Select 2 client whom you observed or counseled this week. Then, address the following in your Practicum Journal: Describe the client (without violating HIPAA regulations) and identify any pertinent hi

Select 2 client whom you observed or counseled this week. Then, address the following in your Practicum Journal: Describe the client (without violating HIPAA regulations) and identify any pertinent hi
Running head: WEEK 5 and 6 JOURNAL ENTRY Week 7 Journal Entry NURS 6640: Psychotherapy with Individuals Dr. Abrahams July 5, 2019 Week 6 Journal Entry 1 Client Information The client is a 28 -year old Caucasian male army veteran with an anxious appearance, and he dressed appropriately for his age. He worked in a body shop as a mechanic and experienced a recent death with his younger brother. The younger brother committed suicide, and he is experiencing the anger stage in stages of grief. He mentioned when he gets anxious or depressed a sense of anger rushes inside him, which he can control most of the time. His anxiety and depression have affected his work since he arrived to work late a few times. He was recently written at work up for being tardy, even though he called in that he was running late. He approached his supervisor about the situation in an assertive calmly manner and found that the manager was not too receptive of his explanation. Therefore, he opened up with the manager about his recent loss and his struggle with post-traumatic stress disorder since he was discharged from the military. The supervisor was able to empathize with the veteran about the loss and mentioned he would take back the write up for being tardy from his record. The client has goals he would like to achieve and is an avid bodybuilder and enjoys working on vehicles of all types. He was excited to report he has been six months alcohol-free, and also mentioned he does not want to take any medications. He recently received a medical marijuana card and started using at the recommendation of his psychiatrist and has noticed it is helping with his moods at night and sleep. He has no thoughts of suicide or thoughts of harming anyone else. Diagnosis The diagnosis I gave the client using the criteria in the DSM-5 is Posttraumatic Stress Disorder (PTSD) 309.81 (F43.10). The criteria for PTSD is witnessing a traumatic event, sleep disturbances, and a decrease in the desire with certain activities they once enjoyed (APA, 2013). The client saw his bother shooting himself in the head three months ago and cycles between anxiety and depression. He catches himself bargaining with his thoughts on things he could have done to prevent the experience. The traumatic experience has affected his appetite and sleep patterns to the point he stopped exercising for about four weeks. However, he noticed he needs weight lifting to distract himself from his thoughts and feelings and recently started up again. According to Wheeler (2014), symptoms of PTSD must be present for a minimum of one month after the traumatic event with varying duration of symptoms depending on the individual. Therapeutic Approach Practitioners need to be able to assess and treat clients with PTSD since many individuals have experienced life-changing traumatic experiences. Cognitive-behavioral therapy (CBT) is the treatment of choice with exposure therapy producing the most efficient results in improving symptoms. Researchers have seen the most improvements once 40 minutes or more of prolonged exposure (Kerin, 2018). There is a multiple steps process for the practitioner to successfully implement prolonged exposure therapy. The steps range from developing an alliance, ID the trauma, collaboration with the therapist, processing memories, and so on. (Ghafoori & Shahrzad, 2012). The goal is to decrease sensitivities to thoughts or situations that can cause fear to debilitate everyday experiences. Hence, repeatedly exposing the individual to the fear causing stressor can lead to overcoming the fear itself. Legal and Ethical Implications Treatment options must be explained in a precise manner to the client with the collaborative setting of goals that will be obtained. According to Wheeler (2014) clients should be advised about their rights and confidentiality in the treatment process and be given a contract to sign which includes this information., Mental health professional need to know both the professional and legal ethics that direct their practice and should commit to memory. Such values and standards. (Cottone & Tarvydas, 2016). As a practitioner, it is essential to have the wisdom and knowledge to avoid unethical and inept practices that put the client at risk. Therefore, the practitioner should stay updated with the latest research in the treatment of the mental health diagnosis while collaborating with the client. References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). Arlington, VA: American Psychiatric Publishing. Cottone, R., & Tarvydas, . M. (2016). Ethics and Decision Making in Counseling and Psychotherapy (4 ed.). New York, NY: Springer Publishing Company.  