Center, the organization featured in the case study introduced last week.
You will continue to work within the same small group.
Note: You will develop an individual philosophy statement, goals, and objectives independently. Through the collegial exchange that follows, you will offer each other suggestions for refinement.
To prepare:
· Review information on philosophy statements, goals, and objectives in Chapter 7 of the Marquis and Huston text and in the other Learning Resources.
· Review the Mountain View Health Center case study presented in this week’s media, and reflect on the mission and vision statements you developed for Discussion 2 in Week 2.
· Conduct additional research as necessary to strengthen your understanding of the process for creating a philosophy statement and developing goals and objectives and to deepen your thinking about the organization. For instance, you may research organizations with similarities to Mountain View and examine their philosophy statements, goals, and objectives.
· Draft a philosophy statement for Mountain View Health Center.
· Craft at least one goal and at least one related objective to operationalize the philosophy.
· Consider what you have learned about the importance of the philosophy statement and the process of developing one, as well as the significance of and distinctions between goals and objectives.