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Mental Health: Recovery Principles & Clinical Recovery

Introduction

The concept of recovery oriented practice has increasingly become a prominent concept in mental health policy internationally. This notion originated from consumer perspectives that challenged traditional beliefs about course of mental health disorders and the effective treatment strategies, and it has become widely conceptualized that recovery oriented care is a deeply unique process that changes a person’s attitudes, feelings, values, goals and skills with the aim of improving life limitations caused by the mental illness (Doran et al., 2015). Using Janet’s case study Version 1 and Version 2, this essay expounds on the concept of recovery oriented care by focusing on recovery principles; and elaborating how mental health recovery principles differ from clinical recovery principles.

Recovery principles

Recovery principles refer to the collective approach used to respond to the mental health distress by supporting empowerment, autonomy and retention of hope. Fundamentally, the recovery principles focus on the benefit of acknowledging a person as a whole instead of defining them by their deficits or difficulties (Evans et al., 2017).

In this context, recovery is supported through the implementation of collaborative and consultative treatment strategies to people with mental health issues. These strategies place the client at the center of care and emphasize on individuals strengths to support their self determination.

The recovery principles are core to the professional standards for Australian and New Zealand mental health includes uniqueness of an individual, autonomy, rights and attitude of their carers, treating mentally ill people with dignity and respect, collaborative care enhanced through effective communication (Mental Health Commission, 2012).

Based on recovery principles, helping patients who experience mental health issues with psychotic clinical issues, such as bipolar disorder and schizophrenia, requires a range of skills and attitudes that are developed from sound knowledge foundation as well as inquisitive approach. The core recovery principle in this group of attributes is the ability to establish a respectful support and collaborative relationship (therapeutic alliance) with the client, their relatives, friends and their loved ones (Slade et al., 2014).

The main challenge for clinical practice during the recovery paradigm is the capacity to remain responsive to the patient’s change and family/loved ones concerns. However, this is vital because client’s capacity to exercise autonomy during decision making may fluctuate over time. For instance, the client may change their desired treatment approach frequently or the client’s family may hold different opinions about the best treatment.

Therefore, the recovery principles enable the provider to develop the capacity to ‘be with’ instead of insisting on the standard clinical practice. For instance, in Janet’s Case study Version 2, “the psychiatrist was happy to reduce drugs after 10 days when Janet told her how horrible they were” (O’Hagan, 2014, p.227).

From this analysis, the healthcare provider should understand their own feelings and values to this practice. This is because their personal ethical beliefs and values could make them to inadvertently exhibit judgmental behaviors which could compromise care. The mental health care providers should perform rigorous and regular clinical supervision so as to retain clarity in nursing practice (Evans, Nizette, & O’Brien, 2017).

Clinical supervision is one of the recovery principle recognized as professional standard for Australian as well and New Zealand mental health nurses. In addition, it is evident that recovery principles are based on reflective care that is not influenced by the individual’s personal values or ethics. These principles emphasize on self determination and collaborative partnership.

For instance, in Janet’s case study version 2,Through collaborative treatment approaches, Janet was able to overcome the sexual abuse trauma; she is better, and now works as a mental health nurse, where she uses her experience to guide other mentally ill patient (O’Hagan, 2017, p.228).

The difference between recovery principles and clinical recovery

Recovery can be viewed through different lenses – personal experience (set of workforce competencies/practices) or clinical recovery process. This personal recovery approach is viewed as the post institutional service philosophy because it challenges the bedrock of traditional mental health system (Barder, 2012).

Clinical recovery is a concept that emerged from the expertise of mental health care providers, and it entails treating of psychosocial symptoms so as to restore functioning or to bring back the patient’s life back to normal. Recovery principle differs in clinical recovery in that the concept emerged from expertise of people who have lived the experienced or mental illness (Hapell et al., 2013).

On the other hand, recovery principle dwells on a deep unique change of a person’s values, attitudes and feelings with the aim of living a satisfactory life within the daily life limitations associated with the illness. It is basically creating a new purpose and meaning in client’s life as she or he grows beyond the catastrophic event associated with the mental illness (Williams et al., 2012).

As depicted in Janet case study Version 1, the traditional healthcare system perceives mental illness with no legitimacy. Most clients experience major mental health issues as frightening, desolate and also destructive. This is because the pain in mentally ill clients is at par with grief and torture of surviving a battle field or that of being accused of heinous crime (Leah, 2012).

The only difference is that the latter experiences have legitimacy and the society has a well defined pathway for their justice and recovery; and surviving them is perceived as heroic and is admirable. On the other hand, mental health is met with fear, reproach and pity.

Unlike clinical recovery, recovery principles recognize the importance of person recovery in that mental illness is perceived as a full human experience; therefore, it does not support justification for segregation, cruelty and coercion. A society that has person recovery mind concepts has place for people with mental health illness because seeks to provide a better pathway to better life (O’Hagan, 2014).

Another aspect of clinical recovery that acts as bedrock of the unfortunate traditional belief is community’s abdication of responsibility for the mentally ill people to the profession and services. In the current society, people seek answers to human problems from state- authorized profession institutions.

Although to some extent this has been of benefit, it is associated with overdependence of deficit oriented institutions and professionals. Their reputed monopoly on expertise has disabled the mentally ill clients by keeping the stuck in the healthcare services as indicated by Janet’s case study version 1, “the mental health system is responsible for the Janet’s terrible state (O’Hagan, 2014, p. 224).

The devaluation of mental illness in conjunction with community abdication has is associated with naïve community consensus around client’s safety, which is based on discriminative assumption that mentally ill people are not responsible of their behavior, and that the mental health institutions and services must take responsibility of their behavior through tightly controlled approaches (Gilburt et al., 2013).

The clinical recovery approach develops unsustainable assumptions that mentally ill persons must be controlled like robots; they lack freewill and those mental health institutions and professionals have magical powers to predict and that the strict measures towards the mentally ill people is meant to establish a safer community.

Unfortunately, the unrealistic demands have led to increase in risk adverse practices such as liberty restrictions, locked doors and compulsory treatment just as those experienced by Janet Version 1 case study (Berglund, 2012; Ivey et al., 2012).

Clinical recovery is important, but focusing on clinical recovery alone makes the patient to feel defined by their mental health problem, thereby exacerbating the problem. This approach also makes a person to neglect other aspects of lives that could be cultivated and potentially lead to improved wellbeing (Evans & Brown, 2012).

Most of the clinicians identify mental illness experiences such as hearing voices a focus of clinical recovery, which not only make it problematic, but also leads to waste or resources in order to get rid of personal idiosyncrasies that otherwise would be the patient’s assets if well understood and work with using the best approaches possible.

On the contrary, the recovery principles of the mental health service seek to design treatment strategies for mental illness is that does not only keeping people out of acute crisis so that they can lessen their dependency and burden to the community. The strategies contemplate the possibility of holistic recovery instead of focusing on clinical issues only, which in most cases could be resolved (Le Boutillier et al., 2015).

Conclusion

Mentally ill people are human beings too; they have rights as other citizens and must be allowed to participate in their local communities. To ensure that the mentally ill patients are socially included in the community’s daily life, the society and mental health professions will be required to change their traditional beliefs and unfortunate assumptions about mental health. In this context, the final frontier is eradicating the barriers that prevent people from experiencing their entitlements as the other citizens.

This involves transformation of “treat clinical symptoms- and recover” world view. In addition, the mental health systems should give priorities to treatments strategies that help the mentally ill patient to continue re-engaging with their life. However, the most important and the broadest challenge is the societal change.

This implies that the mental health professionals should collaborate with people with lived experienced of mental illness to become partners and social activists who challenge the erroneous stigmatizing assumptions associated with mentally ill people which prohibits them from enjoying the same citizenship entitlements as other people in the community.

References

Barder, M.E.(2012). Recovery as the new medical model for psychiatry. Psychiatr Serv 63 (3) 277-279

Berglund, C. A. (2012). Enter the patient. In C. A. Berglund (Ed.), Ethics for health care (4th ed.) (pp.71-97). South Melbourne, Vic: Oxford University Press

Doran, E., Fleming, J., Jordens, C., Stewart, C. L., Letts, J., & Kerridge, I. H. (2015). Managing ethical issues in patient care and the need for clinical ethics support. Australian Health Review, 39(1), 44-50. doi: 10.1071/AH14034

Evans, K., Nizette, D. & O’Brien, A. (2017). Psychiatric and mental health nursing (4th ed.). Chatswood, NSW: Elsevier Australia.

Edwards, K-L., Munro, I., Welch, A. & Robins, A. (2014) Mental Health Nursing: Dimensions of Praxis. (2nd ed) South Melbourne: Oxford University Press.

Evans, J., & Brown, P. (2012). Videbeck’s Mental Health Nursing. Sydney: Lippincott Williams & Wilkins.

Gilburt, H., Slade, M., Bird, V., Oduola, S., & Craig, T. K. (2013). Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study. BMC psychiatry, 13(1), 167.

Happell, B., Cowin, L., Roper, C. & Lakeman, R. & Cox, L. (2013). Introducing mental health nursing: A service user-orientated approach (2nd Ed). Crow’s Nest, NSW: Allen & Unwin.

Ivey, A., Ivey, M. & Zalaquett, C. with Quirk, K., (2012) Essentials of intentional interviewing: Counselling in a multicultural world (3rd ed). Belmont, USA:Brooks/Cole Cengage Learning.

Jones, K., & Creedy, D. (2012). Health and human behaviour (3rd ed.). South Melbourne, Vic: Oxford University Press.

Leahy, R. (2012) (Ed). Treatment plans and interventions for depression and anxiety disorders (2nd ed). New York; London: Guilford Press

Le Boutillier, C., Chevalier, A., Lawrence, V., Leamy, M., Bird, V. J., Macpherson, R., … & Slade, M. (2015). Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implementation Science, 10(1), 87.