Ghafoori, B., & Shahrzad, D. (2012). Training Student Therapists in Prolonged Exposure Therapy: A Case Study Demonstrating Teaching, Supervising, and Learning a Trauma Focused Treatment. Traumatology, 184(2), 72-78. Kerin, U. (2018). Exposure-based cognitive behavioural therapy is effective in reducing post-traumatic stress disorder severity in emergency service personnel. Evidence-based nursing, 22(2). http://dx.doi.org/http://dx.doi.org.ezp.waldenulibrary.org/10.1136/ebnurs-2018-103004 Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2 nd ed.). New York, NY: Springer Publishing Company. Week 6 Journal Entry 2 Client A 29-year-old veteran male came into clinic reporting symptoms of anxiety and depression. He was referred by his primary care physician who he sees for back pain due to a herniated disc. He has complained of having panic attacks and feelings of depression, which have led to thoughts of suicide in the past. He mentioned he no longer has those feelings and is eager to get better. He also said that he would like to start taking psychiatric medications as well. So, he would like to get referred to a psychiatrist for a medication evaluation. The client is married and the father of two small children. He mentioned that he goes for walks, which has helped him alleviate his anxiety at certain times. He also has sleep problems which are leading to night terrors and is affecting his relationship with his wife. He grew up in a well-adjusted home with both parents present for all his school and sporting events. He is going to school to finish up his bachelor’s degree, and currently in between jobs. He has flashbacks that lead to anxiety from a traumatic event that happened in Afghanistan when he was deployed. He is a security surveillance supervisor in charge of a few soldiers. He has guilt over an incident where he was not present, and a suicide bomber when into the base and killed a few soldiers and injured a few others. The event is being played in his mind over and over and has thoughts if he was present, he could have prevented the incident. The veteran is not currently taking medications but is open to the possibilities. Therefore, he would like to talk to a psychiatrist about a medication treatment plan that would benefit him without any adverse effects. DSM-5 The veteran displayed feelings of worry apprehension and muscular tension. The anxiety has been for over a year, which has led to panic attacks. The client has feelings of excessive worrying, which leads to believe he has a generalized anxiety disorder (GAD) (Hobbs, 2010). Since the panic attack has only been once it too early to assume he has a panic disorder. Motivational Interviewing Motivational interviewing is an especially useful therapeutic approach designed to change behavioral problems through active listening (Wheeler, 2014). The practitioner listens to the client while reflecting thoughts and emotions to the client. The practitioner’s goal is to move the client through the stages of change while addressing ambivalence to gain perspective. According to Wheeler (2014), motivational interviewing can be a stand-alone therapy or be used in conjunction with other treatments to achieve outcomes. The young veteran could benefit from motivational interviewing, along with cognitive behavioral therapy. Motivational interviewing can be used to minimize patient resistance, discuss the pros/cons to change while helping identify the barriers that are holding the client back from change (Chemack et al., 2018). The goal is to elicit a “change talk,” which leads to the client moving through the stages of change. Ethical and Legal Implications To achieve these access/quality goals, APPN policy initiatives must address regulatory barriers. Inconsistent regulatory oversight of APNs is associated with poor access to safe and effective health care services (Hanrahan, Delaney, & Merwin, 2010). I live in a state where provider shortages are present, and prescriptive authority is allowed for advanced practice nurses.By addressing the shortage, it will allow for increased access to the underserved. Patients have the right to exercise choice when deciding to participate in treatment programs. Nevertheless, the practitioner needs to be aware of the patient’s safety when the client chooses to participate in treatments. References Chemack, S., Boner, E. E., Goldstick, J. E., Winters, J., Blow, F. C., Friday, S., & Ligen, M. A. (2018). A randomized controlled trial for aggression and substance use involvement among Veterans: Impact of combining Motivational Interviewing, Cognitive Behavioral Treatment and telephone-based Continuing Care. Journal of Substance Abuse Treatment. http://dx.doi.org/10.1016/j.jsat.2019.01.001 Hanrahan, N. P., Delaney, K., & Merwin, E. (2010). Health Care Reform and the Federal Transformation Initiatives: Capitalizing on the Potential of Advanced Practice Psychiatric Nurses. Policy, Politics, & Nursing Practice, 1(3), 235-244. Hobbs, A. G. (2010). The effect of the draft DSM-5 criteria for GAD on prevalence and severity. Australian & New Zealand Journal of Psychiatry, 44(9), 784-790. Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

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