Category: Nurse practitioner

respond to the below discussions using 2 apa citations from the last 5 years EACH. I also need the PDF downloadabe resources that were used:

FIRST DISCUSSION:

Genetics, the nervous system, and hormones can directly impact a persons behavior. For example, Genetic epidemiologic studies have shown that schizophrenia is highly heritable (~80%) but with a multifactorial etiology and complex polygenic genetic architecture. There is evidence that both common and rare genetic variants, as well as diverse environmental factors contribute to its etiology (Merikangas et al., 2022). Various glands throughout the body release chemical messengers (hormones) that can effect a persons behavior and the nervous system includes different regions of the brain that are associated with specific behaviors, such as the amygdalas role in fear and the prefrontal cortexs role in decision-making (Penn State College of the Liberal Arts, n.d.).

Socioeconomically deprived individuals are underrepresented in clinical trials for most common mental disorders. Our knowledge of the effects of psychotherapies is largely limited to data from socalled WEIRD (Western, Educated, Industrialized, Rich and Democratic) individuals, who comprise 90% of study participants in psychological studies, from countries constituting only 12% of the worlds population (Fonagy & Luyten, 2021). It is also well-documented that psychotherapy is met with some reluctance by many minority groups due to feelings of shame and the stigma of having a mental health issue carry. People who receive therapy are seen as privileged by minority groups. Marginalized people with lower economic status tend to focus on their communities whereas those with higher economic status tend to focus on themselves.

Both individualized and group and family therapy have disadvantages and advantages. Individual therapy can be challenging for those who are not yet committed to changing behaviors and may need motivation from peers to help them know they are not alone. Another thing about individualized therapy is the cost. Therapy tends to be less expensive for group therapy. There are more confidentiality, flexibility for customizing treatment, and more of a chance to build a rapport between a therapist and patient in individualized therapy. In group therapy and or family therapy, there is an increased chance for breach of confidentiality since there is more than one patient involved with therapy. There are can also be a less focused therapeutic alliance with group/family therapy sessions (Generes, 2025).

References

Generes, W. (2025). Group Therapy VS Individual Therapy. American Addiction Centers.

Fonagy, P., & Luyten, P. (2021). Socioeconomic and sociocultural factors affecting access to psychotherapies: the way forward. World psychiatry : official journal of the World Psychiatric Association (WPA), 20(3), 315316.

Merikangas, A.K., Shelly, M., Knighton, A. et al. What genes are differentially expressed in individuals with schizophrenia? A systematic review. Mol Psychiatry 27, 13731383 (2022). https://doi.org/10.1038/s41380-021-01420-7

Penn State College of the Liberal Arts, (n.d.). Biological Basis of Behavior. Department of Psychology. https://psych.la.psu.edu/about-us/research/biological-basis-of-behavior/

SECOND DISCUSSION:

Main Discussion Post

Psychotherapy is a biological phenomenon in that it is demonstrable through studies of modern neuroscience whose results reveal that the psychological intervention brings around observable changes in the structure and functions of the brain. The literature review on meta-analysis showed that both psychotherapy and pharmacotherapy do influence neural networks which process emotion regulation and reward, but each one affects them in a distinct manner. The use of a pharmacological intervention typically affects the subcortical areas such as the amygdala but the prefrontal cortex, one of the most important parts of the cognitive control system and emotional regulation, is used during psycho therapeutic interventions (Friedman & Robbins, 2021). This is consistent with the neuroplasticity theory, during which the brain re-organizes through therapeutic experience making enduring changes in cognitive, emotional and behavioral responses (Cammisuli & Castelnuovo, 2023). These findings confirm the fact that psychotherapy, like pharmacotherapy, facilitates therapeutic actions through biologically viable mechanisms and this confirms the fact that psychotherapy is evidence-based intervention re-aligning the neural networks to achieve superior psychological functioning.