Mental Health Commission. (2012). Blueprint II: Improving mental health and wellbeing for all New Zealanders: How things need to be. Wellington: Mental Health Commission, 52.

O’Hagan, M. (2014). Madness made me: a memoir. New Zealand: Open Box/Potton & Burton.

Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., Perkins, R., Shepherd, G., Tse, S. and Whitley, R. (2014), Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry, 13: 12–20. doi:10.1002/wps.20084

Williams, J., Leamy, M., Bird, V., Harding, C., Larsen, J., Le Boutillier, C., … & Slade, M. (2012). Measures of the recovery orientation of mental health services: systematic review. Social psychiatry and psychiatric epidemiology, 47(11), 1827-1835.

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Rentall Trucks Case Study

Introduction

This paper will provide an analysis of the case study of Rentall Trucks using Markov Analysis. The problem statement of the case is about legal issues that surrounded the operation of two main competitors in the truck renting industry Rentall and Rentran. The scope of a problem is the extent of perception, action or inquiry of a concept. In our case study, the scope is an omission in the contracts leading to the sale of Rentall Trucks that could cost the firm millions of dollars according to Jim Fox. (Render, Stair, R. Hanna, & Hale 2015). The critical decision issues to be addressed by Rentall Trucks include how to increase the competitive edge and maintain a large market share in the industry.

Analysis

One of the critical elements of the Rentall Trucks case is the fact that during its sale, the contracted law firm omitted a clause that would prove costly in the long-run. Folley, Smith and Christensen failed to include a clause that would prevent Bob Renton from competing directly with the firm. This led to the creation of Rentran. The case provides another critical element in which Rentall faces stiff competition from Rentran, despite the fact that it is only a few months into its operations.

In six months, Bob has succeeded in convincing and poaching a number of key executives from Rentall into his company, Rentran. The firm managed to acquire a market share of approximately 5% in the first few months of its operation while Rentall had 80% and National rentals, another competitor, had 15% (Render, Stair, R. Hanna, & Hale 2015). The Market share determines the portion of a market controlled by a particular firm (Rego, Morgan, & Fornell, 2013).

It is the percentage of total sales in a given market earned by a company (Gale, 2014). Pete Rosen, the president of Rentall Trucks, got concerned about the situation and decided to conduct research to determine future projections of the firm and the market. His concerns were that his firm would be incapable of maintaining 50% of the market in the future.

The case has provided a clear set of facts on the current scenario facing the firms. These facts were established after a research company hired by Pete Rosen conducted an analysis on truck rental customers. The sample size was 1000 potential and existing customers. Of these, 800 were Rentall customers, while 60 and 140 were Rentran and National customers respectively. After one month, the sample was analyzed again.

It was found that 200 Rentall customers switched to Rentran, 80 switched to National, 3 Rentran customers switched to rental, six switched to National, and finally, 14 National customers switched to Rentall and 35 to Rentran (Render, Stair, R. Hanna, & Hale 2015). An in-depth review of the essential issues is offered by these facts.

Solution

In addressing the main points outlined in the case, various recommendations are needed to solve the problem statement. According to Jim Fox, Rentall Trucks could do nothing to correct the problem of the costly contract omission by the law firm Folley, Smith, and Christensen. The only applicable solution would be to formulate and implement effective business strategies.

These strategies would provide a framework through which counter measures would be adopted to prevent Rentran’s activities and market advancements. The policies adopted would be to curb Rentran’s ability to lure away both customers and investors from Rentall. Three areas would require to be reviewed and appropriate changes made. These areas are advertising, rental policy, and product line.

The issue of rental policies would require that truck rental business is made easier and faster. This would necessitate the implementation of some of the policies used by car rental agencies like Hertz. To attract more customers, changes in the product line would have to include comfortable and easy to drive trucks, trucks fitted with automatic transmission, air conditioners, quality radio and stereo tape systems, comfortable bucket seats and cruise control (Render, Stair, Hanna, & Hale 2015). Zenetti and Klapper (2016), state that advertising promotes sales by influencing the behavior of potential customers.

This showed that additional advertising was required to be aggressive and immediate. A good company had to be contracted and advertising in journals and the television increased. Implementation of these strategies would give Rentall Trucks a chance of maintaining their close to 80% market share. Changes in the advertising strategy would ensure that a bigger target audience is reached and their market behavior influenced to opt for Rentall Truck products and services. This would increase the number of new customers. On the other hand, changes in the product line and rental policies would help maintain a loyal customer base for the firm.

Justification

The recommended course of action is justifiable since policy makers and scholars alike agree to the effectiveness of the stated strategies. The above recommendations have been applied elsewhere and hence, are tried and tested. The justification for the recommendations is that:

1.) Advertising is a proven strategy to help convince more customers to trust the products and services being offered by a company as explained by Buil, Chernatony, & Martínez, (2013). Rentall Trucks is justified in increasing advertising, especially in television and journals.

2.) Changing a product line constitutes to rebranding. The strategy of rebranding helps a company in that it proves to doubtful customers that the brand has reinvented itself andwill, therefore, be in a position to satisfy their tastes and preferences more that before (Todor, 2014). To Rentall Trucks, changes in the product line will ensure that those customers who had switched to their rivals are more convinced about its service and product quality and will be motivated to switch back.

3.) Reviewing of rental policies will revolutionize the whole industry. This is due to the fact that if Rentall are successful in simplifying the processes involved in renting trucks, they will set a standard to be followed by all competitors. Setting standards will make them stand out as market leaders and will therefore have that largest market share.

Summary

This case study provided a case scenario of Rentall Truck Company seeking to gain a competitive advantage over its competitors, Rentran and National. The companies were competing for the market share in the truck renting industry. Rentall faced stiff competition from Rentran, a company owned by its former founder. They found themselves in this situation due to a blunder of omission of an important clause in its contacts. To retain its customers, Rentall recommended changes in its advertising strategies, product line and rental policies. The strategies were justifiable through since they were tried and tested. The justification was further improved by the market research conducted by Meyers Marketing Research firm.

Calculations

1. What will the market shares be in one month if these changes are made? If no changes are made

Rentall – π_{1 =}0.8

Rentran – π_{2 =}0.06

National Rentals – π_{1 =}0.14

Tree diagram (Month 1 with no change)

0.65 0.25 0.1

P = 0.05 0.85 0.1

0.65 0.25 0.1

π (1) = π (0)P

0.65 0.25 0.1

= (0.8, 0.06, 0.14) 0.05 0.85 0.1

0.65 0.25 0.1

= 0.52+0.003+0.091, 0.2+0.051+0.035, 0.08+0.006+0.014

= 0.6, 0.29, 0.1

= 60% 29% 10%

Market share without the changes will be:

60% for Rentall

29% for Rentran

10% for National Rentals

Tree diagram (Month 1 with change)

0.85 0.125 0.025

P = 0.15 0.75 0.1

0.2 0.25 0.55

π (1) = π (0)P

0.85 0.125 0.025

= (0.8, 0.06, 0.14) 0.15 0.75 0.1

0.2 0.25 0.55

= 0.68+0.009+0.028, 0.1+0.045+0.035, 0.02+0.014+0.077

0.72, 0.18, 0.1

72%. 18%, 10%

Market share without the changes will be:

72% for Rentall

18% for Rentran

10% for National Rentals

This shows that Rentall will have a larger market share if the actions suggested are implemented. Rentall’s market share will remain high while Rentran will grow at a slower rate. National Rental’s market share remains the same.

2. What will the market share be in three months with the changes?

π (n) = π (0)Pⁿ

π (3) = π (0)P³

0.61 0.002 0.00002 3

(0.8, 0.06, 0.14) 0.003 0.42 0.001

0.008 0.27 0.17

= 0.6, 0.3, 0.1

Market share after 3 months will be:

60% for Rentall

30% for Rentran

10% for National Rentals

3. If market share remains the same, what market share will Rentall have in the long-run?Ho does this compare to if the changes were not made.

If the market conditions remain the same, the market share for Rentall in the long-run would keep reducing, though at a lower magnitude than if Rentall did not make the changes. The new market shares are shown in the tables below. The market share moves from 80% to 72% in month 1 to 66 % in month 2, 61% in month 3, 58% in month 4 and 56% in month 5.

If the changes were not made, Rentall’s market share would have deteriorated quite fact, moving from 80% to 61% in month 1, 48% in month 2, 40% in month 3, 35% in month 4 and 32% in month 5. This would be a significant loss to Rentran, which would have 58% of the market by the fifth month. Therefore, it can be concluded that the changes will reduce the rate at which the company loses its market share to Rentran. However, Rentall still continues to lose its market share and better strategies are required to enhance competitiveness.

After Change (Excel calculation)
Probabilities			Current Market share
0.85	0.15	0.2		0.8
0.125	0.75	0.25		0.06
0.025	0.1	0.55		0.14

Market share
		Month 1	Month 2	Month 3	Month 4	Month 5
Rentall	0.72	0.66	0.61	0.58	0.56
Rentran	0.18	0.25	0.29	0.32	0.34
National	0.10	0.09	0.09	0.10	0.10

Before Change (Excel calculation)
Probabilities			Current Market share
0.65	0.05	0.65		0.8
0.25	0.85	0.25		0.06
0.1	0.1	0.1		0.14

Market share
		Month 1	Month 2	Month 3	Month 4	Month 5
Rentall	0.61	0.48	0.40	0.35	0.32
Rentran	0.29	0.42	0.50	0.55	0.58
National	0.10	0.10	0.10	0.10	0.10

Reference

Buil, I., De Chernatony, L., & Martínez, E. (2013). Examining the role of advertising and sales promotions in brand equity creation. Journal of Business Research, 66(1), 115-122.

