LEADERSHIP THEORIES IN PRACTICE

A walk through the Business section of any bookstore or a quick Internet search on the topic will reveal a seemingly endless supply of writings on leadership. Formal research literature is also teeming with volumes on the subject.

However, your own observation and experiences may suggest these theories are not always so easily found in practice. Not that the potential isn’t there; current evidence suggests that leadership factors such as emotional intelligence and transformational leadership behaviors, for example, can be highly effective for leading nurses and organizations.

Yet, how well are these theories put to practice? In this Discussion, you will examine formal leadership theories. You will compare these theories to behaviors you have observed firsthand and discuss their effectiveness in impacting your organization.

To Prepare:

Review the Resources and examine the leadership theories and behaviors introduced.

Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.

• Reflect on the leadership behaviors presented in the three resources that you selected for review.
• Post two key insights you had from the scholarly resources you selected. Describe a leader whom you have seen use such behaviors and skills, or a situation where you have seen these behaviors and skills used in practice. Be specific and provide examples. Then, explain to what extent these skills were effective and how their practice impacted the workplace.
• REQUIRED READING

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Chapter 1, “Frameworks for Becoming a Transformational Leader” (pp. 2–19 ONLY)

Chapter 6, “Shaping Your Own Leadership Journey” (pp. 182-211)

• Chan, R. J., Knowles, R., Hunter, S., Conroy, T., Tieu, M., & Kitson, A. (2023). From evidence-based practice to knowledge translation: What is the difference? What are the roles of nurse leaders?

Links to an external site.

Seminars in Oncology Nursing, 39(1). https://doi.org/10.1016/j.soncn.2022.1513

• SECOND PAPER 
• M. A. C
• Introduction
• In our evolving healthcare, integrated care has emerged as a critical approach to address the complex needs of patients with various psychological and physical health challenges.
• Insights from Scholarly Resources

Neville K. et al. (2020) provided a profound insight into the necessity of interprofessional collaboration within integrated care settings. The study highlighted that healthcare leaders must foster an environment where different professionals can work synergistically, transcending traditional disciplinary boundaries. Such collaboration is not only essential for patient-centered care but also for the professional development of the healthcare staff.

Valentijn P. et al. (2013) emphasized the importance of person-centered leadership grounded in empathy and a deep understanding of individual patient needs. This approach involves engaging patients as active participants in their care, which can lead to improved health outcomes and patient satisfaction.

Application of Leadership Skills at HH Treatment Center

• As the Vice President of HH Treatment Center, Williams embodies the leadership qualities and behaviors outlined in the scholarly resources. A solid commitment to interpersonal collaboration and person-centered care characterizes her approach to leadership.

One specific example of William’s leadership is her initiative to implement regular interdisciplinary case conferences(Broyles L et al., 2013). These meetings included professionals from various specialties within the healthcare team, such as physicians, nurses, social workers, and mental health counselors. In these conferences, team members discussed patient cases in depth, sharing their unique perspectives and formulating comprehensive care plans. This practice enhanced the quality of patient care and created a learning environment where staff could gain insights from each other’s expertise.

Another example of William’s person-centered leadership is her involvement in patient feedback sessions (Stanhope V. et al.,2015). She ensures that patients’ voices are heard and acted upon, leading to tangible changes in care delivery. For instance, based on patient suggestions, Williams facilitates redesigning the treatment center’s communal spaces to be more welcoming and therapeutic. This change increased patient engagement and created a more positive atmosphere throughout the center.

Effectiveness and Impact of Leadership Practices

The improved clinical outcomes and the increased satisfaction among both patients and staff can measure the effectiveness of William’s leadership skills. Under her leadership, HH Treatment Center reported higher treatment adherence rates and decreased hospital readmissions. Additionally, staff turnover decreased, indicating a more satisfied and committed workforce (www.oaksintegratedcare.org)

Applying the insights from Neville, K. et al. (2020) and Valentijn, P. et al. (2013) within the context of HH treatment centers illustrates the positive impact of collaborative and person-centered leadership in an integrated care environment. William’s leadership fosters a culture of mutual respect and continual learning, benefiting patients and empowering staff members to perform at their best. 

Conclusion

The scholarly resources provided a theoretical framework through the leadership of Williams at HH Treatment Center. Her ability to incorporate interprofessional collaboration and person-centered care has significantly improved patient care. 

References

Broyles, L. M., Conley, J. W., Harding Jr, J. D., & Gordon, A. J. (2013). A scoping review of interdisciplinary collaboration in addictions education and training. Journal of addictions nursing, 24(1), 29-36.

Neville, K., & Foley, M. (2020). The economic impact of the opioid use disorder epidemic in America: Nurses’Nurses’ call to action. Nursing Economics, 38(1), 7–51.

Stanhope, V., Tondora, J., Davidson, L., Choy-Brown, M., & Marcus, S. C. (2015). Person-centered care planning and service engagement: a study protocol for a randomized controlled trial. Trials, 16, 1-11.

Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care, 13.

www.oaksintegrated care.or

Response 2

Marlyn Diaz

Introduction

According to the American Nursing Association (2023), they act as role models and influence their healthcare organizations at all levels. Nurse leaders can motivate their coworkers, set a tone for safety, create a cordial work environment, and increase morale and job retention. A Nurse leader is best identified by their actions instead of their position in an organization. “Leaders in nursing inspire and influence others to achieve their maximum potential.” There are different styles of leadership that a nurse leader may elect to deliver with the team. The three main leadership styles will be discussed in this post, along with a QUESTION of a leader I have encountered with such styles or behaviors.

Leadership Styles

Singh & Alomari (2023) state that the three main leadership styles are transformational, transactional, and autocratic. These leadership styles “focused on people management that play a significant role in determining desired outcomes.” The transformational leadership style empowers the followers by giving them a sense of autonomy and responsibility; therefore, commitment and efficiency will increase. Transformational leaders must have the skills to facilitate growth and transform evidence into practice. According to Specchia et al., transformational style positively correlates with nurses’ job satisfaction (2021). The second type of leadership is the transactional style. This type of leadership is best employed during a high-stress situation for the employees, and their basic needs must be met (Singh & Alomari, 2023). These leaders motivate employees with rewards and punishment “for achieving or failing to achieve” the organization’s demands. Specchia et al. highlight that this type of leadership does not foster trust between the followers and the leader (2021). The last type of leadership discussed here is the autocratic style. This is an authoritarian type of leadership in which the employees are discouraged from apportioning any input (Singh & Alomari, 2023). This style is highly structured, and staff must be considered competent enough to provide adequate input. For this reason, low team morale and nursing resentment are typical outcomes. This can lead to poor nursing performance, patient care, and patient outcomes.

Types of Leaderships Encountered

In the current organization I am working for, I have encountered these three types of leadership. Depending on the situation, my manager has displayed these three types of leadership. Overall, the administration tries to follow a transformational style of leadership where the staff nursing input is considered to improve morale, working conditions, and patient care. During our quarterly meetings, our manager will discuss topics with the team, such as increased nurse burnout due to short-staffing, and ask for input on what can be done to help us. Some inputs discussed, such as having a CAN in the unit when acuity is high to help care, were employed immediately. This made the team feel heard and supported, and work morale improved. Other times, leadership has been autocratic, such as when the staff wanted to update the current vacation requests and grants rules. Management would not hear any input and stated that nothing could be done. Staff continue to be dissatisfied because it is challenging to approve your vacation request if you have no seniority. It goes to them if someone with seniority requests the exact dates as you. Therefore, there is no guarantee that you will get any PTO approved. There have been times when leadership has been transactional. Again, during the short staffing period, they would offer incentives to have nurses pick up extra shifts. This resulted in neutral feelings as it was optional for nurses to pick up.

Conclusion

Three types of leadership are most used in nursing. According to Specchia et al. (2021), the ideal leadership style for nursing is transformative, as the leader welcomes input from staff and not only supports but empowers staff to be autonomous (Singh & Alomari, 2023). In my organization, management has utilized these three types of leadership depending on the situation. Given the staff’s response to these leadership styles, transformative is the most welcomed by staff.

References

American Nursing Association. (2023). Leadership in nursing: Qualities & why it matters. https://www.nursingworld.org/content-hub/resources…

Links to an external site.

.

Singh, K., & Alomari, A. (2023). Leadership styles and transformational leadership skills among nurse leaders in Qatar, a cross?sectional study. Nursing Open, 10(6), 3440-3446. https://doi.org/10.1002/nop2.1636

Specchia, M. L., Cozzolino, M. R., Carini, E., Pilla, A. D., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review. International Journal of Environmental Research and Public Health, 18(4). https://doi.org/10.3390/ijerph18041552

S.M R

Introduction 

Effective leadership plays a crucial role in shaping the quality of care and overall performance in healthcare settings. Through insights gleaned from scholarly research, two primary aspects of leadership emerge: the influence of leadership style on quality of care measures and the significance of leadership effectiveness in healthcare (Broome & Marshall, 2021). By evaluating the effectiveness of these leadership approaches through real-life experiences, we can gain and highlight the importance of adept leadership in fostering positive outcomes and cultivating a conducive work environment in healthcare settings.

Key Insights 

The scholarly resources I selected shed light on two key insights regarding leadership in healthcare settings. Firstly, Sfantou et al.’s (2017) systematic review emphasizes the pivotal role of leadership style in influencing the quality of care measures. This study highlights the direct correlation between leadership approach and various aspects of care delivery, including patient outcomes, safety, and satisfaction. Effective leadership styles, particularly transformational leadership, are associated with improved quality of care and organizational performance, underscoring the significance of leadership in shaping the healthcare environment. 

Secondly, Restivo et al.’s (2022) systematic review and meta-analysis underscore the importance of leadership effectiveness in healthcare. The synthesis of evidence from diverse studies demonstrates a positive association between effective leadership and healthcare outcomes, including patient care, staff satisfaction, and organizational performance. Effective leaders exhibit key characteristics such as vision, communication skills, team building, and strategic decision-making, contributing to enhanced patient care quality and safety. These insights highlight the critical role of leadership in driving positive outcomes in healthcare settings and emphasize the need for investing in leadership development initiatives to foster a culture of effective leadership and improve the overall quality of care.

