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Clinical Social Work in a Digital Environment: Ethical and Risk-Management Challenges
Get PDFClinical social workers’ use of digital and other technology to provide distance counseling services is proliferating. Increasing numbers of contemporary practitioners are using video counseling, email chat, social networking websites, text messaging, smartphone apps, avatar-based websites, self-guided web-based interventions, and other technology to provide clinical services to clients, some of whom they may never meet in person. The advent of this technology has produced a wide range of ethical challenges related to social workers’ application of traditional social work ethics concepts: client informed consent; client privacy and confidentiality; boundaries and dual relationships; conflicts of interest; practitioner competence; records and documentation; and collegial relationships. The principal purpose of this article is to identify pertinent ethical and ethically-related risk-management issues that clinical social workers need to consider if they contemplate using this technology to assist people in need. The author addresses compelling ethical issues concerning (1) social workers’ use of digital technology to communicate with clients in relatively new ways, and (2) whether social workers’ use of digital technology alters the fundamental nature of the therapeutic relationship and clinicians’ ability to provide clients with a truly therapeutic environment
Nurses\u27 Knowledge of Signs and Symptoms of Anxiety and Agitation
Get PDFThe diagnosis of mental illness is becoming more prevalent in the United States. With the increased identification, it is imperative that health care professionals are astute in identifying mental health conditions and behaviors associated with those conditions. The most common use of pro re nata (PRN) or “as needed” psychoactive medications in the inpatient psychiatric setting is for the reduction of behaviors associated with anxiety, agitation, and aggression. The administration of PRN medication rests solely on the nursing staff and their ability to use autonomous clinical decision-making to distinguish between different behaviors associated with those conditions prior to the administration of PRN medication. For the past 30 years, research has recognized the lack of national standards, assessment criteria, and ethical practices when administrating PRN medications in the acute inpatient setting. The purpose of this study was to identify nurses’ knowledge of signs and symptoms of anxiety or agitation in the acute care setting. The model used to guide this research is the Synergy Model of Patient Care. The design for this research study was a descriptive design using a case study approach. This study was conducted at a nonprofit, general medical-surgical community hospital in Rhode Island specializing in rehabilitation and psychiatric services. The target sample consisted of all registered nurses working on three study units. Two case studies, each portraying a patient experiencing symptoms or behaviors of anxiety and agitation were used to measure nurses’ knowledge of signs and symptoms of anxiety and agitation. A total of 17 RNs (N=17) participated in this research project. This research implied that there were gaps in clinical knowledge and variations in practice when nurses were asked to recognize symptoms of anxiety or behaviors associated with agitation
Reversing the Stop Signs to Proactive Nursing Care in DNR Patients
Get PDFResearch has supported that patients with a do-not-resuscitate (DNR) code status receive less aggressive treatment and have higher mortality rates compared to those without DNR orders, after adjusting for confounding factors (Cohn, Fritz, Frankau, Laroche, & Fuld, 2012). Health care providers erroneously understand DNR status to imply that a patient is dying and should not undergo other life-saving interventions (Hewitt & Marco, 2004). Surveyed critical care nurses revealed that they believed that interventions such as complete history and physicals, checking vital signs, monitoring neuro status, and ICU admission should not be performed as regular interventions on patients with a DNR status (Sherman & Branum, 1995). The purpose of this paper was to explore the factors that contribute to less aggressive nursing care in DNR patients that are not actively dying from a terminal illness. This study employed a qualitative approach using semi-structured interviews. The sample consisted of five critical care registered nurses. Three common themes were revealed: the definition of DNR code status; interpersonal relationships between nurse/patient; and personal views and feelings directing nursing care. Recommendations and implications for practice are discussed
Cap and Gown Convocation Program, Spring 2015
Get PDFIncludes recipients, description and history of award, and Alma Mater sheet music.https://digitalcommons.ric.edu/cg_convocation_programs/1035/thumbnail.jp
Innovation Lab Fall Newsletter
Get PDFThe 1st issue of the RIC/CF Innovation Lab newsletter (Fall, 2015).
