Category: Clinical

Instructions

Students are required to complete process recordings during the semester. This learning tool requires the student to critique an interview with a client by identifying and analyzing thoughts and emotional reactions/responses to the encounter with the client. Social work values and standards are applied as a guideline for this analysis. The Walsh (2002) reading will inform this assignment.

Guidelines

• Students will complete Process Recordings using the attached Template (also available in Appendix B).
• The written Process Recording should include reflection on specific practice competencies, and social work principles of ethical practice.
• Process Recordings must be discussed with MSW Supervisor.
• Students are responsible to protect client confidentiality.

The Process Recordings should be no more than 3-4 pages in length (double-spaced) and make use of the attached suggested outline. Please adhere to the writing assignment policy in the Syllabus.

Instructions

Overview

This is a group assignment. Each group will be given a choice of two different case studies ( Case study 1, ) that describe an individual who is experiencing symptoms of substance use disorder and the way the substance use disorder is interacting with that persons environment. Each group will demonstrate its collective knowledge of screening, assessment, diagnosis, case conceptualization, and determining options for evidence-supported substance use treatment using the instructions below. When possible, the instructor will assign groups based on time zone.

Steps to Complete This Paper

1. Please select the case study (provided by the professor) that you would like to use for your assignment. There are two choices. One case study focuses on an adolescent and one case study focuses on an adult.
2. Read the Case Study
3. Answer the prompts provided. Please use section headers to divide your paper; each prompt should be its own section.

Writing Prompts

• Section One: Screening Process Which screening or diagnostic tools would you choose to use in your assessment of the client in the case study? Why is the screening or diagnostic tool (or tools) appropriate? Please use research from either peer-reviewed sources or your textbook to support your choices.
• Section Two: Diagnosis Using the DSM-5, describe the substance use diagnosis you would assign to this client given the information in the case study. You are welcome to fill in the blanks and embellish upon the case study if that helps you, and you can also use the screening or diagnostic tools you discussed in section one to help you with your diagnosis. This section should include

1. You should explain the way the client meets each criterion for the diagnosis or diagnoses you consider. Remember that the client should meet every single criterion to meet the diagnostic criteria. If the client does not meet the criterion all the way, you should explain this and offer the closest diagnosis possible with your explanation.
2. Remember to cite the DSM-5

• Section Three: Case Conceptualization Here you should explain your theory of the case. Explain why you think this person developed a substance use disorder, factors that impacted the development of the disorder, and factors that will impact treatment. You may want to discuss the clients stage of change and motivation for treatment. What is your prognosis? Do you think the client can and will recover and why? What kind of timeline do you imagine recovery would take?
• Section Four: Treatment Options (be sure to use research in this section)

1. Do you recommend detox? Why or why not. Justify your answer with research or information from a reputable source.
2. What treatment does the research recommend? Find the best treatment option for your client and justify the reason it is the best treatment option using research and reputable sources.
3. If this person were a client for you in your town/city, would the recommended treatment option be available?
4. If yes – name and describe the program or option
5. If no – explain what you would recommend instead, and name and describe that program or option

Writing Guidelines

• Please use APA style. You do not need to use a reference for the case study.
• Please use section headers. Each prompt should be in its own section
• Please make sure that your title includes the name of the client in the case study you selected
• Use at least 5 academic references
• 5 and 7 pages of written text. The professor will stop grading after 7 1/2 pages of written text.
• Only one person needs to submit the assignment on behalf of the group.
• Each person needs to submit a word document or PDF document describing their contribution to/ participation in the group project as well as a summary of their perception of their group members contributions to the assignment.

Group Project Policy

While students often work well together, sometimes different workstyles, time management, and/or personal and work life can make it difficult to work effectively and efficiently. Students are encouraged to share their work styles with their group mates to reduce miscommunication and frustration.

Be aware, if one group member is not communicating with their group, attending group meetings or failing to complete their assigned work, this member will receive a lower grade than the rest of the group, possibly a zero, for the project.

What to do when you are experiencing group participation problems: (1) Email your concerns to your group members in a timely manner (before assignment due date), (2) Together, write a project completion timeline with names assigned to tasks, (3) If group members do not adhere to these commitments, contact the professor to moderate the situation. Finally, please remember, this is a professional program in which the goal is to prepare students to work effectively with individuals, groups, and organizations. If students are not acting professionally, it will impact the group environment and assignment quality. The instructor reserves the right to vary group participants grades based on performance, participation, professionalism, and input.