Leadership Examples

For my selected leader, I chose a charge nurse named Brian, with whom I used to work in the emergency department. Brian is an astounding leader and demonstrates these identified skills. He epitomized transformational leadership qualities in the face of challenging and dynamic situations. One particular incident that showcased Brian’s leadership occurred during a busy weekend shift when the ED experienced an abnormal surge of patients due to the closing down of a nearby hospital. In addition to this, we were also short-staffed that day. Despite the chaos and high-stress environment, Brian remained calm, composed, and focused on ensuring the smooth operation of the department while delivering quality patient care. 

Firstly, he demonstrated exemplary communication skills by swiftly coordinating with the ED team to triage and prioritize patients based on the severity of their injuries. He effectively delegated tasks to nurses, physicians, and support staff, ensuring everyone understood their roles and responsibilities (Restivo et al., 2022). Secondly, he exhibited flexibility and adaptability in his leadership approach. Recognizing the need for additional resources and staff, he made the difficult decision to go on diversion after acknowledging the staff would not be able to provide efficient and safe care if more patients came in and acknowledging that management and administration could not provide us with additional staff. Brian was able to lead by example by actively participating in patient care activities alongside his team members. He also remained positive despite the critical circumstances we were all under. He remained visible and accessible throughout the shift, offering guidance, support, and reassurance to staff members experiencing heightened stress and fatigue (Sfantou et al., 2017).

Skill Effectiveness and Implementation Into the Workplace 

As a result of Brian’s transformational leadership, the ED team successfully managed the surge of patients with efficiency and effectiveness. Despite the overwhelming workload, morale remained high, and staff members felt supported and empowered to deliver optimal care under challenging circumstances. Additionally, Brian’s leadership during the crisis fostered a sense of camaraderie and unity within the ED team. The experience catalyzed collaboration, innovation, and continuous improvement as team members recognized the importance of working together cohesively to overcome adversity and deliver outstanding patient care (Restivo et al., 2022). Brian’s adept utilization of transformational leadership behaviors and skills proved instrumental in navigating the challenges of a short-staffed, busy day and fostering resilience and teamwork within the emergency department. His ability to inspire, empower, and lead by example exemplifies the transformative impact of effective leadership in high-pressure healthcare environments.

Conclusion 

In conclusion, exploring leadership in healthcare settings underscores leaders’ critical role in shaping organizational dynamics and patient care outcomes. The insights from scholarly research emphasize the significance of leadership style and effectiveness in driving positive change and fostering a conducive work environment. Specific examples illustrated how adept leadership behaviors and skills, such as transformational leadership and effective communication, can improve the quality of care, staff morale, and organizational performance. 

Respond using and cite from text attached

Shakir:Week 2 – Case Conceptualization

Client and Theory: 

Dale and Person-Centered Theory

Presenting Problem: 

Dale, 52 years old, White male, prison guard, ex-police officer, divorced, estranged father of an adult son, currently married, exhibits racist views and actions. In mandated therapy by the employer. His beliefs and actions are causing hardships for him in both his professional and personal life.

Hypothesis: 

The client is living incongruently to his abilities and it’s creating difficulties in various aspects of his life. The client’s life has been shaped by a desire to please those around him, especially his father. This acceptance of the parents’ negative social ideology and discriminatory constructs during his formative years, are incongruent to his innate self. Congruent individuals are those who trust their view of the world and trust their basic positive nature (Hazler, 2022).

The client is demonstrating his true desire to assist others, through the examples of his employment selections, as both a police and correctional officer. Through self-actualization of the person-centered theory the client can begin to hone in on his inner resources to take fundamental steps towards a positive congruent shift. Self-actualizing has the ability to create positive development in people (Hazler,2022). The client’s life has arrived at a point, where he is now being forced to explore, reflect and create change.

Treatment Goals: 

The goals for the client will be to join and assist him as he explores the roots of his anger, prejudices and discriminating actions. Reflecting upon past decisions has the ability to allow him to immerse into a state of self-actualization. Self-actualization is the driving force in the positive development of the individual. It propels the individual away from the control of others and towards autonomy (Hazler, 2022). Through these steps, the client will begin to explore inwardly without the inherited beliefs that have caused tremendous turbulence within his life.

According to the person-centered theory, everyone has the ability to learn, adjust and grow in positive directions (Hazler, 2022). The client has the chance to course correct his past aggressions, to possibly gain trust and admiration from not only his peers, but his son.

Intervention / Techniques:

The intervention methods used in this case conceptualization will be aligned with the Person-Centered theory. 

Intervention 1: Active Listening

Active listening in a counseling session delivers empathy for the client by being attentive and compassionately listening (Hazler, 2022). This approach would deliver a positive therapeutic alliance, which would assist the client with relaxing, trusting and begin the process of revealing his inner self, thoughts and ideas. Dale would greatly benefit from having an active listener, due to the immense pressure is receiving from his external world. His professional career is in jeopardy as a result of his actions.

Intervention 2: Reflection of Content and Feelings

The primary steps in extending empathy within a session are recognition and reflection of the actual words and feelings being shown by the client (Hazler, 2022). These steps will allow for recognizing the body language and feelings that Dale has compartmentalized or has made an attempt to express in possibly negative actions. 