Gale, . (2014). Market share reporter. Place of publication not identified: Gale, Cengage Learning.

Rego, L. L., Morgan, N. A., & Fornell, C. (2013). Reexamining the market share–customer satisfaction relationship. Journal of Marketing, 77(5), 1-20.

Render, B., Stair, R. M., Hanna, M. E. & Hale T. S. (2015). Quantitative analysis for management. (12^thed.). Upper Saddle River, NJ: Pearson.

Todor, R. D. (2014). The importance of branding and rebranding for strategic marketing. Bulletin of the Transilvania University of Brasov. Economic Sciences. Series V, 7(2), 59.

Zenetti, G., & Klapper, D. (2016). Advertising Effects Under Consumer Heterogeneity–The Moderating Role of Brand Experience, Advertising Recall and Attitude. Journal of Retailing, 92(3), 352-372.

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Primary Health Care Organizations in Georgia

Organizations that deliver primary health care here include Georgia’s Voice to end Breast Cancer, Georgia Public Health Association, Georgia Advocacy Office and Georgia Charitable Care Network among others.

Georgia’s Voice to end Breast Cancer is an organization founded by breast cancer survivors. Their focus is helping the people of Georgia put to an end the devastating disease cancer. They want to make a difference to about eight thousand Georgians who are yearly diagnosed with breast cancer (Kohler et al., 2015). They receive funding from collaborations with National Breast Cancer Coalition and individuals who were willing.

Georgia Public Health Association is a non-profit organization started in the role of promoting the public and personal health of the people of Georgia. It provides training, technical help and strategies to expand Federally Qualified Health Centers. Joining this organization gives one access to other health professionals, scholarships, recognition awards and opportunities for continuing education. Georgia Public Health Association receives most of its funding from government grants (Murray et al., 2013). This organization has for sure improved the environmental and personal health conditions of Georgia.

Georgia Advocacy Office is yet another organization that delivers primary health care in Georgia. They provide an array of services to people with disabilities in Georgia (Livermore, 2015). Examples are Investigation of an allegation of abuse, neglect, or violation of rights, assistance in negotiation on behalf of individuals and multicultural outreach to underserved or unserved persons with disabilities. Donations and grants from individuals and corporations fund this organization’s activities.

Finally, Georgia Charitable Care Network was founded in 2003 as a clinic network to offer free medical services to the people of Georgia. It consisted of a network of compassionate caregivers. They work with communities interested in starting clinics and solicit funds to distribute to members. This care network gets its primary funds from individuals and private foundations. This organization has been of great value Georgians for providing easier access to medical facilities.

References

Kohler, B. A., Sherman, R. L., Howlader, N., Jemal, A., Ryerson, A. B., Henry, K. A., … & Henley, S. J. (2015). Annual report to the nation on the status of cancer, 1975-2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. Journal of the National Cancer Institute, 107(6), djv048.

Livermore, G. A., & Honeycutt, T. C. (2015). Employment and economic well-being of people with and without disabilities before and after the great recession. Journal of Disability Policy Studies, 26(2), 70-79.

Murray, C. J., Abraham, J., Ali, M. K., Alvarado, M., Atkinson, C., Baddour, L. M., … & Bolliger, I. (2013). The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Jama, 310(6), 591-606.

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Resuscitation: Case Study

Part 1: Code Blue educational video from the Regina Qu’Appelle Health Region.

Time sequence	Issue noted	code	comments
0-22 seconds	Breach of Australian Resuscitation Council Guidelines:	BARCG- Guideline 2 priorities in an emergency	Finds Mr. Smith unresponsive. Fails to follow the Guide 2 BLS algorithm because she failed to assess danger, but she assessed the airway, as she is seen checking for the escape of air from the patients mouth or nose as recommended by guide 5. Implications: Delay in resuscitation processes increases the risk of reduced cardiac output to the brain due to poor compressions.
Time 3.26	Poor technical skills	PTS – BARCG Guide 6 & 8	Chest compressions inadequate as recommended by Guide 6. The recommended chest compressions are 30 chest compressions followed by two breaths. The chest compressions are slow than required by Guide 8. “A good CPR should deliver chest compressions over the lower half of the sternum at a depth of 5 cm” (ARC guide 8). Long pauses in CPR before shock delivery. Guide 6 discourages long pauses and distractions during a CPR Implications: Long pauses, distractions, slow and inadequate chest compressions lower the chance of patient’s survival
Poor Non-Technical skills PNTS
Time 0.30	Situation awareness	PNTS- SA	The nurse did not press the emergency push button system to call for help immediately and instead used the overturn Implications: Delayed response by the code blue team
Time 0.30 secs Time 2.26 minutes	Decision making	PNTS- DM	Delay in full code response. The team arrived 2 minutes later after the call alert Implications: This led to delay important activities such as defibrillation. However, the rest of the decisions such as medication, hyperventilation and defibrillation activities went on well once the code blue captain arrived.
Time 3.36	Task management	PNTS-TM	Compressors for more than five cycles. One compressor was working for almost 5 minutes which is too long for a compressor. According to Guide 5, “the compressor roles approximately after 2 minutes or after five cycles of compressions and ventilations at a ratio of 30:2 so as to maintain the quality of compressions” (ARC guide 5). However, other task management processes such as airway positioning, nasopharyngeal airway placement, bag-valve mask ventilation were correctly performed.
Time 5.28 Time 12.55	Communication	PNTS- comm	Occasionally fails to use the closed up communication which leads to miscommunications. For instance, at minute 12.55, the recorder had missed recording the endotracheal tube particulars due to poor communication strategy. The team used the SBAR technique to report the patient’s medical history to the code blue team leader. All the information was recorded including all the medication administered and other CPR outcomes such as cardiac rhythm before a shock was delivered. This is vital for future references.
	Teamwork	PNTS-Team	No introduction was done by the team members, but they delegated the resuscitation duties appropriately. The team consisted of a coordinator, compressor nurse, airway manager, nurse in charge of defibrillator, captain/leader and crash cart manager.
	Leadership	PNTS- Leadership	The leader failed to evaluate the BLS on arrival. However, Mr. Sellinger (the code captain) performed his tasks effectively including identification of cardiac rhythm, initiation of ACLS protocol, and evaluation of the protocol reviewed the code blue documentation form and signed the code blue form after completing the code blue.

PART 2: Analysis of the issues covered

Code blue should be contacted immediately for all unresponsive patients. Calling for help and initiation for help should be done simultaneously. One of the issues identified in this case study is delayed in the response of code blue code due to poor call out systems. The code team member should call out loudly for help through the facility-wide response system. In this technology, the nurse should have pressed the Blue code push button to ensure that the code blue team were notified accordingly (Bayramoglu et al., 2013).

As the nurse in charge waits for code blue team, he or she should initiate CPR (Clarke, Apesoa-Varano, & Barton, 2016). The code team are expected to introduce themselves as they arrive as well as and their roles statements such as “Am Mr. J. and will take document” or “I’ll take the airway” which helps in ensuring there is clear role differentiation. The service user physician should be contacted immediately.

According to Price, Applegarth & Price (2012), the healthcare provider should first assess the patient dangers and risks before they start the air management. This was not done in the case study and violated the ARC guide four which states that the patient’s mouth should be opened and head slightly turned downwards to remove the airways (Australian Resuscitation Council, 2008).

An ineffective cough indicates a severe obstruction. In this case, if the patient is responsive, the healthcare provider should give about five back blows, and if still, it is ineffective, they should give at least five chest thrusts (McInnes et al., 2012). This article states that for all unresponsive patients, the healthcare should send for help and start CPR immediately. Similarly, guideline 5 recommends that all patients who are breathing abnormally or are unresponsive require being resuscitated.

The first thing when assessing breathing, the rescuers should check for movement around the chest (lower part) and abdomen (upper part). They should check for the exhalation through the patient’s oral cavity or nose, and feel the movement of air in the patient’s mouth or nose. The guide recommends a ratio of compressions to rescue breaths as 30:2 (Australian Resuscitation Council, 2008).

According to this article, the first nurse to respond should start saving the patient’s life by performing chest compressions immediately (100 compressions per minute). Although important, the nurse should not wait for backboard , they should start chest compressions as it can be put in place later when the code team arrives. The switching the compressor roles in the case study is present but it took quite a long time than that recommended by ARC guide 6 which is approximately after 2 minutes.

To maintain the quality, the ventilations ratio should be maintained at 30:2 (Castelao et al., 2013). This is supported by Guide 6 which recommends that interruptions to chest compressions should be minimized. The best location to perform the compressions is the sternum- the lower half part of it. The healthcare provider’s heel is placed at the central part of the chest and put the other hand on top it. The recommended rates of compressions are 100 to 120 compressions per minute which are about two compressions per second.

The guide also outlines on the quality of compressions ( which is identified as poor in the case study) where it suggests that depth of compressions should be “at least 2 inches (5cm) with complete chest recoil after every compression” this helps the heart to re-fill completely by the next round of compressions. The number of interruptions should be minimized to ensure maintain the quantity and quality of compressions (Eroglu et al., 2014).

According to the article, the patient should be given 2 ventilations for every 30 seconds of oxygen-bag-mask device assisted ventilation. The oxygen level should be set to the flow meter 15 L/min, and where applicable, the reservoir should be fully open ensure that the patient gets 100% oxygen for each breath. One strength observed in the study is the fact that bag-mask device is best done by two blue code team members where one open the airway to fasten the mask on whereas the second one squeezes the oxygen bag.

Also, the article states that defibrillation is very critical and that the use of placement hands-free defibrillation pads is a safer option than hands held defibrillation paddles (Girotra et al., 2012; Prince et al., 2014). The article states that the deployment of automated external defibrillators (AED) should be used as soon as possible as it reduces mortality and morbidity associated with cardiac arrest caused by either ventricular fibrillation or ventricular tachycardia (Australian Resuscitation Council, 2008).