Instructions

Students will identify a resource in their community that offers substance use treatment using a harm reduction approach. Examples of these treatment providers might be intensive outpatient programs, residential treatment centers, needle exchange programs, or any other resource you are able to identify.

Steps to Approach This Paper

1. Spend some time researching harm reduction programs in your area. The preference is for you to identify a program that offers substance use treatment (either exclusively or in conjunction with other services) from a harm reduction perspective.
2. Schedule and conduct an interview with a clinician (social worker or other type of therapist role) at the identified agency. During the interview, learn about the harm reduction approach used by the program, whether it is grounded in research or theory, and the clinicians perspective of using this harm reduction approach.
3. Conduct research about the harm reduction approach you learned about in your interview. Find at least 2 research sources that give you information about the approach you learned about and its efficacy.
4. Critically review the program you learned about by comparing it to the findings in the research In particular, you are asking: does this community program appear to be offering practices that are supported by research? Do you think this program is offering best practices to its clientele? What is it doing well and/or what could it do better?

Paper Guidelines

• Describe the agency you interviewed and the highlights of the interview. Make sure to describe the harm reduction approach used at the agency and the population worked with. (1 to 2 pages)
• Describe the research you found on the approach used at the agency (approximately 2 pages)
• Offer your critical review of the program by answering the following questions: (a) does this community program appear to be offering practices that are supported by research? Do you think this program is offering best practices to its clientele? What it is doing well or doing better (with input from the research and your perspective)? (approximately 1 page)

Writing Guidelines

• Please follow APA style for this paper, and it is okay to use first-person language.
• You should use a title page, references page, and in-text citations.
• As a reminder, in-text citations should be used for personal communication but this does not appear on your references page; this is an odd rule in APA style.
• Use at least 2 academic references in addition to your interview. These should be peer-reviewed articles or articles or articles published in a reputable publication. You will most likely find these through the library/ published in a scholarly journal.
• Your paper should include 5 to 6 pages of written text plus title page and references page. The professor will stop grading after 6 pages of written text, so please reserve time for editing.

please add one more page. if you can

Patient case study (fictional) for BSN students nearing graduation

Patient ID: MRN 000123456 (fictional) Name: Thomas Riley (Mr. Riley) Age: 68 Sex: Male DOB: 08/14/1957 Date of admission: 02/07/2026 Admission source: ED from home via EMS Code status: Full Code Allergies: Penicillin (rash)

Presenting complaint: Progressive shortness of breath for 3 days, increased lower-extremity swelling, cough with white sputum, orthopnea (needs 3 pillows), decreased exercise tolerance.

Past medical history:

• Chronic heart failure with reduced ejection fraction (HFrEF), diagnosed 5 years ago (EF 30%)
• Coronary artery disease (stented 3 years ago)
• Hypertension
• Chronic obstructive pulmonary disease (COPD), emphysema-predominant
• Type 2 diabetes mellitus, diet-controlled
• Chronic kidney disease stage 3a (eGFR ~52 mL/min/1.73 m2)
• Hyperlipidemia
• Osteoarthritis of knees

Surgical history:

• CABG x1 (no), PCI with stent 3 years ago
• Left knee arthroscopy

Social history:

• Lives with wife in single-level home
• Retired factory worker
• Former smoker: 40 pack-year history, quit 5 years ago
• Alcohol: occasional wine
• No illicit drug use
• Support: spouse able to assist; adult daughter nearby

Home medications (prior to admission):

• Metoprolol succinate 100 mg PO daily
• Lisinopril 20 mg PO daily
• Furosemide 40 mg PO daily (often misses doses)
• Spironolactone 25 mg PO daily
• Atorvastatin 40 mg PO nightly
• Tiotropium inhaler 18 mcg daily
• Albuterol inhaler PRN (uses 23 times/day)
• Aspirin 81 mg PO daily
• Multivitamin

Allergies: Penicillin rash

Initial ED assessment / triage vitals:

• T: 99.1F (37.3C)
• HR: 110 bpm, regular
• BP: 160/92 mmHg
• RR: 26 breaths/min
• SpO2: 88% on room air, improves to 94% on 4 L/min nasal cannula
• Pain: 2/10 (chest tightness occasionally)

Physical exam (on admission):

• General: Alert, anxious, mild respiratory distress
• HEENT: No JVD at 30 degrees (note: JVD present when more upright)
• Lungs: Bilateral crackles at bases, decreased breath sounds with expiratory wheeze; mild use of accessory muscles
• Cardiac: Tachycardic, S1/S2, S3 present, no murmurs noted
• Abdomen: Soft, non-tender
• Extremities: Bilateral pitting edema to mid-shins, cool peripheries
• Neuro: Alert and oriented x3

Initial diagnostics:

• CXR: Cardiomegaly with pulmonary vascular congestion and bilateral interstitial/alveolar edema, small bilateral pleural effusions
• ECG: Sinus tachycardia, no acute ischemic changes
• BNP: 1,200 pg/mL (elevated)
• Troponin I: 0.02 ng/mL (normal)
• ABG on 4 L NC: pH 7.45, PaCO2 34 mmHg, PaO2 70 mmHg (mild hypoxemia)
• CBC: WBC 9.8 x10^9/L, Hgb 13.2 g/dL, Hct 39%, Plt 210 x10^9/L
• BMP: Na 132 mmol/L, K 4.8 mmol/L, Cl 98 mmol/L, HCO3 22 mmol/L, BUN 28 mg/dL, Creatinine 1.4 mg/dL (baseline 1.2), Glucose 150 mg/dL
• LFTs: within normal limits
• Echo (prior record): EF 30% (last year)
• Urinalysis: trace protein, otherwise unremarkable
• Sputum culture: sent (pending)

ED course and admitting diagnosis:

• Primary: Acute decompensated heart failure (HFrEF exacerbation), likely precipitated by missed diuretic doses and possible COPD exacerbation
• Secondary: COPD exacerbation, volume overload
• ED treatment: Supplemental oxygen, IV loop diuretic (furosemide 40 mg IV bolus), nebulized albuterol/ipratropium, started on scheduled IV furosemide infusion protocol pending response, placed on telemetry, continuous pulse oximetry.
• Admitted to telemetry/medical-surgical step-down unit under cardiology.

Hospital day 1 plan & orders (sample):

• Continue oxygen titrated to SpO2 92%
• Furosemide IV 40 mg bolus then 10 mg/hr infusion (adjust per urine output and daily weights)
• Metoprolol hold until euvolemic and HR <100; resume later per cardiology
• Continue lisinopril 20 mg PO daily (hold if creatinine rises >30% or K >5.5)
• Spironolactone hold while on IV diuresis
• Nebulized albuterol/ipratropium q6h PRN for wheeze
• VTE prophylaxis: sequential compression devices (consider LMWH once stable)
• Daily labs: BMP, BNP qAM
• Strict I&O, daily weight each AM
• Cardiology consult for HF management and medication titration
• Respiratory therapy for inhaler technique, nebulizer treatments, pulmonary toilet
• Diet: cardiac (2 g sodium), diabetic-consistent as needed
• Education: low-sodium diet, medication adherence, activity tolerance, when to call provider
• Discharge planning: assess home support, f/up with cardiology & primary care within 1 week, consider home health if needed

Nursing assessment data (ongoing):

• Urine output: first 6 hours after IV furosemide bolus: 800 mL; next 12 hours: 1,200 mL
• Weight: admission 95 kg; prior baseline 90 kg (weight gain 5 kg)
• Vitals (12 hours after admission): T 98.6F, HR 96, BP 138/84, RR 20, SpO2 93% on 2 L NC
• Breath sounds: crackles improved slightly; dyspnea decreased from moderate to mild
• Peripheral edema decreased to ankles (pitting 1+)
• Blood glucose: 160 mg/dL fasting
• BMP (12 hours): Na 130, K 4.6, Creatinine 1.45 mg/dL, BUN 30

Potential and actual nursing diagnoses (examples):

• Impaired gas exchange related to pulmonary edema and COPD exacerbation as evidenced by SpO2 88% on room air and bilateral crackles.
• Excess fluid volume related to compromised regulatory mechanism (heart failure) as evidenced by weight gain, peripheral edema, pulmonary congestion, BNP elevated.
• Activity intolerance related to decreased cardiac output as evidenced by dyspnea on exertion and tachycardia with minimal activity.
• Risk for electrolyte imbalance related to diuretic therapy as evidenced by diuretic orders and borderline creatinine/BUN elevation.
• Deficient knowledge regarding disease process and medication adherence related to missed diuretic doses.