I would like to guide the client to reflect upon his innermost feelings about being a parent, and of his current estranged relationship with his son. The possible reflection of a loved one has the ability to allow the client to reach his sincerest essence as a person. While allowing the client to be open and vulnerable, can allow the work to go beyond his overall persona. As stated, “At its most powerful, reflection can also bring together complex elements of the client’s world that draw a much more accurate picture of the client as a whole than the individual elements provide separately” (Hazler, 2022).

Expected Outcome:

The goal in utilizing the person-centered theory with the client, is to provide empathy as the client sets out to explore his inner self. Since this work can be challenging for this client, it’s important to express encouragement through active listening and being aware of the physical movements that may occur. “Counselors who accurately reflect content and feelings act like a mirror by helping clients see what they are expressing so that clients can revise and expand perceptions of themselves based on counselor reflections” (Hazler, 2022). 

The expected outcome after aligning with the person-centered theory, the client will begin to shift towards self-actualization. This would prove to provide significant breakthroughs within the client’s life. These changes will allow Dale the opportunity to define his own reality and become more aware of his former self. The participation in self-actualization can move individuals away from the constructed thoughts, beliefs and control of others, and move them towards self-determination (Hazler, 2022). The outcome should demonstrate unique momentum towards being a more balanced, caring and loving individual.

References:

Hazler, R.  (2022).  Adlerian theory. In D. Capuzzi & M. D. Stauffer (Eds.), Counseling and          psychotherapy: Theories and interventions (7th ed., pp. 139-160). American Counseling Association

response 2 Lindsay:

Case of Anna Johnson: Person-Centered Theory

Presenting Problem: “The client’s mom Ms. Johnson contacted [Behavioral Health Services of Virginia] seeking mental health assistance and intervention for their child Anna Johnson. The client is a single 12-year-old Latino female living in a nuclear family with 1 brother and 1 sister. The client is attending experiencing Tuckahoe Middle School in the 6th grade. The client currently does not have an Individual Education Plan but has a school counselor. The client has not had services before the conceptualization. The client is showing signs of Anxiety, depression, and ADHD but has potential signs of Autism as well. The signs for both disorders closely co-exist interchangeably and the speculation from the mother includes that the client is having anger outbursts, shuts down, and is having a delay in social skills. The mother also states that Anna is on Adderall XR 10mg and she needs new medication since the new Adderall medication isn’t working and she believes that the medication is not helping manage the symptoms. The mother also reports that Anna is pacing, needs constant prompting socially, and needs to be watched” (Chambers, 2024).

Hypothesis: 

“The client has also shown symptoms of anxiety and depression according to her mom as well as lack of eye contact, negative thoughts, lack of engagement with the siblings and other family members, lack of speaking, and body language that indicates discomfort such as arms crossed, zoning out, and having to be prompted 2-3x daily every month by teachers as well as friends according to the mother”(Chambers, 2024). Anna’s mom explains that Anna is constantly doubting herself as she handles challenges in her life. Anna’s mom believes she may be suffering from self-esteem problems from social media as well as social comparison. Ms. Johnson explained how she believes that Anna has body dysmorphia and is always being critical to herself. Anna believes she has low self-esteem and self-image due to bullying as well as not doing well in school, so she said that it makes her lack confidence in herself. Ms. Johnson suggests that the issue is that “school makes her feel like she isn’t smart when in reality she is and she isn’t aware of this. However, I believe Anna is not only good at school, but is a very intelligent person although she just isn’t very self-aware as well as she has trouble expressing herself and seeing that potential and growth within her. Ms. Johnson believes that Anna doesn’t recognize herself as a motivated person. Anna believes that she lacks the ability to improve, to trust herself, and the capability to change how she views herself to benefit her well-being. According to Hazler (2022), The first principle [of a person-centered perception] is “to treat clients as trustworthy, or there will be no reason to allow them to take a leadership role in the helping relationship”. Ms. Johnson claims that Anna needs some self-direction and needs to be deeply heard by the counselor to improve the quest of her quality of life and to help Anna trust in herself. The second principle emphasizes that self-actualization is the “driving force in the positive development of the individual. It clearly moves the individual away from control by others based on conditions of worth and toward autonomy and self-control.” (Hazler, 2022). Anna can improve her life with confidence most importantly within herself but also through the eyes of a counselor and support from her family and friends. However, Anna believes that she has to constantly meet her mother’s expectations as they are very high for her especially when it comes to her making friends and doing well in school which makes it hard for her to accept all aspects of herself, especially success. Anna fears that she will never be able to come to terms with herself in a positive light and that she will continue to be depressed about school and not connecting with herself and others.

Goals:

The main goal for Anna is to achieve congruence. What this goal means is that “Individuals can and must rely on themselves for direction and strength” (Hazler, 2022). Anna has ideas about herself that are very negative which impacts the way she views the world as well as her traits. Anna and her family are working on trying to better herself and showing Anna that she can handle life obstacles on her own and that she is going to need to make decisions even though she might not like it because that is what comes with growth. Anna has to learn to use these skills to manage and maintain her well-being, so she does not fall into depression repeatedly. Anna’s goal is that she wants to get help and obtain a better self-image instead of being insecure and nervous. Anna’s mother wants Anna to least appear to others that she is secure within herself and eventually work towards loving herself. However, Anna is embarrassed that her mom is forcing her to pretend that she is okay with others and would desire to work with a therapist on not judging herself, meeting her goals, and improving her own personality traits without the opinions of others to pave the way for her (specifically her mother) but to talk to someone about the issues and have them trust that she can find her own way. “[Congruence] begins with the counselor demonstrating trust in [Anna’s words], values, and ability to make productive decisions. Rather than trying to “show her the way,” the counselor will trust in her ability to find the better way and will be her professional companion along the way even as she makes missteps and then works to adjust them. Through active listening, demonstrating empathy, showing understanding, and recognizing the difficulties” (Hazler, 2022).