The compressions should resume immediately after delivering shock even with a normal heart rhythm as it will not provide enough cardiac output that will ensure adequate perfusion. It is recommended that 2 minutes the cardiac rhythm should be assessed after 5 cycles of a CPR (Merchant et al., 2014). The use of vasopressors in cardiac arrest is recommended only when there are no high-quality CPR. It is important to be extra cautious when administering a drug. This is because miscommunication is a common issue which often leads in the administration of incorrect drug doses or medications.

This can be prevented by using “closed loop” method of communication (Segon et al., 2014; William et al., 2016). For instance, when a nurse receives an order to inject some medicine, they should repeat the information of drug prescribed out loud, inject it and then announce it again after administration (Price et al., 2012). This method was used in some instances, but in the instance that it was absent, the recorder was prone to miss out some key aspects; for example, in this code blue simulation, the recorder had missed recording the endotracheal tube measurements.

The article suggests that an effective code blue team should have leader who controls the all the procedures and efforts of resuscitation. They communicate with the staff involved and evaluate the cardiac rhythm of a patient. Mr. Sellinger is the team captain of the case study and was standing in a position such that he could effectively see all of the resuscitation procedures and efforts. If the organization allows, the family member can be allowed into the room. It is also important to ensure that the information is well recorded.

In the case study, the recorder is shown documenting all the resuscitation process. However, it is important to understand that documentation process is done according the healthcare facility’s policy (McEvoy et al., 2014; Sahin et al., 2016). The recorder should remind the code team when time for a specific task has elapsed and must record all the activities taking place including the medicines prescribed. The article also suggests that all clinical areas should grant quick access to equipment such as blood glucose, blood pressure, and equipment of pulse oximetry and other equipment so as to effectively manage a deteriorating patient (Clarke, Carolina Apesoa-Varano, & Barton, 2016).

Through this case study, it is evident code training programs using simulation is beneficial and has been recommended by various healthcare institution organizations since 1999. This training will help the learners to improve cardiac resuscitation outcomes as it offers an opportunity for regular hands-on practice within the hospitals. This also helps the team to understand the various roles and responsibilities expected during a full code. Along with continuing education and mock codes, the team members become confident in their responsibilities (Gutwirth, Williams, Boyle, & Allen, 2012).

References

Australian Resuscitation Council. (2008). Standards for Resuscitation: Clinical Practice and Education. Retrieved from http://www.resus.org.au/clinical_standards_for_resuscitation_march08.pdf

Bayramoglu, A., Cakir, Z. G., Akoz, A., Ozogul, B., Aslan, S., & Saritemur, M. (2013). Patient-Staff Safety Applications: The Evaluation of Blue Code Reports. The Eurasian Journal of Medicine, 45(3), 163–166. http://doi.org/10.5152/eajm.2013.34

Castelao, E. F., Russo, S. G., Riethmüller, M., & Boos, M. (2013). Effects of team coordination during cardiopulmonary resuscitation: A systematic review of the literature. Journal of critical care, 28(4), 504-521.

Clarke, S., Apesoa-Varano, E. C., & Barton, J. (2016). Code Blue: Methodology for a qualitative study of teamwork during simulated cardiac arrest. BMJ open, 6(1), e009259.

Eroglu, S. E., Onur, O., Urgan, O., Denizbasi, A., & Akoglu, H. (2014). Blue code: Is it a real emergency? World Journal of Emergency Medicine, 5(1), 20–23. http://doi.org/10.5847/wjem.j.issn.1920-8642.2014.01.003

Girotra, S., Nallamothu, B. K., Spertus, J. A., Li, Y., Krumholz, H. M., & Chan, P. S. (2012). Trends in Survival after In-Hospital Cardiac Arrest. The New England Journal of Medicine, 367(20), 1912–1920. http://doi.org/10.1056/NEJMoa1109148

Gutwirth, H., Williams, B., Boyle, M., & Allen, T. (2012). CPR compression depth and rate about physical exertion in paramedic students. Journal of Paramedic Practice, 4(2).

McEvoy, M. D., Field, L. C., Moore, H. E., Smalley, J. C., Nietert, P. J., & Scarbrough, S. (2014). The Effect of Adherence to ACLS Protocols on Survival of Event in the Setting of In-Hospital Cardiac Arrest. Resuscitation, 85(1), 10.1016/j.resuscitation.2013.09.019. http://doi.org/10.1016/j.resuscitation.2013.09.019

Merchant, R. M., Berg, R. A., Yang, L., Becker, L. B., Groeneveld, P. W., & Chan, P. S. (2014). Hospital Variation in Survival After In‐hospital Cardiac Arrest. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 3(1), e000400. http://doi.org/10.1161/JAHA.113.000400

McInnes, A. D., Sutton, R. M., Nishisaki, A., Niles, D., Leffelman, J., Boyle, L., … Nadkarni, V. M. (2012). The ability of code leaders to recall CPR quality errors during the resuscitation of older children and adolescents. Resuscitation, 83(12), 1462–1466. http://doi.org/10.1016/j.resuscitation.2012.05.010

Price, J. W., Applegarth, O., Vu, M., & Price, J. R. (2012). Code Blue Emergencies: A Team Task Analysis and Educational Initiative. Canadian Medical Education Journal, 3(1), e4–e20.

Prince, C. R., Hines, E. J., Chyou, P.-H., & Heegeman, D. J. (2014). Finding the Key to a Better Code: Code Team Restructure to Improve Performance and Outcomes. Clinical Medicine & Research, 12(1-2), 47–57. http://doi.org/10.3121/cmr.2014.1201

Segon, A., Ahmad, S., Segon, Y., Kumar, V., Friedman, H., & Ali, M. (2014). Effect of a Rapid Response Team on Patient Outcomes in a Community-Based Teaching Hospital. Journal of Graduate Medical Education, 6(1), 61–64. http://doi.org/10.4300/JGME-D-13-00165.1

Sahin, K. E., Ozdinc, O. Z., Yoldas, S., Goktay, A., & Dorak, S. (2016). Code Blue evaluation in children’s hospital. World Journal of Emergency Medicine, 7(3), 208–212. http://doi.org/10.5847/wjem.j.1920-8642.2016.03.008

Williams, K.-L., Rideout, J., Pritchett-Kelly, S., McDonald, M., Mullins-Richards, P., & Dubrowski, A. (2016). Mock Code: A Code Blue Scenario Requested by and Developed for Registered Nurses. Cureus, 8(12), e938. http://doi.org/10.7759/cureus.938

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Healthcare Delivery: Case Study

The Impact of Electronic Health Record (EHR) Systems on Healthcare Delivery in Australian Hospitals

Abstract

Variations in healthcare needs of today’s population compel modern healthcare organizations to change the manner in which they deliver healthcare. A good number of contemporary healthcare organizations have taken advantage of advancements in information technologies, and they increasingly integrate electronic health record (EHR) systems into healthcare delivery.

The current study aims at finding the impact of electronic health record systems on healthcare delivery in Australian healthcare organizations. The study will utilize a theoretical research approach that involves a review of records of selected companies in order to obtain relevant data. Findings obtained from this study will be used to advise modern healthcare organizations on some of the reasons why they should either adopt or avoid implementation of electronic health record systems.

The Impact of Electronic Health Record (EHR) Systems on Healthcare Delivery in Australian Hospitals

1.0 INTRODUCTION

With the rapid rate of advancements in information communication technologies, contemporary healthcare organizations have integrated electronic health record system into healthcare delivery to match healthcare needs of the current population (Zeng, 2016). An electronic health record (EHR) system is a computerized version of a patient’s health data, including past medical history, laboratory reports, vital symptoms, demographics, medications, and progress notes, that can be shared among healthcare practitioners within a healthcare organization (Bowman, 2013).

According to Gao, Sorwar, and Croll (2013), Australian healthcare industry began to consider electronic health record systems in 2000. Since then, many hospitals in the country have made an effort to develop and implement electronic health record systems. As opposed to the traditional paper records system, it is anticipated that electronic health record systems will enhance the quality of care, minimize medical errors, improve patient satisfaction, and reduce healthcare costs in Australian healthcare organizations (Gao, Sorwar, and Croll, 2013).

This proposal will direct a study on the impact of electronic health record systems on healthcare delivery in Australian hospitals. It provides a detailed analysis of existing body of literature on the study topic. Additionally, the paper outlines the procedures and processes that will be followed to gather data to answer the research question. It also highlights the relevance of the study approach as well as the implications of study findings.

1.1 Problem Identification

Traditionally, hospitals used to rely on paper records to keep important medical information of patients. Although clinicians used well-organized templates to document their patient’s health data, retrieving this information was sometimes difficult due to illegible handwriting. Furthermore, the handwritten information could not be shared among healthcare providers through computer systems.

Paper records were also easy to destroy, thereby resulting in loss of patient’s data. Advancements in information technology systems allow contemporary healthcare organizations to store patients’ medical data electronically to allow easy sharing and analysis. The number of hospitals which are implementing electronic health record systems is on the rise in today’s society due to the anticipated benefits of this new technological advancement.

In order to help Australian hospitals to evaluate the financial feasibility of implementing electronic health record systems, it is important to investigate and reveal the nature of impact that an electronic health record system has on healthcare delivery.

1.2 Significance of the Problem

An electronic health record system makes it much easier to track and retrieve patient data as compared to paper reviews. Availability of these systems in hospitals makes patient information available to authorized healthcare practitioners who may need it within the organization. For this reason, healthcare organizations that use electronic health record systems are highly likely to have a form of healthcare delivery that is different from those organizations that use paper records (Bowman, 2013).

1.3 Research Question

Have electronic health record systems improved healthcare delivery in Australian Hospitals?