The attitude to and appreciation of psychotherapy is heavily dependent on cultural, religious and socioeconomic factors. Cultural values play an important part in the ability of individuals to recognize mental problems as a cause to seek professional assistance, and within certain cultures, emotional distress is described in spiritual or moral terms and not in psychological ones, lowering the efficacy of psychotherapy (Avasthi et al., 2022). Furthermore, there are other reasons of the suffering given by religious systems and people will think rather about faith-related intervention than therapeutic help thus, impacting the usefulness of psychotherapy (Fonagy & Luyten, 2021). Access to psychotherapy is also influenced by the socioeconomic status since individuals in less prosperous economic groups may be faced with such barriers as financial limitations, the lack of insurance, or the stigma of seeking mental health care (Fonagy & Luyten, 2021). These aspects of sociocultural forces assist in highlighting cultural competence as an important part of the current state of therapeutic practice since clinicians must navigate these aspects to render psychotherapy an actual and proper form of care, particularly in marginalized populations.

Group and family therapy has many differences compared to the individual therapy in legal and ethical issues because there are a number of clients in the therapeutic group. Within individual therapy, the position of the therapist regarding confidentiality is straightforward and has legal bases that have been created that govern confidentiality and disclosure, such as reporting (Avasthi et al., 2022). Still the question of confidentiality in group and family therapy is more complex since the therapists must act in terms of ethical concerns of information that may be provided by one member of a group or family, which may affect other members. It will necessitate the clear compromises in the margins of discretion and the potential threats of leaks (Hansson et al., 2022). There are difficulties when it comes to ensuring the confidentiality of the individual client and the therapeutic benefits of considering the family members, who can be enemies, when providing family therapy (Hansson et al., 2022). Regarding the same, regarding group therapy there must be explicit confidentiality rules and the boundaries must always be reinforced by the therapists in order to make sure that those of each member will be protected. These tones would also involve therapists being more subtle and contextual about confidentiality in group and family therapies as opposed to individual therapy.

These differences influence the selection of the therapeutic method that clinical practitioners ought to adopt because of differences in legal and ethical assumptions in individual, group and family therapy. One of the pillars of the therapeutic alliance confidentiality in individual therapy is the ability to discuss the issues and do it extensively about the personal issues in a safe and confidential environment. Group therapy, in its turn, implies that therapists need to establish and maintain clear and explicit maintenance of confidentiality, ensuring that the participants are going to be trusting each other and the therapist, who will keep and classify confidential information (Avasthi et al., 2022). Even though the family therapy is still founded on the principle of confidentiality, it also involves various problems since the therapists must strike the balance between the autonomy of individuals and family relationships. The therapist work is to ensure that the family members are aware of the limitations of confidentiality and how it can be affected by the family members (Hansson et al., 2022). These differences also demand that therapists adopt various methods that would most effectively apply to this or that modality and ensure that they are acting ethically and exploitation potential to their fullest. The complexity of the procedure of mediation confidentiality and relating matters in group and family counseling make it imperative that the professionals should be particularly sensitive as far as striking a balance between law and treatment goals is concerned.

References

Avasthi, A., Grover, S., & Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian Journal of Psychiatry, 64(7), 4761. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21

Cammisuli, D., & Castelnuovo, G. (2023). Neuroscience-based psychotherapy: A position paper. Frontiers in Psychology, 14(14). https://doi.org/10.3389/fpsyg.2023.1101044

Fonagy, P., & Luyten, P. (2021). Socioeconomic and sociocultural factors affecting access to psychotherapies: the way forward. World Psychiatry, 20(3), 315316. https://doi.org/10.1002/wps.20911

Friedman, N., & Robbins, T. (2021). The role of prefrontal cortex in cognitive control and executive function. Neuropsychopharmacology, 47(47), 118. https://doi.org/10.1038/s41386-021-01132-0

Hansson, K., Romoren, M., Weimand, B., Heiervang, K., Hestmark, L., Landeweer, E., & Pedersen, R. (2022). The duty of confidentiality during family involvement: Ethical challenges and possible solutions in the treatment of persons with psychotic disorders. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-04461-6

click the link for instructions. My clinical was a weight loss clinic where behavioral health NPs did assessments to see if mental health related to weight gain such as emotional or stress eating.

FOCUSED SOAP NOTE GUIDE and RUBRIC The SOAP note should mimic clinical documentation in the practicum setting. The documentation should be accurate, clear, well organized, and utilized medical terminology.

SUBJECTIVE (20 points) CC – the reason for the visit as stated in the patient’s own words Example: I have been coughing frequently for 5 days. HPI (History of Present Illness) – includes symptom dimensions, chronological narrative of patients complaints.