Intervention/Techniques: 

Intervention 1: The intervention method that would be beneficial would be Genuineness and Self-Disclosure. Using this intervention can be helpful because the counselor “will work with her situation, see her inner strength, trust in her willingness and ability to move in positive directions”, “The result is an environment that is supportive of the potential for progress and striving for more self-actualization” (Hazler, 2022). I believe this might be a useful approach because it focuses on how to encourage the client even when situations can be frustrating, which is helpful to Anna when she shuts down. Anna needs to be comfortable discussing her internal conflicts as well as having someone help her stay positive during a hard time. It would be beneficial for Anna’s growth because she would have to face the reality that with her disorders, she would have to work extra hard on how to be more in tune with her thought processes. Anna’s family has provided Anna with constructive criticism and is continuing to do so that way Anna can know that she is struggling and needs extra guidance because sometimes she is not as self-aware as she and others would like her to be (Chambers, 2024).

Intervention 2: Another intervention that would be beneficial for Anna would be Active Listening. “After putting themselves in the best possible position to listen, counselors must then hear and see what is communicated by words and action to turn the bits and pieces into a holistic picture” (Hazler, 2022). The idea is to always have a good listening ear to be able to gather as much information as possible to see how one can approach the situation at hand. I believe this might be a useful approach because Anna doesn’t feel heard by her mother and so this technique could encourage her to be more open with her problems (because her mother problem-solves and makes decisions for her and doesn’t allow her to just vent). The counselor can then reflect on what was said, give thought-provoking follow-up questions to Anna, and then point out to Anna some patterns within her behavior so that Anna can then make a decision based off the feedback and hopefully become more capable of self-improvement.

Expected Outcome:

The goal of person-centered therapyis so that the “individual is working together for the purpose of self-actualization growth rather than towards overcoming the illness” (Hazler, 2022). Anna hopefully will take away from the session that she is able to see her own strengths and trust in herself as well as also be able to engage in more social behaviors that help with her ADHD, anxiety, depression, and potential Autism. The main goal is for Anna to reach a point where she feels as if she can understand her problem areas as well as learn a solution-focused way to help herself in a positive light. The person-centered approach emphasizes a belief that this ability to grow in positive directions is available to everyone” (Hazler, 2022).

California Missions SLO Exercise (ASSIGNMENT)

This assignment is due Friday, March 22 at 11:59 PM.  Late submissions will be accepted for ten days through Monday, April 1, and a one-grade late deduction will be added to your score. This assessment will ask you to do several things:

1. Read/view a set of primary sources, including art works, related to the founding and development of the Spanish mission system in California

2. Analyze and synthesize primary and secondary sources in response to a historical thesis or question.

3. Articulate a cause or consequence of the event represented by the sources.

4. Describe one historical personality involved in this event and explain his or her significance in this event.

Write your answers directly into Canvas. Do not send back any files.

Here is the nuts-and-bolts video on the SLO exercise that was recorded in 2019.  This video was recorded with the Camtasia software and it does include the closed-captioning feature.  Just click the “CC” icon on the YouTube viewer to access the subtitles.

**NOTE: For this exercise, you are encouraged to bring in any information that you’ve learned about the historical period/topic from lecture, textbook, primary source documents, films and other sources. The term “secondary sources” refers to outside materials, including readings from “Between the Conquests.”**

Formal Instructions:

Read/view the attached set of primary sources, (the Father Duran and Indian laborer drawings, and the Father Jayme and La Perouse documents)

Address the following thesis statement: How do these sources prove that the policies of the Spanish Crown and Franciscan officials directly contributed to the cultural destruction of the California native populations as the mission system was being established? Explain in at least 5-6 sentences (based on your analysis of the primary and secondary sources) how the sources prove the thesis statement?

Articulate a cause or consequence of the California Mission system represented by the sources. Name and describe one cause or consequence of an event discussed in these sources in at least 5-6 sentences:

Describe one historical personality involved in this event ( the California Mission system) and explain his or her significance in this event. Name one person involved in this event. Why was that person significant?  Compose your answer in at least 5-6 sentences:

History 115 SLO Assessment: Set of Primary Source Documents

Source #1: Father Narciso Duran and Child, Mission San Jose (1844 painting)

Source #2 Father Luis Jayme criticizes the behavior of Spanish Soldiers (1772)