1.4 Hypotheses

Alternate Hypothesis (H1): Electronic health record systems have improved healthcare delivery in Australian hospitals

Null Hypothesis (HO): Electronic health record systems have not improved healthcare delivery in Australian hospitals

1.5 Variables

Independent variable; an electronic health record system

Dependent variables; health care quality, medical errors, and patient safety

2.0 LITERATURE REVIEW

A number of studies have been performed with the aim of finding out the benefits of electronic health record systems as far as their influence on clinical outcomes is concerned. The main clinical outcomes that have been the center of focus in a large percentage of these studies are patient safety, healthcare quality, and medical errors (Menachemi and Collum, 2011). Healthcare quality is achieved when the healthcare provider delivers the right type of care, in the right manner, at the right time, and to the right patient, with the aim of having the best results possible.

In order to maximize patient safety, healthcare providers must avoid injuries for their clients and ensure that services offered are able to generate the intended help (Gao, Sorwar and Croll, 2013). As Gao, Sorwar and Croll (2013) explain, medical errors are minimized during care delivery when data is entered accurately and when there is clarity of medical records. According to Menachemi and Collum (2011), electronic health record systems generally minimize medical errors, improve health care quality, and enhance patient safety.

In a survey conducted across Australian health organizations in 2015, Australian Digital Health Agency revealed that electronic health records have got numerous benefits for healthcare providers which translate into improved healthcare delivery for patients. According to the Australian Digital Health Agency (2015), electronic health record systems enable healthcare providers to spend more time with their patients as they do not have to waste time looking for clinical information.

This gives patients an opportunity to share their important health information with health care providers thereby contributing to improved health care quality. Furthermore, healthcare providers in Australian health organizations which have implemented electronic health record systems are able to closely monitor their patients’ progress, including those with chronic health problems, while at the same time offering them necessary medical support. This helps patients to have a comprehensive understanding of their health problems (Australian Digital Health Agency, 2015).

Australia is one of the industrialized countries which support the integration of electronic health record systems into healthcare delivery. The version of electronic health record system which majorly operates in Australia is the Personality Controlled Electronic Health Record (PCEHR) system (Gao, Sorwar and Croll, 2013). The Australian public has demonstrated support for PCEHR system due to a number of benefits they have experienced since its adoption.

For instance, with PCEHR systems, patients can now have immediate access to their health information, easily track their prescriptions and medications, as well as make necessary changes to their health records. Basically, PCEHR system has helped Australian healthcare organizations to keep accurate patients’ health records, deliver the right care at the right time, and to maximize patient safety (Gao, Sorwar and Croll, 2013).

Several researchers agree that electronic medical systems are associated with reductions in medical errors in healthcare organizations because they improve the accuracy with which patients’ health data is maintained (Menachemi and Collum, 2011). In a study conducted by Bates, Leap, and Cullen (1998), an electronic health record system reduces medical errors in healthcare settings by approximately 50 percent.

In a similar study, Bowman (2013) found out that computerization of patients’ health data results into an error rate reduction of approximately 10 percent. These findings indicate that clarity and accuracy of medical records are greatly enhanced with the use of electronic health record systems in healthcare organizations.

Although electronic health record systems generate numerous benefits, healthcare organizations serious negative consequences by adopting the technology due to inappropriate design choice and careless use (Bowman, 2013). For instance, poor design choice of an electronic health record system will increase medical errors instead of reducing them. Additionally, poor use of the system may interfere with the integrity of data thereby endangering patient safety and decreasing the quality of care (Zeng, 2016).

In most instances, these are unintended consequences which may make an organization to face lawsuits and pay huge legal fines. As health information technology becomes increasingly involved in the delivery of care, healthcare organizations must be prepared to manage HIT-related risks which may damage their reputations if no appropriate actions are taken. The most appropriate ways through which such risks can be avoided are; choosing appropriate electronic health record system design, and ensuring proper use of the system (Sitting and Singh, 2011).

3.0 METHODOLOGY

The study will involve a detailed analysis of the impact of electronic health record systems on healthcare delivery in Australian hospitals. The first step of the study approach will involve selecting Australian health organizations which have already adopted electronic health record system. A list of this category of hospitals will be obtained from the Australian Public Health Database. Top 30 largest hospitals which have adopted the EHR systems will be used in the study.

The Chief Executive Officers of the selected organizations will be contacted via email in order to obtain an appointment to visit their organizations. The chosen healthcare organizations will be visited physically in order to obtain consent from them and to request usage of their health records for purposes of the study. During the visit, the Chief Executive Officers will be informed about the purpose of the study, the study objectives, how research findings will be used, benefits of taking part in the study, as well as the risks involved. Only those organizations that will agree with the provided terms will be used in the study.

Under the permission of Chief Executive Officers, health records and annual reports of the selected organizations will be reviewed. Changes in a number of factors will be recorded from when the selected companies used paper-based records to the period following adoption of the electronic health record systems.

Specific items which will be extracted from the health records include changes in; patients’ waiting time, the manner in which care is delivered, clarity of medical records, the accuracy of patients’ data, recovery period, readmission rates, and death rates. Similar data will be collected across all healthcare organizations which will have agreed to take part in the study. The collected data will be analyzed using Statistical Packages for Social Sciences (SPSS) software.

4.0 DISCUSSION

4.1 Relevance of the study approach

The proposed methodology is highly appropriate for this study because it will help in gathering data that will best answer the research question. A list of Australian healthcare organizations which have adopted electronic health record systems is found in country’s Public Health Database. The rationale behind selecting top 30 largest organizations in the list is the large volume of relevant data that these organizations can provide.

In addition, it is important to obtain consent from the Chief Executive Officers of the selected organizations due to high privacy concerns associated with the release of important health records. The Chief Executive Officers of the chosen health care organizations must be convinced that their health records will be used solely for purposes of research before they can allow anybody to access them.

The effectiveness of healthcare delivery in hospitals are best measured in terms of major clinical variables namely; quality of care, medical errors, and patient safety (Gao, Sorwar and Croll, 2013). The type of data collected during health records’ review can easily tell the degree of health care quality, medical errors, and patient safety in the selected hospitals. For instance, data related to changes in patients’ waiting time and the manner in which care is delivered will help the researcher to understand the quality of care in the selected organizations.

Data related to changes in clarity of medical records and accuracy of patients’ data will tell more about medical errors, while data related to changes in the recovery period, readmission rates, and death rates will inform the researcher more about patient safety in the selected hospitals. By analyzing the collected data using SPSS software, the researcher will be able to see the impact of electronic health record systems on healthcare delivery in Australian hospitals. This research approach will help the researcher to easily answer the research question.

4.2 Limitations of Methodology

The main limitation of the methodology is reviewing health records of only 30 hospitals. By limiting the data collection process to only top 30 hospitals which have already adopted electronic health record systems, the researcher may leave out other small hospitals which might have successfully adopted HER systems, and which may have better information than the organizations used.

The other limitation of the methodology is over-reliance on secondary data which is available in company records and annual reports. Conducting actual research would produce more accurate data because the validity of information available in company records might be questionable.

4.3 How the study findings may lead to further research

The proposed study focuses on how clinical factors may be impacted by the adoption of an electronic health record system. For instance, in the study, the researcher intends to evaluate how electronic health record system will impact health care quality, medical errors, and patient safety in Australian hospitals. Findings obtained from this study can guide further research on the impact of electric health record systems on organizational factors such as healthcare cost.

5.0 CONCLUSION

The number of Australian hospitals which are adopting electronic health record systems is on the rise. Australian healthcare organizations which are implementing electronic health record systems anticipate that the new technology will help them to improve the quality of care, minimize medical errors, improve patient satisfaction, and reduce healthcare costs.

Prior to spending a lot of money in the implementation of electronic health record systems, Australian healthcare organizations should be aware of the financial feasibility of implementing those systems. Making a decision of whether the approach is financially possible requires a comprehensive knowledge of the nature of impact that EHR systems will have on the quality of care, medical errors, and patient safety.

The proposed study intends to investigate whether electronic health records systems have improved healthcare delivery in Australian hospitals, by focusing on three variable; quality of care, medical errors, and patient safety. A comprehensive analysis of available literature has been conducted to show previous studies on the topic.

In addition, a methodology that will help to answer the research question has been identified. Findings obtained from this study will be used to advise modern healthcare organizations on some of the reasons why they should either adopt or avoid implementation of electronic health record systems.

References

Australian Digital Health Agency. (2015). Retrieved May 19, 2017, from https://www.digitalhealth.gov.au/get-started-with-digital-health/benefits

Bates, D., Leap, L. & Cullen, D. (1998). Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA, 280(15):1311-1316.

Bowman, S. (2013). Impact of electronic health record systems on information integrity: Quality and safety implications. Perspectives in Health Information Management, 10(Fall):1c.

Gao, J. X., Sorwar, G. & Croll, P. (2013). Implementation of E-health record systems in Australia. The International Journal Technology Management Review, 3(2):92-104.

Menachemi, N. & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Quality, 4: 47-55. Doi:10.2147/RMHP.S12985

Sitting, D. F. & Singh, H. (2011). Defining health information technology-related errors. Archives of Internal Medicine, 171:1281.

Zeng, X. (2016). The impacts of electronic health record implementation on the health care workforce. North Carolina Medical Journal, 77(2):112-114. Doi:10.18043/ncm.77.2.112

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Rape Case Study: Formulating Research Questions

Rape Case Study

Discussion 3: Formulating Research Questions

In the case of Talia, several questions ought to get researched on because of the massive effects a victim of rape undergoes. However, the author has critically analyzed and chose the following two questions as the most appropriate in providing a reliable solution for this persistent and growing menace. The questions include:

Why is it suitable for a victim of rape to open up to someone they trust about the condition?
How has the enacted laws and rules affected the issue of rape cases?