Inside this issue:
- A Note from the Leadership Team
- Congratulations on Blogging and Food-Logging to Present at American School Health Association
- Project Highlight: Conditional Acceptance
- Honored Article on NACAC Official Blog
- Innovation Lab in the News
- Connect with U
Visual Attention and Behavior Under Positive Stereotypes
Get PDFAfrocentricity bias occurs when Black individuals with dark skin, wide nose, and large lips are associated with certain negative and positive traits (e.g., criminality and athleticism) compared to those with Eurocentric features (i.e., light skin, narrow nose, thin lips). In racial bias research, inhibition of biased responses is common. The current study employed positive stereotypes associated with Blacks and Whites (physical and verbal ability, respectively) in order to link implicit behavior (visual attention) to explicit behavior. Participants selected, from an array of two faces, the best candidate for a team requiring either physical strength or verbal ability. Stereotypes did not affect visual behavior and choice; rather, Afrocentric features did. Visual attention to highly Afrocentric Black faces was greater when with White faces. In terms of choice, when present with two Black faces, the more Eurocentric face was more likely to be selected. Selections did not vary for White and highly Afrocentric Black candidate pairs. Eurocentric Black faces were selected more often when paired with a White candidate. Trait rating data showed that highly Afrocentric features resulted in higher ratings of agility and strength, whereas Eurocentric features resulted in higher ratings for verbal and grammatical skill. Although participants rated Blacks as predicted by Afrocentricity Bias, their behavior did not reflect the bias
Pressure Ulcer Assessment and Documentation
Get PDFAccurate assessment and documentation of skin is an important nursing activity yet the task of identifying and documenting wounds can be difficult. New regulations from the Centers for Medicare and Medicaid dictate that hospitals will not receive payment for the treatment of stage III or stage IV hospital-acquired pressure ulcers. Literature supports that accurate assessment and documentation of a pressure ulcer is important to the care of the patient, to provide legal documentation, and for reimbursement. The purpose of this project was to develop and implement a pressure ulcer assessment and documentation pocket guide. The development of the pocket guide was guided by Malcolm Knowles’ adult learning theory and developed by evaluating different pocket guides, the NPUAP website, and evidence based literature. The project employed an intervention, post intervention evaluation design. The sample was drawn from nurse members of the Pressure Ulcer Prevalence Committee at the Miriam Hospital in Providence, RI. Nurse members of the committee who agreed to participate utilized the Pressure Ulcer Assessment and Documentation Pocket Guide to assess patients during the monthly meeting and then completed an evaluation. The guide was evaluated as being valuable in assessing and documenting pressure ulcers and it was recommended for distribution to staff nurses. Use of the tool has the potential to improve assessment, identification, and documentation of pressure ulcers. Implications for advanced practice are discussed
Perceived Barriers to Health Promotion Behavior of Women in Early Recovery from Alcohol Use Disorder
Get PDFWomen with Alcohol Use Disorder (AUD) have a higher risk of chronic illness and a mortality rate that is 50 to 100% greater than men’s (National Institute on Alcohol Abuse and Alcoholism, 2008). Lifestyle changes in the recovery from AUD include adopting behaviors that foster health and identifying women’s barriers to health promotion behavior is important to fostering a healthy lifestyle. The purpose of this study was to explore perceived barriers to health promotion behavior of women in early recovery from AUD. Participants were women (N = 50) who attended 12-step recovery meetings for alcoholism, of which: 86% were 26 to 57 years old; 72% had greater than a ten year history of consumption; 80% had less than six months of sobriety; 50% had relapsed three or more times. Results indicated some women perceived certain barriers to be very troublesome but generally barriers were only a moderate challenge. Greatest perceived barriers cited were financial aspects, fatigue, time management issues, selfefficacy concerns, and communication difficulties. Implications for practice include conducting research on the nature of the most concerning barriers and the impact that severity of disease, culture, ethnicity, or demographics has on these barriers. Increasing awareness of women’s barriers, lobbying and supporting policies and systems processes that reduce barriers and support access to preventative services, early intervention, gender specific programs, and addressing patient-specific barriers will improve outcomes. Utilizing a comprehensive approach will have the greatest impact on the health promotion behaviors of individuals and the population health status of women with AUD
Disparities Between Men and Women in the Time of Initial EKG Acquisition
Get PDFCardiovascular disease is the most common cause of death around the world. Initial treatment is often time dependent. An EKG is the single most important initial clinical test to diagnose acute myocardial infarctions. Recognizing acute coronary symptoms in the initial presentation to an emergency department is critical in order to obtain the initial EKG. Of concern is the likelihood of delay in the initial EKG acquisition for females. The purpose of the research study was to distinguish if there is a disparity between genders to the best practice of door to EKG in 10 minutes from the arrival time in the Emergency department. A retrospective chart review was conducted with a total of 60 charts consisting of 30 females and 30 males who experienced an AMI. The time of initial arrival to the ED and initial EKG acquisition were compared. Results demonstrated that the initial EKG acquisition was shorter for males, average of 15 minutes as compared to females, average of 18 minutes. The data also demonstrated that only 32% (n=19) of patients had an initial EKG in 10 minutes or less and 68% (n=41) in greater than 10 minutes. Average age of females was 72 compared to males at 62. Thirty seven percent (n=22) of the patients presented with a chief complaint other than chest pain. Further research is indicated to determine reasons for delay in initial EKG acquisition between genders
Exploring the Mitigating Effects of Early Somatosensory (Tactile) Stimulation and Acoustic Discrimination Experience in Neonatal Hypoxic-Ischemic Male Rats
Get PDFThe focus of this study was to determine the effects of early somatosensory (tactile) stimulation and acoustic discrimination experiences in hypoxic-ischemic (HI) male rats on long-term behaviors, learning sensory, and brain weight outcomes. 58 Wistar rats were randomly assigned to one of the three conditions: no stimulation, somatosensory stimulation and auditory stimulation. To observe the effects of the early life stimulation on adult behavioral measures, the following testing was performed: analysis of exploratory behavior, acoustic discrimination, spatial/memory learning, and brain weight. Overall we hypothesized that somatosensory and auditory interventions earlier in life would have beneficial effect on subjects’ performance in all the testing. Results suggested that tactile and auditory stimulation in early life did not have any significant beneficial effects on improving spatial learning, auditory processing or exploratory behavior in HI and sham subjects. However, some beneficial effect was found in the spatial memory task but only for the tactile HI and auditory sham group