With reference to the Indians, I wish to say that great progress would be made if there was anything to eat and the soldiers would set a good example. We cannot give them anything to eat because what Don Pedro has given is not enough to last half a year for the Indians from the Californias who are here. Thus little progress will be made under present conditions. As for the example to be set by the soldiers, no doubt some of them are good exemplars and deserve to be treated accordingly, but very many of them deserved to be hanged on account of the continuous outrages which they are committing in seizing and raping the women. There is not a single mission where all the gentiles have not been scandalized, and even on the roads, so I have been told. Surely, as the gentiles themselves state, they are committing a thousand evils, particularly those of a sexual nature. The fathers have petitioned Don Pedro concerning these points, but he has paid very little attention to them. He has punished some, but as soon as they promised him that they would work at the presidio, he turned them loose. That is what he did last year, but he does not even punish them or say anything to them on this point. I suppose that some ministers will write you about the cases which have occurred at other missions. I shall speak only of Mission San Diego. At one of these Indian villages near the mission of San Diego, which said village is very large, and which is on the road that goes to Monterey, the gentiles therein many times have been on the point of coming here to kill us all, and the reason for this is that some soldiers who were carrying the mail to Monterey turned their animals into the fields and they ate up their crops. Three other Indian villages about a league or a league and a half from here have reported the same thing to me several times. For this reason on several occasions where Father Francisco Dumetz or I have gone to see these Indian villages, as soon as they us they fled from their villages and fled to the woods or other remote places, and the only ones who remained in the villages were some men and some very old women. The Christians here have told me that many of the gentiles of the aforesaid villages leave their huts and the crops which they gather from the lands around their villages, and go to the woods and experience hunger. They do this so that the soldiers will not rape their women as they have already done so many times in the past. No wonder the Indians here were bad when the mission was first founded. To begin with, they did not know why they (the Spaniards) had come, unless they intended to take their lands away from them. Now they all want to be Christians because they know that there is a God who created the heavens and earth and all things, that there is a Hell, and Glory, that they have souls, etc., but when the mission was first founded they did not know these things; instead they thought they were like animals, and when the vessels came at first, they saw that most of the crews died; they were very loathe to pray, and they did not want to be Christians at all; instead they said that it was bad to become a Christian and then they would die immediately. No wonder they said so when they saw how most of the sailors and California Indians died, but now, thanks be to the Lord, God has converted them from Sauls to Pauls. They all know the natural law, which so I am informed, they have observed as well or better than many Christians elsewhere. They do not have any idols; they do not go on drinking sprees; they do not marry relatives; and they have but one wife. The married men sleep with their wives only. The bachelors sleep together and apart from the women and the married couples. If a man plays with any woman who is not his wife, he is scolded and punished by his captains. Concerning those from the Californias I have heard it said that they are given to sexual vices, but among those here I have not been able to discover a single fault of that nature. Some of the first adults whom we baptized, when we pointed out to them that it was wrong to have sexual intercourse with a woman to whom they were not married, told me that they already knew that, and that among them it was considered to be very bad, and so they do not do so at all. “the soldiers,” they told me, “are Christians and, although they know that God will punish them in Hell, do so, having sexual intercourse with our wives. We,” they said, “although we did not know that God would punish us for that in Hell, considered it to very bad, and we did not do it, and even less now that we know that God will punish us if we do so.” When I heard this, I burst into tears to see how these gentiles were setting an example for us Christians. 

Source #3 Jean Francois La Perouse Describes the Mission Indians of Carmel (1786)

The color of these Indian, which is that of Negores; the house of the missionaries; their storehouses;…the appearance of the ground on which the grain in trodden out; the cattle, the horses, everything in short, brought to our recollection a plantation at Santo Domingo or any other West Indian island. The men and women are collected by the sound of a bell; a missionary leads them to work, to the church, and to all their exercises. We observed with concern that the resemblance is so perfect that we have seen both men and women in irons, and others in the stocks. Lastly, the noise of the whip might have struck our ears, this punishment also being administered. Corporal punishment is inflicted on the Indians of both sexes who neglect the exercises of piety, and many sins, which in Europe are left to Divine justice, are here punished by irons and the stocks. And lastly, it must be observed that the moment an Indian is baptizes, the effect is the same as if he had pronounced a vow for life. If he escapes to reside with his relations in the independent villages, he is summoned three times to return; if he refuses, the missionaries apply to the governor, who sends soldiers to seize him in the midst of his family and conduct him to the mission, where he is condemned to receive a certain number of lashes with the whip. They have so little courage that they never make any resistance to the three or four soldiers who so evidently violate the rights of men in their persons. The custom is kept up because theologians have decided that they could not in conscience administer baptism to men so inconstant unless the government would in some measure serve as their sponsor and answer for their perseverance in the faith. Punishments are adjudged by Indian magistrates, called caciques. There are three in each mission…These caciques are like the overseers of a plantation: passive beings, blind performers of the will of their superiors. Their principal function…is to maintain order and the appearance of attention. Women are never whipped in public, but in an enclosed and somewhat distant place that their cries may not excite a too lively compassion, which might cause the men to revolt. The latter, on the contrary, are exposed to the view of all their fellow citizens, that their punishment may serve as an example. They usually ask pardon for their fault, in which case the executioner diminishes the force of his lashes, but the number is always irrevocable. An hour after supper, they take care to secure all the women whose husbands are absent, as well as the young girls above the age of nine years, by locking them up, and during the day they entrust them to the care of elderly women. All these precautions are still inadequate, and we must have seen men in the stocks and women in irons for having eluded the vigilance. These Indians have no knowledge of a God or of a future state… The missionaries, persuaded from their prejudices and perhaps from their experience that the reason of these men is scarcely ever developed, consider this a just motive for treating them like children, and admit only a very small number to the communion… The government is a true theocracy for the Indians, who believe that their superiors have immediate and continual communication with God, and that they cause him to descend every day on the altar. By virtue of this opinion, the holy fathers live in the midst of the villages with the greatest security. Their doors are not shut, even in the night.