The first question is vital in the sense that it explores the reasons for the victim of abuse to report the case instantly. Talia Johnston failed to report her case to anyone for about three weeks a condition that left her with painful scars she wouldn’t bear. This question, therefore, would help the researcher to seek for new and appropriate reasons for the victim to share the occurrence.

It would lead to the enhancement of new knowledge in the field of art. Through informing a person about the case of rape, then greater and efficient interventions will transpire (Lisak & Miller, 2002). Besides, the process of healing of the victim would become faster, and hence there would be social change. The question will as well open a good way for more research to erupt.

Also, the question “How has the enactment and implementation of rules and laws impacted the issue of rape cases?” is very crucial. In essence, Talia went through a traumatic condition because of sexual abuse by an unfamiliar person. The question would lead to the exploration of the impacts that lack of law application can result in dire effects altogether as detailed by Lisak (2006).

This would add a lot of knowledge for social work. Besides, a critical analysis of how these rules have affected the number of rape cases need to be carried out. There would as well be a positive impact on the social change of the approach taken concerning rape cases. Answering the question would assist greatly in more research to get done about sexual assault.

The author has selected the resources by applicability, the content in the articles and the recentness year of publication of the articles. The content of the two articles would aid in answering the above questions critically.

References

Lisak, D. (2006). Understanding the predatory nature of sexual violence. Boston.

Lisak, D., & Miller, P. L. (2002). Repeat rape and multiple offending among undetected rapists. Violence and Victims, Vol. 17, No. 1, 73-84.

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Dell Case Study

Case Analysis: Dell Case Study

Major facts

Major facts, in this case, include Dell’s strategies involving direct sales, product customization and stakeholder engagement and the changing competitive environment. These are strategies that have worked for Dell in its quest to provide customers with the highest quality products. A focus on direct sales has ensured that Dell can reach its clients and meet their needs better.

Engaging suppliers as important stakeholders of the organization have enhanced Dell’s manufacturing strategy of mass customization by ensuring that supplies are made just-in-time and with short lead times. Dell utilizes focused mass customization where a limited number of common platforms are manufactured and then customized to meet customer needs. This has created more demand because customers demand unique products. Despite the success in strategy, downward price pressure, competition and a weakening market position challenge the company’s survival.

Major problem

Dell faces a weakening market position, perpetrated by the intense competition in the marketplace, combined with downward price pressure.

Possible Solutions

Dell has various options that it can consider in increasing its market share and absorbing downward pressure as follows.

New products: Diversification can be a viable option for Dell and may involve developing more advanced computers and laptops to meet competitors such as Apple. It could also invest in new products such as smartphones whose demand is currently high in the market. This has the advantage of attracting a larger market share but may be expensive to implement (Hans-Ruediger, 2014).

Cost-cutting measures: To increase profitability and counter falling prices, Dell can revise costs in its production system by reducing wastage, streamlining processes and automation. The advantage of this strategy is that it increases returns through reducing the company’s production costs. However, it may impact on process quality when important aspects are eliminated or downsized. Ethical issues may also arise from some steps such as employee layoffs and automation which creates unemployment (Ciravegna, Fitzgerald & Kundu, 2013)

Increased Marketing: Dell could increase its market position through increased advertising of its products. This will ensure that more customers are aware of their products and capabilities, thus improving the market (Kotler & Armstrong, 2015). This has the advantage of increasing product visibility and increasing market share. On the other hand, it may be very costly to implement.

Invest in more advanced research and development: Technology is changing rapidly, and to benefit from the growing market, companies must provide clients with unique products that meet their needs. This calls for investment in research and development to promote the development of advanced products (Ciravegna, Fitzgerald & Kundu, 2013). While new products will increase the company’s market position, research and development are very costly, especially where customer demands keep changing.

Choice and Rationale

New product development is chosen as the best choice of strategy for Dell to pursue. This is because the current customer is increasingly demanding more sophisticated technology and companies that take the opportunity to satisfy this demand will capture a large market share.

Dell should invest in more advanced computers to serve different customer needs. I did not choose cost cutting as the best strategy because Dell has already implemented cost cutting measures before including the laying down of staff. The company may not be ready for more cuts as it would impact its performance. Increased marketing and research and development would come automatically if Dell chooses the new product strategy.

To succeed in new product development, Dell would need to invest in research and development to ensure the production of sophisticated products, which would later be followed by marketing to promote sales (Kotler & Armstrong, 2015).

Implementation

New product development will be achieved using the following plan.

New Product Development Implementation Plan
Objectives	Develop ten new computer models in the next yearIntroduce a smartphone range with ten new models in the next two years
Strategies and procedures	Appoint a marketing research team to explore the market on new technology trends and demandsFund the research and development unit to conduct research on new technologies Train the team on new technologies and aspects of the smartphone marketDevelop new products based on the research and development team’s recommendations
Timelines	July 2017 – July 2019
Person(s) responsible	Chief Executive OfficerResearch and Development ManagerInformation Technology Manager
Budget	$ 130,000,000

References

Ciravegna, L, Fitzgerald, R. & Kundu, S. K. (2013). Operating in Emerging Markets. A Guide To Management and Strategy in the New International Economy. Pearson: FT Press.

Hans-Ruediger, K. (2014). Handbook of Research on Managing and Influencing Consumer Behavior. Hershey, PA: IGI Global

Kotler, P. & Armstrong, G. (2015). Principles of Marketing. Harlow, UK: Pearson Education.

Appendix

Case questions

Question 1: Fundamental reasons for Dell’s success

Some of the most fundamental reasons for Dell’s success include direct sales, focus on partnerships and product customization. By focusing on selling direct to the customer, Dell had an opportunity to interact with its clients and thus understand their needs better. Building effective relationships with suppliers and linking them to production systems ensured that Dell could implement its production strategy, which included the just-in-time supply of components to save time and warehouse costs. Product customization played a role in increasing demand by providing products that met customer expectations (Hans-Ruediger, 2014). Mass customization was also effective I saving costs.

Question 2: Maintaining competitive advantage and viability of business model

As customers’ needs continue to change amidst increasing competition, Dell should invest in research and development and leverage the social media strategy to maintain its competitive advantage. Research and development will ensure that the company can come up with innovative products to meet the needs of its customers (Ciravegna, Fitzgerald & Kundu, 2013).

Social media is the novel platform that contemporary organization must maximize on to reach existing and potential customers, given the advancement in technology and potential to reach customers across the globe. As part of the organization’s strategy that involves direct customer sales, Dell could reach more customers to increase its sales while engaging them directly to get feedback about its products.

Question 3: Will Dell formula work elsewhere?

The Dell formula is highly successful and can be replicated elsewhere. Customization is a growing trend, informed by customer demand to have products that meet their unique needs. By adopting customization, companies could gain a higher market share. It is notable that creating good relationships with customers and stakeholders can yield great outcomes through better quality products and efficiency.

However, the just-in-time formula and direct sales may not work for all companies. Businesses that thrive on mass production, for example, require regular supplies and warehousing is necessary to meet demand. Direct sales may not work for most consumer products because there need to be middlemen to connect geographical boundaries and enhance availability in locations nearer to the customer. Direct sales would also be costly for the organization (Kotler & Armstrong, 2015).

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Foundations of Terrorism: Case Study

Foundations of Terrorism

Case Study of Aum Shinrikyo terrorist group

Introduction

Terrorism is founded on carefully planned structures. This paper intends to discuss terrorist organizations by developing a case study of Aum Shinrikyo terrorist group.

Origin of Aum Shinrikyo

Aum Shinrikyo refers to a doomsday cult whose origin is in Japan. The cult was formed by Shoko Asahara in the year 1984 (Ingram, 2017). Aum Shinrikyo earned international infamy after carrying out a deadly attack on Tokyo subway in the year 1995. Furthermore, in 1994 Aum Shinrikyo was also involved in a small sarin attack (Ingram, 2017). However, initially, Aum Shinrikyo conducted its activities in secret and never confessed. Shoko Asahara, the founder of Aum Shinkyo, bought a signal in Russia, which he directed to Japan and uses it in broadcasting his singing and persisting on his blamelessness (Ingram, 2017).

In 2007 Aum Shinrikyo was divided into two groups a group known as Aleph and a group called “Hikari no Wa” (Ingram, 2017). Thus, Aum Shinkyo became designated by many countries as a terrorist association. Among the countries is Japan and North Korea. For instance, in Korea, the commission in charge of examining public security made a public announcement in 2015 in the month of January that the group Aleph along with “Hikari no Wa” group is both branches of religion, which is considered as dangerous (Ingram, 2017). The commission also added that it would continue surveillance on the two groups for three subsequent years.

As a logistical set-up, Aum Shinkyo inspired and is still inspiring acts of terrorism globally. Notably, Aleph which is one of the groups of Aum Shinrikyo is a system based on syncretism belief (Kearns, Conlon & Young, 2014). Aleph draws upon an idiosyncratic understanding of elements by Shoko Asahara regarding ancient Indian Buddhism, Tibetan Buddhism, and Hinduism. The main icon of worship was taken to be Shiva (Kearns, Conlon & Young, 2014). Aleph also incorporates millennialism ideas, which it borrows from the Bible’s Revelation book (Orsini, 2015).

Aleph also borrows from Yoga and Nostradamus writings (Kearns, Conlon & Young, 2014). Aum Shinrikyo’s group Aleph was founded by Chizuo Matsumoto who alleged that he was seeking to reinstate original Buddhism. Thus, in the year 1992, Chizuo Matsumoto started calling himself Shoko Asahara, which became his name (Kearns, Conlon & Young, 2014).

In the same year 1992, Shoko Asahara was able to publish an introductory book where he declared himself to be “Christ.” Furthermore, in the book Shoko Asahara refers to himself as the only master who is fully enlightened and identifies with “God’s Lamb” (Kearns, Conlon & Young, 2014).