Nursing care plan interventions (examples with rationale and expected outcomes):

1. Oxygen therapy and respiratory support

• Intervention: Administer O2 to maintain SpO2 92%; monitor respiratory rate, work of breathing, ABGs.
• Rationale: Improve oxygenation, decrease work of breathing.
• Expected outcome: SpO2 92%, RR <22, decreased dyspnea.

1. Fluid removal and monitoring

• Intervention: Administer IV furosemide per order; monitor urine output hourly during infusion, record daily weights, assess mucous membranes and skin turgor, monitor electrolytes and renal function qAM.
• Rationale: Reduce volume overload, prevent renal impairment and electrolyte disturbances.
• Expected outcome: 0.51.0 kg weight loss/day initially, decreased edema, stable creatinine.

1. Prevention of complications

• Intervention: Telemetry monitoring for arrhythmias, fall risk precautions, VTE prophylaxis.
• Rationale: HF patients at risk for arrhythmias, falls, and thromboembolism.
• Expected outcome: No arrhythmias requiring emergent intervention, no falls, no DVT.

1. Medication management and reconciliation

• Intervention: Reconcile meds, clarify home diuretic adherence, educate on medication purposes and schedule, coordinate with pharmacy for discharge meds (ensure diuretic dosing and potassium monitoring).
• Rationale: Prevent readmission due to nonadherence and optimize HF regimen.
• Expected outcome: Patient verbalizes meds and doses, demonstrates inhaler technique.

1. Education and discharge planning

• Intervention: Teach low-sodium diet, daily weights, recognition of worsening HF signs (increased SOB, >23 lb overnight gain), when to seek care; arrange follow-up appointments; involve spouse in teaching.
• Rationale: Early recognition prevents readmission; caregiver involvement improves adherence.
• Expected outcome: Patient and spouse demonstrate understanding and plan for outpatient follow-up.

1. Mobility and activity progression

• Intervention: Encourage graded activity as tolerated, monitor vitals with ambulation, provide rest periods.
• Rationale: Prevent deconditioning while avoiding cardiac stress.
• Expected outcome: Activity tolerance improves, HR and BP within acceptable range during activity.

Progress notes example (Hospital day 2 morning):

• Subjective: Denies chest pain; reports breathing easier, requires 2 pillows at night now. States will try to take furosemide at home but sometimes forgets.
• Objective: Vitals stable, SpO2 94% on 2 L NC, RR 18, HR 86, BP 130/78. Lungs: decreased crackles. Urine output last 24 hrs: 2,400 mL. Weight 92 kg (down 3 kg from admission). BMP: Na 131, K 4.4, Creatinine 1.35 mg/dL.
• Assessment: Responding to diuresis; stable for step-down care. Needs med teaching and discharge planning.
• Plan: Continue diuretic per protocol, hold spironolactone until assessment by cardiology, schedule cardiology follow-up, begin discharge teaching, consider home diuretic supply and home health for initial medication reconciliation and weight monitoring.

Lab trends to monitor:

• Daily BMP (Na, K, Cr, BUN)
• BNP trends
• Weight and I&O
• Oxygenation and ABGs if indicated
• ECG/Telemetry for arrhythmias
• Sputum culture results (if infectious etiology suspected)

Discharge considerations (anticipated if stable by day 34):

• Transition IV diuretics to oral high-dose furosemide (e.g., 80 mg PO daily or as individualized) with clear instructions and pharmacy reconciliation
• Reinstate guideline-directed medical therapy (beta-blocker, ACE inhibitor) with cardiology input; titration outpatient
• Arrange cardiology appointment in 37 days
• Provide written and teach-back education: low-sodium diet, daily weights, medication schedule, inhaler technique, signs/symptoms requiring immediate care
• Consider home health for weight, vitals, medication reconciliation for first 12 weeks
• Provide referral to CHF clinic or heart failure management program