Source #4: Indian neophytes were responsible for plowing acres of mission property

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to their:

Alexis Renee Johnson

The Psychiatric Evaluation and Evidence-Based Rating Scales

Psychiatric Interview

There are multiple components to the psychiatric interview. While each one of the components is important, I am going to focus on the assessment, DSM-5 Diagnosis, and treatment plan. “The assessment should be a brief recapitulation of the overall clinical picture and a discussion of differential diagnosis.” (Carlat, D. J., 2017). Carlat also notes this is often the area other clinicians will focus on therefore it is important to capture all pertinent information here. In the assessment should include identifying data, current clinical picture, family, and medical history that may be associated with the current diagnosis. “The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the standard language by which clinicians, researchers, and public health officials in the United States communicate about mental disorders.” (Regier, D. A., Kuhl, E. A., & Kupfer, D. J., 2013). In the psychiatric interview, the DSM-5 is where the clinician will list all the diagnosis for the patient being interviewed. The treatment plan is where the clinician will document the plan of care for the patient. The treatment plan should include: any diagnostic testing planned (i.e., neuropsychological testing, laboratory tests), plans for medication, if you can prescribe, plans for therapy, if needed, referrals to other health care practitioners, if applicable, when you plan to see your patient again. (Carlat, D.J., 2017).

Psychometric Properties

There are multiple screening tools to diagnosis and determine the severity of depressive disorders. I chose to discuss the Beck Depression Inventory (BDI) scale. “The BDI was developed in the early 1960s to rate depression severity, with a focus on behavioral and cognitive dimensions of depression.” (Boland, R. & Verduin, M. L. & Ruiz, P., 2022). This screening tool consists of 21 questions the patient will answer based off their symptoms over the last 2 weeks. The scale is then scored and determines the severity of symptoms. The tool can be readministered to evaluate changes in symptoms over treatment. The screening tool can be administered anytime but would be most helpful and the beginning of the interview to help identify the severity of symptoms.

References:

Carlat, D. J. (2017). The psychiatric interview (4th ed.). Wolters Kluwer.

Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th

ed.). Wolters Kluwer

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria

changes. World psychiatry: official journal of the World Psychiatric Association

(WPA), 12(2), 92–98. https://doi.org/10.1002/wps.20050

Mathew Ajemba

Hello professor and class,

The three important elements of the psychiatric interview are chief complaint and history of presenting illness (HPI), mental status examination (MSE), and family and social history. The CC offers direction on what kind of HPI (including onset, duration, symptom progression, alleviating, and triggering factors) to gather to understand the patient’s current mental health status (Sadock et al., 2017). By understanding the patient’s CC and HPI, the provider can gain valuable insight into their mental state and help formulate differential diagnoses and an appropriate treatment plan. The MSE helps gain insight into the patient’s mental status by assessing their appearance, behaviors, speech, thought content and process, mood and affect, cognition, perception, insight, and judgments, information fundamental to developing differential diagnoses by identifying specific abnormalities and patterns that indicate certain psychiatric illnesses and informing the development of a treatment plan (Newson et al., 2020). Family and social history is important considering it influence psychopathology. Information about the family’s mental illnesses, social practices (e.g. drinking, drug use, and smoking), and significant life events (e.g. divorce) can help understand the patient’s life and aid in identifying potential stressors and differential diagnoses (Sadock et al., 2017).

The screening tool assigned is the Overt Aggression Scale-Modified (OAS-M), a tool used to assess aggression in psychiatric patients, both inpatient and outpatient (Mistler & Friedman, 2022). According to Coccaro (2020), the OAS-M is a valid and reliable tool, with an alpha coefficient of 0.88 for OAS-M Global Anger and Aggression (GAA) and 0.78 for OAS-M aggression score (AGG), demonstrating internal consistency. The tool also has high inter-rate reliability with a Kappa coefficient of 0.84 and ICC value of 0.97; high temporal stability with an ICC of 0.55; and high face validity.

The OAS-M, as described by Coccaro (2020), is relevant for patients who present with aggressive behaviors such as a history of threats, violence, agitation, or irritability. It provides healthcare professionals with a structured and standardized approach to assessing the risk of overt aggression through the assessment of physical aggression, verbal aggression, hostility, and other aggressive behaviors. The tool also guides the development of appropriate intervention by informing on the severity and nature of the patient’s aggressive behaviors. For instance, helping identify specific triggers and developing targeted and individualized interventions for the management of aggressive behaviors (Mistler & Friedman, 2022). The OAS-M tool is also used to monitor the effectiveness of the intervention in which it is administered at regular interventions to track changes in severity and nature of aggregation, helping inform any change to treatment plans and making necessary adjustments to help attain therapeutic efficacy (Coccaro, 2020).

