The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system. 

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time. 

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected. 

To Prepare:

• Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
• Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected. 
• Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor. 

The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

• Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
• Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations. 
• Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

 From the previous discussion:

The healthcare environment is significantly growing, which explains the reason for the existing significant issues. Improving the quality of healthcare requires a strong emphasis on critical aspects such as leadership, cost of care, skills and service delivery, technology, as well as patient management practices. A significant health care issue currently has been technological disruption. Substantial changes in the healthcare industry that are being undertaken are dependent on technology. This provides a unique platform where it is more accessible to attain better health outcomes across different settings.

Quality has been a critical measure in the delivery of quality healthcare outcomes. The integration of different results has aimed at providing a unique system where it would be easier to improve healthcare outcomes. The ability to incorporate technology in monitoring patient development offers a strong emphasis on essential processes which help maintain a unique level of engagement within a healthcare setting. Within my healthcare organization, patient information has been stored using healthcare information management systems compared to previous documentation of patient information in healthcare files (Engelhardt, 2017).

Management of healthcare information has become a critical factor which provides a strong consideration on critical processes which help create a reliable system. The inclusion of health information management systems has integrated vital processes which help identify important concepts which help manage patient information. Storage of patient details provides a strong consideration on specific aspects which help improve the level of commitment among healthcare providers (Sultan, 2015).  The health information management system that has been put in place identify specific measures which focus on ensuring that there is quick information retrieval of patient information.  Accessing patient information within a healthcare context requires authorization from a patient or when reviewing the patient situation.

The impact of technology disruption in my workplace

Integration of technology in healthcare is aimed at controlling healthcare errors. It is a crucial aspect to consider primarily based on previous errors in healthcare delivery.  The use of technology is aimed at improving efficiency in the delivery of healthcare. In my workplace, management of patient health information is a significant improvement to the storage of health information which has been a considerable challenge, especially retrieval of patient files. The use of technology has made it possible to access patient information from a cloud-based database quickly (Schwamm, 2014).

Conclusion

The use of technology has also created challenges, especially concerning the common cyber threats. The fact that we deal with sensitive patient information, they are at a higher risk of falling victims to intruders who target such information.   The present risks are significant. Thus, integration of vital information security risks will help in controlling the current risks through the development of robust techniques. The techniques are integrated into the healthcare industry to protect patient information. Thus, management of these risks has been a significant aspect to consider in ensuring that there is a better level of implementation of healthcare outcomes. Thus, technology disruption is having both positive and negative influence in healthcare.

                                                                                                      References

Engelhardt, M. A. (2017). Hitching healthcare to the chain: An introduction to blockchain technology in the healthcare sector. Technology Innovation Management Review, 7(10).

Schwamm, L. H. (2014). Telehealth: seven strategies to successfully implement disruptive technology and transform health care. Health Affairs, 33(2), 200-206.

Sultan, N. (2015). Reflective thoughts on the potential and challenges of wearable technology for healthcare provision and medical education. International Journal of Information Management, 35(5), 521-526.

or 

 Increased workload on nurses is one of the stressors facing nurses and is a significant problem all over the world. It includes multiple factors such as work environment, condition of the client or consumer, characteristics of the providers, nursing interventions, to name a few.  Contributing further to the already heavy nursing workload are an inadequate supply of nurses, decreased patient length of stay, complex patients, increased demand for nurses, and increased overtime had added to already demanding work of nurses and eventual nursing burnout. As a result, the nurse-patient ratio, which has been used commonly in measuring the workload of the nursing workforce, has been increasing (Vaidya, 2018).  

reference:

Vaidya, A. (2017, September 21). Increasing nurse’s workload by 1 patient ups odds of patient

              death by 7%. Clinical Leadership and Infection Control. Retrieved from

               https://www.beckershospitalreview.com/quality/increasing-nurse-s-workload-by-1-patient-ups-odds-of-patient-death-by-

              7.html

Looking Ahead

The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.

rubic:

      

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

·   Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).–Levels of Achievement:Excellent 23 (23%) – 25 (25%)
The response accurately and thoroughly describes in detail the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate, clear, and detailed data to quantify the impact of the national healthcare issue/stressor selected.
Good 20 (20%) – 22 (22%)
The response describes the national healthcare issue/stressor selected and its impact on an organization.