Student tasks / learning activities (for evaluation):

1. Perform focused cardiopulmonary assessment and document findings.
2. Calculate fluid balance for prior 24 hours and interpret significance.
3. Formulate 3 prioritized nursing diagnoses with supporting data.
4. Create a 24-hour nursing care plan with specific interventions, rationales, and measurable outcomes.
5. Demonstrate proper inhaler technique and teach-back with spouse.
6. Identify potential medication interactions/contraindications (e.g., ACE inhibitor + spironolactone with rising creatinine/K).
7. Develop discharge teaching checklist and complete a teach-back session (document results).
8. Recognize signs of worsening HF and when to escalate care.
9. Interpret BMP trend and suggest nursing actions for abnormal K or creatinine changes.
10. Communicate change-of-shift report including SBAR to receiving nurse.

Visit one 12 Step Self-Help group (AA, NA, ACOA, GA, SA, etc.) or any other self-help group. Submit a 23-page reflection paper that identifies observed principles of group dynamics, including type of group, group process components, developmental stages, group leaders roles, members roles and behaviors, therapeutic factors of group work, and your personal reaction to the group. Must include and use a minimum of two references.

*Please note: This must be an open meeting unless you are a member of this 12-step self-help organization. You can attend any type of self-help group.

Rubric for Group Visit/Professional Development Paper 15 points

Did Not Meet Requirements 9 points or less

Met Minimal Requirements 10- 12 points

Met or Exceeded

Requirements 13 – 15points

Did not submit reflection, did not submit reflection on time and/or submitted without all elements: process and content, structure, leadership, substantive contribution regarding emotional and cognitive reaction

Did not attend an appropriate 12-step self-help group

Submitted reflection with most elements: process and content, structure, leadership, substantive contribution regarding emotional and cognitive reaction

Attended an appropriate 12-step self-help group

Submitted reflection with all elements: process and content, structure, leadership, substantive contribution regarding emotional and cognitive reaction

Attended an appropriate 12-step self-help group

Did not demonstrate critical thinking and/or professional writing

Demonstrated a limited degree of professional writing and critical thinking

Demonstrated professional writing and critical thinking

Did not use APA style format including cover page and references and/or submission had more than a few errors

(spelling and grammar errors are worth 1/3 of a point each)

Used APA style format including cover page and references with minimal errors

(spelling and grammar errors are worth 1/3 of a point each)

Used APA style format including cover page and references

(spelling and grammar errors are worth 1/3 of a point each)

Did not submit minimum of 2 typed pages APA style and/or was missing cover page and/or reference page

Submitted minimum of 2 typed pages APA style not including cover page or reference page

Submitted minimum of 2 typed pages APA style not including cover page or reference page

Group Movie Analysis Paper – total 15 points

View the movie The Breakfast Club. Write a (3 page) critical paper analyzing the group. Please use APA style; write in third person using concepts from the text and course to identify (a) stages, (b) therapeutic factors, (c) member roles, leader roles, (e) group process, (g) critical incidents, and (h) challenging members. This paper is to be an analysis, and not a summary of the movie.

Rubric for Group Movie Analysis Paper – 15 points

Did Not Meet

Competency

9 points or less

Met Competency Minimally

10 -12 points

Met or Exceeded Competency

13-15 points

Did not use APA style for format, movie citations, and references or used with multiple errors

(spelling and grammar errors are worth 1/3 of a point)

Used APA style for format, movie citations and references

(spelling and grammar errors are worth 1/3 of a point)

Used APA style for format, movie citations, and references

(spelling and grammar errors are worth 1/3 of a point)

Did not demonstrate professional writing and/or critical thinking

Demonstrated professional writing and critical thinking

Demonstrated professional writing and critical thinking

Did not identify or identified member roles, group process, critical incidents, stages, therapeutic factors, member roles, leader roles, critical incidents, and group process with several omissions or errors

Identified member roles, group process, critical incidents, stages, therapeutic factors, member roles, leader roles, critical incidents, and group process with minimal omissions or errors

Identified member roles, stages, therapeutic factors, member roles, leader roles, critical incidents, and group process

Summarized most if not all of the movie

Included some analyzation and summarization of the movie

Appropriately analyzed the movie