References

Coccaro, E. F. (2020). The Overt Aggression Scale Modified (OAS-M) for clinical trials targeting impulsive aggression and intermittent explosive disorder: Validity, reliability, and correlates. Journal of Psychiatric Research, 124, 50-57. https://doi.org/10.1016/j.jpsychires.2020.01.007Links to an external site.

Mistler, L. A., & Friedman, M. J. (2022). Instruments for measuring violence on acute inpatient psychiatric units: Review and recommendations. Psychiatric Services, 73(6), 650-657. https://doi.org/10.1176/appi.ps.202000297Links to an external site.

Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment. Frontiers in Psychiatry, 11, 76. https://doi.org/10.3389/fpsyt.2020.00076

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. In Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry. (4th ed., pp. 39–52). Wolters Kluwer.

MY POST

Natalie Farquharson

Exploring Psychiatric Assessment and the Montgomery-Åsberg Depression Rating Scale (MADRS)

Components of the Psychiatric Interview

The key psychiatric interview components were rapport-building mental state analysis, and accurate diagnosing. Initial rapport-building fosters a therapeutic partnership that encourages patients to open up. This requires creating a sympathetic, nonjudgmental space for conversation. A comprehensive examination of cognitive, emotional, and perceptual functions reveals the patient’s mental health. Structured questions, observations, and open-ended inquiries help discover mental disorders in this complete examination (Carlat, 2017). Finally, a correct diagnosis is crucial. After the mental state exam, the diagnostic evaluation and formulation procedure synthesizes the data using DSM-5 criteria. This improves comprehension and helps create customized treatment programs.

Psychometric Properties of MADRS

The Montgomery-Åsberg Depression Rating Scale (MADRS) demonstrates robust psychometric properties, affirming its reliability and validity in assessing depressive symptoms. With good internal consistency, MADRS items exhibit high correlation, ensuring homogeneity in measuring depressive constructs. Inter-rater reliability is also notable, indicating consistent ratings across different assessors. Content validity is supported by the scale’s comprehensive coverage of various depressive aspects, and construct validity is evidenced by its effectiveness in measuring depressive symptoms (Borentain et al., 2022). MADRS exhibits sensitivity to change, crucial for tracking symptom severity changes over time in clinical trials. Its criterion-related validity is affirmed through significant correlations with other established depression measures. Furthermore, the one-factor structure of MADRS underscores its simplicity and efficiency in capturing the overall severity of depression.

Application of MADRS

It’s appropriate to use the scale as nurse practitioners during psychiatric interviews. The Montgomery-Åsberg Depression Rating Scale (MADRS) proves particularly valuable within nurse practitioners’ responsibilities. Employing MADRS during the initial psychiatric assessment allows nurse practitioners to gauge the severity of depressive symptoms, establishing a crucial baseline for informed treatment planning. As care progresses, the scale becomes an effective tool for ongoing monitoring, enabling nurse practitioners to track symptom changes and assess the effectiveness of therapeutic interventions (Ntini et al., 2020). MADRS also supports collaborative care models, facilitating standardized communication with other healthcare professionals involved in a patient’s mental health management. In research settings, nurse practitioners can utilize MADRS for data collection, contributing to a more comprehensive understanding of depressive symptomatology.

MADRS use in Nurse Practitioner’s Psychiatric Assessment

The Montgomery-Åsberg Depression Rating Scale (MADRS) significantly enhances a nurse practitioner’s psychiatric assessment by providing a structured and standardized method for evaluating the severity of depressive symptoms. Utilizing MADRS during the initial evaluation establishes a quantifiable baseline, enabling tracking changes in symptomatology over time and facilitating ongoing monitoring of treatment effectiveness (Ntini et al., 2020). The scale’s comprehensive nature ensures a systematic exploration of various depressive symptoms, contributing to a more accurate and holistic understanding of the patient’s mental state. MADRS also promotes consistency and effective communication in multidisciplinary care settings, enhancing collaboration with other healthcare professionals. In research contexts, MADRS serves as a valuable tool for data collection, contributing to evidence-based practice.

References

Borentain, S., Gogate, J., Williamson, D., Carmody, T., Trivedi, M., Jamieson, C., Cabrera, P., Popova, V., Wajs, E., DiBernardo, A., & Daly, E. J. (2022). Montgomery?Åsberg Depression Rating Scale factors in treatment?resistant depression at the onset of treatment: Derivation, replication, and change over time during treatment with esketamine. International Journal of Methods in Psychiatric Research, 31(4). https://doi.org/10.1002/mpr.1927Links to an external site.

Carlat, D. J. (2017). The psychiatric interview (4th ed.). Philadelphia Wolters Kluwer.

Ntini, I., Vadlin, S., Olofsdotter, S., Ramklint, M., Nilsson, K. W., Engström, I., & Sonnby, K. (2020). The Montgomery and Åsberg Depression Rating Scale – self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy. Nordic Journal of Psychiatry, 74(6), 415–422. https://doi.org/10.1080/08039488.2020.1733077Links to an external site.

Please respond to Alexis and Mathew with 2 paragraphs with references

THE PSYCHIATRIC EVALUATION AND EVIDENCE-BASED RATING SCALES

EditEditAssessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.