The response includes accurate data to quantify the impact of the national healthcare issue/stressor selected.
Fair 18 (18%) – 19 (19%)
The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague or inaccurate.

The response includes vague or inaccurate data to quantify the impact of the national healthcare issue/stressor selected.
Poor 0 (0%) – 17 (17%)
The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague and inaccurate, or is missing.

The response includes vague and inaccurate data to quantify the impact of the national healthcare issue/stressor selected, or is missing.Feedback:

·   Provide a brief summary of the two articles you reviewed from outside resources, on the national healthcare issue/stressor and explain how the healthcare issue/stressor is being addressed in other organizations.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
A complete, detailed, and specific synthesis of two outside resources reviewed on the national healthcare issue/stressor selected is provided. The response fully integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the summary provided.

The response accurately and thoroughly explains in detail how the healthcare issue/stressor is being addressed in other organizations.
Good 24 (24%) – 26 (26%)
An accurate synthesis of at least one outside resource reviewed on the national healthcare issue/stressor selected is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the summary provided.

The response fails to integrate any resources to support the summary provided.Feedback:

·   Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected and explain how they may impact your organization both positively and negatively. Be specific and provide examples.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
A complete, detailed, and accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.

The response explains how the strategies may impact an organization both positively and negatively that is vague and inaccurate, or is missing. Does not include any examples.Feedback:

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 is provided which delineates all required criteria.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

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.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.

 

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Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

• Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
• Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor.
• Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

• Describe the healthcare program or policy outcomes.
• How was the success of the program or policy measured?
• How many people were reached by the program or policy selected?
• How much of an impact was realized with the program or policy selected?
• At what point in program implementation was the program or policy evaluation conducted?
• What data was used to conduct the program or policy evaluation?
• What specific information on unintended consequences was identified?
• What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
• Did the program or policy meet the original intent and objectives? Why or why not?
• Would you recommend implementing this program or policy in your place of work? Why or why not?
• Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

 

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Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

• Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
• Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor.
• Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

• Describe the healthcare program or policy outcomes.
• How was the success of the program or policy measured?
• How many people were reached by the program or policy selected?
• How much of an impact was realized with the program or policy selected?
• At what point in program implementation was the program or policy evaluation conducted?
• What data was used to conduct the program or policy evaluation?
• What specific information on unintended consequences was identified?
• What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
• Did the program or policy meet the original intent and objectives? Why or why not?
• Would you recommend implementing this program or policy in your place of work? Why or why not?
• Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

 

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The Assignment:

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

· Decision #1

·  

o Which decision did you select?

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

· Decision #2

·  

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

· Decision #3

·  

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Note: Support your rationale with a minimum of three academic resources no more than five years old. 

Co-morbid Addiction (ETOH and Gambling)

53-year-old Puerto Rican Female

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.”

 
 

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.

 
 

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One:

Select what the PMHNP should do:

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection

Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned

Decision Point Two:

Select what the PMHNP should do next:

Add on Valium(diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Mrs. Perez reports that when she first received the valium, it helped her tremendously. She states “I was like a new person- this is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her valium early

Client is asking today for you to increase the valium dose or frequency

Decision Point Three:

Select what the PMHNP should do next:

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At this point, we need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

 

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76-year-old Iranian Male with Alzheimer’s Disease

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

 
 

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

 
 

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

Decision Point One #1

Select what the PMHNP should do:

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks

The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two #2

Select what the PMHNP should do:

Increase Exelon to 4.5 mg orally BID

RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks

Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three #3

Select what the PMHNP should do next:

Increase Exelon to 6 mg orally BID

Guidance to Student

 At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.

At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

The Assignment

Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. 

You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

· At each decision point stop to complete the following:

·  

o Decision #1

o  

§ Which decision did you select?

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

§  

o Decision #2

o  

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

o Decision #3

o  

§ Why did you select this decision? Support your response with evidence and references to the Learning Resources.

§ What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

§ Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

· Also include how ethical considerations might impact your treatment plan and communication with clients.

·  

Note: Support your rationale with a minimum of three academic resources. 

 

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