Command structure of Aum Shinrikyo

Aum Shinrikyo is known to apply precise methodologies. Furthermore, Aum Shinrikyo has a prearranged study of doctrine which is in harmony with a particular system of learning. For a follower of Aum Shinrikyo to reach another stage, it is expected that the member successfully passes a given exam (Orsini, 2015). The practice of meditation is combined with hypothetical studies.

However, Shoko Asahara emphasized to his followers that hypothetical studies cannot serve any purpose when practical experience is not achieved. Additionally, Shoko Asahara also advised members of Aum Shinrikyo never to try explaining anything if they could not mostly experience it (Orsini, 2015).

Aum Shinrikyo’s followers were grouped into two. The first group was lay practitioners. The lay practitioners are Aum Shin rik yo’s members who live together with their families (Orsini, 2015). A second group is a group of members who lived a lifestyle that is ascetic. In most cases, the second group included individuals who usually live as a group (Orsini, 2015). For any follower to earn the status of an attained member, it was an obligation for the member to meet precise conditions so as to influence senior members to recognize that the member has reached a state of higher spirituality (Orsini, 2015).

For instance, in the stage of Kundalini Yoga a member was required to give a demonstration regarding his or her ability in showing abridged oxygen consumption, modification of electromagnetic activities of the brain, and reduced rate of the heart, which was to be proven by being measured using a corresponding equipment (Richards, 2014). When a member demonstrated all the changes described above, then he or she was considered having entered a higher state referred as Samadhi (Richards, 2014). Thus, a member who has attained Samadhi state was given permission to educate other members.

The purported mission of Shoko Asahara was taking all the sins that people in the world have committed. Shoko Asahara claimed that he had the ability to transfer spiritual power to Aum Shinrikyo’s members (Richards, 2014). Additionally, Shoko Asahara claimed he would ultimately cleanse Aum Shinrikyo’s members’ sins by taking them away. Consequently, scholars view Aum Shinrikyo as an outcome from Japanese Buddhism. The view by scholars influenced how Aum Shinrikyo’s definition and view of itself. Notably, Shoko Asahara made an outline of a prophecy on doomsday that integrated the “World War III” to be prompted by the United States (Richards, 2014).

Leadership of Aum Shinrikyo

Shoko Asahara is known to be the historical leader of Aum Shinrikyo. Furthermore, Shoko Asahara was also the chief of senior operations for Aum Shinrikyo (Sageman, 2014). Shoko Asahara came from a Japanese family that was poor. After realizing a personal enlightenment in religion, Shoko Asahara formed Aum Shinrikyo, a religious cult (Sageman, 2014).

Shoko Asahara had recruited almost 10,000 followers to Aum Shinrikyo during the 1990s. Notably, Shoko Asahara dreamt of being an emperor in Japan. Thus, Shoko Asahara assumed the role of interim commander of Aum Shinrikyo (Sageman, 2014).

Shoko Asahara tried to register Aum Shinrikyo with Japan’s government based on the law of religious corporations known as “Shukyo-hojin-Ho” in 1989 (Shapiro, 2013). The registration was to include benefits such as privileges regarding taxation, rights of owning property as Aum Shinrikyo organization, along with protection from interference by the state and other external bodies (Shapiro, 2013).

Initially, the Japanese government denied permission of registration to Aum Shinrikyo citing a string of complaints raised by families with members practicing the Shukkesha (Shapiro, 2013). Shukkesha refers to a practice where members are demanded to sever all the ties they have with family and ensure they cease communication (Shapiro, 2013).

Aum Shinrikyo gave a response to the Japanese government’s rejection by holding public demonstrations, holding lawsuits, and starting legal appeals to counter the government’s decision. Consequently, in the month of August in the year 1989 Aum Shinrikyo was approved of a legal status (Zúquete, 2015).

Thus, Aum Shinrikyo started a new trend in 1989 of greeting every difficulty that comes their way with vigorous denials accompanied by lawsuits (Zúquete, 2015). Notably, in May of 1989 many parents had hired a lawyer from Yokohama known as Sakamoto Tsutsumi. However, Sakamoto uncovered claims that were faulty arguing that tests had been carried out in Kyoto University revealing that he had a unique DNA in his blood (Zúquete, 2015).

Afterward, Aum Shinrikyo started the practice of blood initiation, which was assumed to increase the spiritual power of an individual though no tests were run (Shapiro, 2013). Later, Sakamoto, his wife along with infant son disappeared. An Aum badge was found indicating that Aum Shinrikyo was involved with the disappearance, but no direct evidence was available to link the group.

Thus, Aum Shinrikyo embraced the accusations as an opportunity of getting publicity. Asahara professed the need for political action in saving the world thus, launching “Shinrito” political party which translates to “Supreme Truth Party” (Shapiro, 2013).

Motivation of Aum Shinrikyo

Aum Shinrikyo is motivated by both general reasons and particular motives. For instance, Tomomitsu Niimi attacked a VX victim at 7 am on the 12^th of December in 1994 after Shoko Asahara reported of suspecting the victim of being a spy (Zúquete, 2015). The victim was murdered by being sprinkled on the neck for being a nerve agent. Aum Shinrikyo capitalizes on visions of the millennium along with predictions of the apocalypse in framing its doctrine. Consequently, Aum Shinrikyo is highly prejudiced by Nostradamus work. Notably, Nostradamus work provides a cornerstone to Aum Shinrikyo’s teachings.

Markedly, the followers of Aum Shinrikyo actively recruit students along with professionals working in the medicine field, field of science, field of computers, the engineering field, along with other areas, which are technical. Therefore, the charisma by Shoko Asahara and his messages appeared to have more appeal to a majority of people who felt estranged by the modern society, the secular society and the conformist features of the Society of Japan (Zúquete, 2015).

At the crest of Aum Shinrikyo, it is approximated to be worth over $1.5 billion. Notably, having enormous financial resources, Aum Shinrikyo is motivated to invest its capital in high-technology, laboratories for “state-of-the-art,” and funding Aum’s research. Thus, Aum Shinrikyo can circumvent restrictions, which are associated with large laboratories for corporate research.

Additionally, for Aum Shinrikyo to raise funds, they collect money from donations, followers tithe, and selling of sacred materials. Aum Shinrikyo also conducts seminars along with courses regarding the teachings of the cult where it charges all individuals who are participating in the sessions (Kearns, Conlon & Young, 2014). Furthermore, Aum Shinrikyo diversifies its enterprises through running a string of hotels in Tokyo and a firm for manufacturing computers that assembles and sells computers within Japan using parts traded in from Taiwan.

Aum Shinrikyo is also motivated by the support it gets from a Japanese mafia known as the Yakuza, who provide the group with an agreement for marketing illegal drugs manufactured by Aum Shinrikyo. Aum Shinrikyo is also motivated by cooperation given by community leaders through engaging in greenmail practice, which involves extorting money from community leaders (Kearns, Conlon & Young, 2014).

Aum Shinrikyo extorts money from community leaders through threatening them about establishing Aum Shinrikwo’s branch office or an Aum Shinrikwo’s school in the local community in question. Consequently, Aum Shinrikyo also aims at gaining leverage by engaging in extortion, acts of coercion, engaging in theft along with murder as a way of raising money for the group.

Goals of Aum Shinrikyo

The primary goal of Aum Shinrikyo is to defend the ancient faith by promoting worldwide operations that endorse theologies collected from diverse sources. Furthermore, Aum Shinrikyo also operates on a goal of collapsing dictatorship from western countries and institutions within the Middle East. According to Shoko Asahara, Aum Shinrikyo has the goal of uniting all doctrines and establishing, forcefully a desperate need of the society adhering to rules given by the original Caliphs (Kearns, Conlon & Young, 2014).

For instance, in his religious decree, Shoko Asahara talks of individuals duty globally being leading a holy life through cleaning one’s sins based on the doctrine of Aum Shinrikyo, with Shoko Asahara as the self-proclaimed “Christ”. Furthermore, in the book Shoko Asahara refers to himself as the only master who is fully enlightened and identifies with “God’s Lamb” (Kearns, Conlon & Young, 2014).

The ideology of Aum Shinrikyo is based on an idiosyncratic understanding of elements by Shoko Asahara regarding ancient Indian Buddhism, Tibetan Buddhism, and Hinduism. The main icon of worship was taken to be Shiva (Kearns, Conlon & Young, 2014). Aleph one of the groups of Aum Shinrikyo also incorporates millennialism ideas, which it borrows from the Bible’s Revelation book (Orsini, 2015).

Furthermore, Aleph also borrows from Yoga and Nostradamus writings (Kearns, Conlon & Young, 2014). The ideology is manifested by Tomomitsu Niimi’s willingness to attack and murder a VX victim at 7 am on the 12^th of December in 1994 after Shoko Asahara reported of suspecting the victim of being a spy.

Even though most doctrines disagree with almost all thoughts of Shoko Asahara, Aum Shinrikyo is rooted in earning a status (Kearns, Conlon & Young, 2014). For instance, the doctrine of Aum Shinrikyo dictates that in order for any follower to earn the status of an attained member, it is the obligation that member to meet precise conditions so as to influence senior members to recognize that the member has attained a state of higher spirituality (Orsini, 2015).

In one of the stages known as Kundalini Yoga a member was required to give a demonstration regarding his or her ability in showing abridged oxygen consumption, modification of electromagnetic activities of the brain, and reduced rate of the heart, which was to be proven by being measured using a corresponding equipment (Richards, 2014).

Threat posed by Aum Shinrikyo

Aum Shinrikyo poses a number of threats. According to an annual report by the department of state in the United States regarding global terrorism, Aum Shinrikyo is a great threat as it has evolved. Aum Shinrikyo has evolved leading to its current dispersion in the Middle East. The two groups Aleph and a group known as “Hikari no Wa”, which are operationally self-governing affiliates of Aum Shinrikyo are developing to be increasingly aggressive (Kearns, Conlon & Young, 2014).