Use PQRST or OLDCARTS mnemonic to guide you in obtaining pertinent information. If the information is obtained from other sources, always identify the source.

For example, Mr. X is a 54 yr. old man with HTN, wo presents with frequent cough X 5 days, worse at night with small amount of whitish sputum, etc. (include all pertinent negatives and pertinent positives to the chief complaint) HTN was diagnosed 5 years ago and treated with amlodipine. Reports normal BP readings and at home and at other PCPs offices last 6 months. PMH (Pertinent past medical history)

Medications – Current medications (list with daily dosages). Allergies Pertinent Family History, Social History and other subjective data if relevant to the patients presenting problem and diagnosis. ROS (Pertinent review of systems) a system- based list of questions that help uncover symptoms not otherwise mentioned by the patient. In a focused SOAP note, only include systems pertinent to the presenting problem and/or diagnosis.

OBJECTIVE (20 points) Vital signs other objective data PE focused physical exam finding limited to systems pertinent to the problem Same systems reviewed in ROS should be addressed in PE Laboratory or diagnostic data if applicable (date of these diagnostics; before this visit or during this visit).

ASSESSMENT (Problem List) with ICD-10 Codes This section documents the synthesis of subjective and objective evidence to arrive at a diagnosis. This is the assessment of the patients status through analysis of the problem, possible interaction of the problems, and changes or progress in the status of the problems. List the problem list (diagnosis/es) in order of importance. The assessment could also contain the possible causes of the patients problem, especially if the patient is experiencing an illness.

If the patient had made a visit before, it should also contain the progress which had been made since the last visit as well as the overall progress towards fully treating the symptoms, based on the perspective of the main physician.

Example: #1 acute viral bronchitis (J20.9) – Mr. X is a 54 yr. old man with HTN presents with frequent cough x 5 days, worse at night with small amount whitish sputum, denies SOB, fever and chills. Lungs clear, fremitus is equal and there is no egophony. Most likely acute viral bronchitis.

#2 HTN, controlled (I10) PLAN This has to be evidence-based using the latest clinical guidelines. This should include pharmacologic, non-pharmacologic, education, referrals, and follow-up when applicable. The plan should be personalized and appropriate for the patient.

The plan should address all the problems in Assessment.

Example: #1 acute viral bronchitis (J20.9) – supportive care, no antibiotic therapy – OTC Dextromethorphan/guaifenesin 10ml Q4hrs – Avoid decongestants due to HTN – Follow up in 1 week if no improvement or if condition worsens, a CXR can be done to r/o pneumonia.

#2 HTN, controlled – continue amlodipine 5 mg daily. – Low Na diet discussed EVIDENCE-BASED RATIONALE (20 points) –

Identify 3 differential diagnoses considered. Provide a brief rationale for each differential diagnosis (3-4 sentences) – rationale should provide data that support your differential diagnoses presentation, PE finding and/or lab/diagnostic test results that make it similar to the diagnosis and explain the difference between the differential and working diagnoses and/or the laboratory/diagnostic tests that would make the diagnosis. Cite. – Briefly discuss the rationale of the plan. Provide clinical guidelines used to support the plan, cite.

utilizing the document below:

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you to identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.

Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum

• Refer to the Advanced Nursing Practice Competencies and Guidelines found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
• Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1, and consider your strengths and opportunities for improvement.
• Refer to your Patient Log in Meditrek, and consider the patient activities you have experienced in your practicum experience. Reflect on your observations and experiences.

In 450500 words, address the following:

Learning From Experiences

• Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
• Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?
• What did you learn from this experience?
• What resources did you have available?
• What evidence-based practice did you use for the patients?
• What new skills are you learning?
• What would you do differently?
• How are you managing patient flow and volume?

Communicating and Feedback

• Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
• Answer the questions: How am I doing? What is missing?
• Reflect on the formal and informal feedback you received from your Preceptor.

Reflection demonstrates a high level of critical thinking in applying and integrating key course concepts and theories from readings, lectures, and/or Discussions. Insightful and relevant connections are made through contextual explanations and examples.

Expresses solid evidence of reflection on own work. Demonstrates substantial personal growth and awareness of deeper meaning through inferences, well developed insights, and significant depth in awareness and challenges. Synthesizes current experience into future implications.