Furthermore, the affiliates of Aum Shinrikyo in the Middle East use the instability of their regions to their advantage. Moreover, affiliates of Aum Shinrikyo tend to be financially sovereign from the central leadership of Aum Shinrikyo. Notably, affiliates of Aum Shinrikyo raise funds to run their operations from illegal activities such as extorting money from community leaders, acts of coercion, engaging in theft along with murder-kidnapping people and requesting for ransom or fraud of credit cards.

Aum Shinrikyo is also highly active in Japan according to the department of the state of the United States. Compared to all affiliates Aum Shinrikyo in Aleph is the greatest threat to the United States. The head of Aleph in Japan was appointed in 2013 to be the deputy leader of the entire system of Aum Shinrikyo globally (Finn & Momani, 2017). Furthermore, in 2013, acts of terrorism were influenced by sectarian reasons, which present a major threat.

It was also revealed that there was the resurgence in the activities conducted by Iranian security forces along with Iranian intelligence, as the two institutions were linked to primarily supporting Iran for its Assad administration in Syria. Iran also was revealed to have allies in Japan, known as “Hikari no Wa”. “Hikari no Wa” is a renowned terrorist group known for its high-level illegal activities and affiliation to Aum Shinrikyo.

Policies of combating Aum Shinrikyo

There are various policies of combating Aum Shinrikyo. Notably, Aum Shinrikyo is no longer hiding when performing its operations. At the moment Aum Shinrikyo controls its operations mainly from Japan. Thus, America is faced with a great challenge regarding its lifestyle. Aum Shinrikyo constantly fights against the United States with the aim of creating a global caliphate. Consequently, it has been globally recognized that there is need to acknowledge the terrorism problem intensity, and the magnitude required in terms of effort for combating the problem (Eid, 2014).

One of the policies of combating the problem of terrorism is having coordinated regional counterinsurgency operation. Markedly, this policy involves robust efforts of stabilization and combination of diplomatic efforts, political attempts, security endeavors, and informational attempts. The second policy is to end the brutality that averts regional cohorts from fighting Aum Shinrikyo, thus creating space or energy for Aum Shinrikyo to make recruitments and execute its operations.

The third policy is a unification of the private sector with the government in an effort of fighting Aum Shinrikyo. The fourth policy is creating strong partnerships locally as a way of ensuring the stability of governments (Eid, 2014). Notably, a majority of countries have developed less responsiveness to terrorism while others have been overpowered by terrorism through terrorists acquiring and staying on their land.

The main aim of having partnerships is to ensure that Aum Shinrikyo will not reemerge after it has been defeated. The fifth policy is analyzing the position held by key players who notably are within the majority world of Buddhism, Muslims, and Hinduism (Eid, 2014). For instance, partnering with Russia requires careful diplomatic engagement as its presence of forces within Aum Shinrikwo’s territories develops a challenge.

Conclusion

Terrorism is a global problem. For years the problem of terrorism has been shifting from one continent to another. Consequently, it has been established that terrorism is founded on carefully planned structures. Thus, this paper has discussed terrorism foundations by developing a case study of Aum Shinrikyo terrorist group. Aum Shinrikyo is known for dominating its operations within Japan along with the Middle East.

The paper above has revealed that initially, Aum Shinrikyo was a logistical set-up that aimed at defending the ancient faith by promoting worldwide operations that endorse theologies collected from diverse sources. Furthermore, it has come out clearly through the paper above that there are two separate groups of Aum Shinrikyo terrorist group. A group is known as Aleph and a group known as “Hikari no Wa”.

However, the paper has also revealed that Aum Shinrikyo cannot be termed as an organization rather Aum Shinrikyo refers to a doomsday cult whose origin is in Japan. Furthermore, the paper has revealed that activities of Aum Shinrikyo are motivated by both general reasons and specific motives. Thus, Aum Shinrikyo tends to engage in illegal acts as a way of gaining leverage. The illegal acts include engaging in extortion, acts of coercion, engaging in theft along with murder, as a way of raising money for the group.

References

Eid, M. (2014). The Media Amid Terrorism and Counterterrorism. Terrorism And Political Violence, 26(5), 842-854. http://dx.doi.org/10.1080/09546553.2014.968025

Finn, M., & Momani, B. (2017). Building foundations for the comparative study of state and non-state terrorism. Critical Studies On Terrorism, 1-25. http://dx.doi.org/10.1080/17539153.2017.1287753.

Ingram, H. (2017). The Strategic Logic of the “Linkage-Based” Approach to Combating Militant Islamist Propaganda: Conceptual and Empirical Foundations. Terrorism And Counter-Terrorism Studies. http://dx.doi.org/10.19165/2017.1.06

Kearns, E., Conlon, B., & Young, J. (2014). Lying About Terrorism. Studies In Conflict & Terrorism, 37(5), 422-439. http://dx.doi.org/10.1080/1057610x.2014.893480

Orsini, A. (2015). Are Terrorists Courageous? Micro-Sociology of Extreme Left Terrorism. Studies In Conflict & Terrorism, 38(3), 179-198. http://dx.doi.org/10.1080/1057610x.2014.987593

Richards, A. (2014). Conceptualizing Terrorism. Studies In Conflict & Terrorism, 37(3), 213-236. http://dx.doi.org/10.1080/1057610x.2014.872023

Sageman, M. (2014). The Stagnation in Terrorism Research. Terrorism And Political Violence, 26(4), 565-580. http://dx.doi.org/10.1080/09546553.2014.895649

Shapiro, S. (2013). The Intellectual Foundations of Jewish National Terrorism: Avraham Stern and the Lehi. Terrorism And Political Violence, 25(4), 606-620. http://dx.doi.org/10.1080/09546553.2013.814502

Zúquete, J. (2015). Martin A. Miller.The Foundations of Modern Terrorism: State, Society and the Dynamics of Political Violence. Terrorism And Political Violence, 27(4), 786-788. http://dx.doi.org/10.1080/09546553.2015.1068094

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Cultural Competence Case Study

Rapid demographic changes in today’s society require health care professionals to deliver care that demonstrates respect to patients’ diverse beliefs, preferences, and values. By providing culturally responsive care, health care practitioners help to promote improved health outcome for patients and encourage sufficient use of resources by their employing organizations.

In their effort to deliver culturally sensitive care, therapists must be able to differentiate cultural differences from other related client characteristics that may have an impact on patient outcomes (Saha, Beach, and Cooper, 2008).

In the given case study, the physical therapist should take cultural, physical, cognitive, communicative, and environmental factors into consideration in working with Hernando Gonzales in a home care situation. The cultural factors that should be taken into account include age, nationality, gender, marital status, religion, ethnicity, and beliefs about health.

The therapist should understand that Mr. Gonzales is a 63-year old Mexican male who is currently a widower. Also, Mr. Gonzales goes to church regularly, and being a Catholic; he believes that God is the provider of strength. Furthermore, the therapist should consider the fact that Mr. Gonzales may want to use many herbs in the course of therapy (Saha, Beach, and Cooper, 2008).

The physical factor that the therapist should consider is that Mr. Gonzales once had a partial knee replacement and he still needs assistance with activities of daily living, despite the fact that he has made good physical recovery since he had an accident. The cognitive, communicative, and environmental factors that the therapist needs to consider include; reduced mental functioning as a result of traumatic brain injury, limited spoken English, and limited social support in Maria’s house respectively (Saha, Beach, and Cooper, 2008).

Lack of cultural competence by the therapist may make him or her to confuse cultural variations with other physical, communicative, environmental, and cognitive characteristics in this case. For instance, if the therapist is not culturally competent, he or she may think that Mr. Gonzales reactions due to influence from cognitive problems and environmental factors are as a result of cultural beliefs and values (Santisteban, Mena, and Abalo, 2012).

Furthermore, the therapist may think that Mr. Gonzales’ incapacities to speak fluent English and to carry out his physical activities normally are as a result of cultural influence. It is important to differentiate cultural differences from those related to the client’s other characteristics because positive health outcomes for the patient largely depend on the therapist’s ability to deliver culturally sensitive care (Sue, Zane, Hall, and Berger, 2009).

Cultural competence solutions

The therapist should make adjustments in both assessment and intervention based on Mr. Gonzales’ cultural, cognitive, and linguistic backgrounds. Since the therapist does not speak fluent Spanish, he or she should consider using a translator to help Mr. Gonzales to understand any information that may be presented in English during the assessment. Also, the therapist should use a cultural broker to help reduce cultural-related conflicts that may arise during the assessment (Sue et al., 2009).

Furthermore, the therapist should approach Mr. Gonzales with a lot of humility because he currently has traumatic brain injury. Again, he or she should recommend interventions that Mr. Gonzales can easily implement, bearing in mind that he has some form of physical inability and limited family support in Maria’s house (Saha, Beach, and Cooper, 2008).

The therapist can enlist the help of Mr. Gonzales’ family to facilitate therapy in two different ways. First, the therapist can advise the family on the types of social support that they should give Mr. Gonzales to promote quick recovery. Second, the therapist can help Mr. Gonzales’ family to identify the most appropriate forms of physical support that are necessary to promote positive health outcomes for him (Santisteban, Mena, and Abalo, 2012).

References

Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence, and health care quality. Journal of the National Medical Association, 100(11): 1275-1285.

Santisteban, D. A., Mena, M. & Abalo, C. (2012). Bridging diversity and family systems: Culturally informed and flexible family based treatment for Hispanic adolescents. Couple and Family Psychology, 2(4): 246-263. doi: 10.1037/cfp0000013

Sue, S., Zane, N., Hall, G. & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60: 525-548.

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