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#adult organizational psychology

chalkrevelations · 11 months

Text

Review guide under here, so I can cross things off as I go. Certification exam coming up soon. This is what I’m going to be doing for the next month or so. Meanwhile, queue is in charge.

disease progression and imminent death

assessment and staging scale

FAST

**FAST staging: 1. (normal adult) no difficulties; 2. (normal older adult - mild memory loss) word finding, location of objects; 3. (early dementia) decreased job function evident, decr. organizational capacity, difficult travel to new locations; 4. (mild dementia) decr. ability at complex tasks, handling finances; 5. (moderate dementia - diff with serial subtraction; date/year/home address) assistance in proper clothing choice; 6a. (moderately severe dementia - diff with names of family/friends, delusions/hallucinations/obsessions, increased anxiety, poss violent; daytime sleep/night wakefulness) assistance in dressing; 6b. assistance bathing more freq.; 6c. assistance toileting more freq.; 6d. urinary incont. more freq.; 6e. bowel incont. more freq.; 7a. (severe dementia - incontinent x2, lose speech & ability to walk; bedridden -> sepsis, pna) limited speaking ability (half dozen words in av. day/interview); 7b. single intelligible word in av. day/interview); 7c. lost amb. ability; 7d. needs assistance to sit up (i.e., arms on chairs); 7e. lost ability to smile

Karnofsky

PPS

local coverage determination

disease-specific guidelines

SSx of imminent death - usually in clusters rather than individual SSx

weeks to months

loss of appetite (early sign) -> weight loss, cachexia (family distress: signifies decline, inability to nourish as a sign of care. educate that force feeding -> vomiting and aspiration). artificial nutrition if consistent with GOC, but educate that it does little good and may increase distressing symptoms. consider decrease if patient has in place but vomiting, aspiration, edema, CHF, pulmonary edema, other SSx fluid overload

cachexia incl. muscle wasting, anorexia, fatigue, weakness, as well as weight loss

unintentional weight loss = or >5% body weight

BMI < 20 (pt <65yo) OR <22 (pt >65yo)

<10% total body fat

increased cytokine levels (-> muscle tissue breakdown/catabolism)

albumin level <35 g/L

enourage oral fluid intake for as long as possible; team to work with family to determine if supplemental hydration. NOT USUALLY NECESSARY in terminal phase, although in some cases hypodermoclysis may ease delirium, opioid toxicity, agitation, dehydration

days to weeks

possible psychological and spiritual distress - depression, anxiety, grief, isolation in final weeks (highest levels of anxiety - COPD likely d/t dyspnea). Hopelessness, general dissatisfaction with life, overall sense of suffering in advanced dz.

increasing weakenss and dependence on caregivers

dysphagia/aphagia - if unable to take PO, consult with prescriber to d/c unnecessary meds; to promote comfort, KEEP pain meds, anxiolytics, antiemetics, anticholinergics, antipyretics (alteranate routes)

asthenia -> bedbound + incontinence, malnutrition -> risk for skin breakdown. SKIN CARE, frequent repositioning. Kennedy ulcers in final days, despite skin care (sacral, pear- or butterfly-shaped)

focus care on SYMPTOM MGMT and comfort as pt declines.

hours to days

educate family on saying goodbye/resolving conflicts, creating mementos (recording pt’s voice, hand casts, photos, etc), finalizing funeral arrangements, gathering loved ones who want to be present at TOD, normal changes in pt condition (decr. appetite, incr. somnolence, cyanosis, etc.) and that they don’t cause pain/distress for pt

aggressive and prompt symptom mgmt to alleviate distress - determine if change in meds/routines is root cause.

Some SSx may not be distressing for pt (ex. some terminal agitation) but impacts safety - address via activity as tol., thx environmen, music thx, meds (haloperidol, chlorpromazine, risperidone, lorazepam)

some distressing for family but not pt - terminal secretions (death rattle). educate family, reposition pt., suction oropharynx (NOT deep suction). if dyspnea or pt distress, anticholinergics (hyoscamine SQ, atropine SL, glycopyrrolate SL, scopolamine SQ/topical

SSx: confusion and vision of loves ones who’ve passed away; terminal agitation -> incr somnolence -> unresponsiveness; respiration changes (aphea, Cheyne-Stokes, agonal breathing, terminal secretions); temporal wasting; dehydration; pain; cyanosis (lips, extremities), cooling of extremities; HTN -> hypotension; peripheral edema; mottling; incontinence -> oliguria -> anuria. increasing asthenia and somnolence -> coma OR mutliple symptoms w/ terminal agitation period prior to coma.

pts withdraw and lose verbal ability, but THOUGHT REMAINS INTACT - caregivers should continue to talk, provide soothing sounds (music) throughout dying process

educate caregivers on nonverbal signs of pain/discomfort (often r/t tumor pressure, GI distress, frailty, siffness, immobility, bladder distention (FLACC scale)

FINAL HOURS: profound weakness/fatigue, guant/pale, withdrawal from others/reduced awareness, glassy/cloudy eyes, unable to take PO, oliguria-anuria, agonal respirations/apnea, tachycardia, unresponsive

adhere to advance care plan, avoid unnecessary interventions incl. VSx monitoring, treat FEVER, d/c unneeded routine meds

educate family re: pre-death “rally” - sudden reawakening/awareness of surroundings, coherent conversation, increased appetite -> semicomatose within hours (family distress, false hope)

if esophageal varices - prep family for poss. terminal hemorrhage (not usually painful for pt but visually distressing), provide support, focused attn during. poss. pt sedation if awake and alert. hemostatic dressings in chronic bleeding. dark towels.

inteventions: agitation (benzos, music, massage, dim lights, cool env.); dehydration (freq. oral care, ice chips as tolerated, hypodermoclysis/protoclysis if GOC consistent); dry mouth (oral care, lip balm, ice chips and oral swab as tolerated, artificial saliva); dyspnea (trx cause if poss., opioids, reposition for comfort, fan for moving air/cool env.); edema (elevate extremities as tolerated, diuretics, decrease/discontinue artificial nutrition/hydration of fluid overload SSx); fever (acetominophen PR, fan, light clothing, cool compress to head); incontinence (change promptly, skin care after each incident, reposition freq to protect skin); pain (PO meds until not tolerated -> SQ, PR; adjuvant meds PRN, reposition, distraction, massaage, heat/cold); terminal secretions (reposition, anticholinergics, oral suction); decubitus ulcers (skin care, wound care, topical lidocaine)

afterdeath care

assessment/document: general appearance, absence of heart/lung sounds on auscultation (1 full minute), lack of pupillary response to light, absence of response to verbal/tactile stimuli, TOD, who was notified of death, what time family/caregiver notified hospice agency (for home care patients), to who body released (morgue, funeral director, etc.)

postmortem care with attention to cultural/religious preferences; invite family to participate if they desire; emotional support for family with assurance team will provide bereavement support up to 1yr

prep death certificate as req. by state law, notify primary care provider

FEDERAL LAW - if death in hospital, primary decision maker must be approached re: organ donation

DISEASE SPECIFIC

end-stage cancer

neuro disorders

neurologic

neurovascular (w/ cva, coma admission criteria)

cardiac disorders

pulmonary disorders

renal disorders

hepatic disorders

infx (esp. viral hepatitis), autoimmune dz, genetic predisposition to liver dz, cx, chroncia ETOH, fatty liver -> liver damage

risk factors: ETOH abuse, exposure to blood/body fluids (parenteral drug abuse, tattoos, blood transf. prior to 1982), hepatotoxic chemical exp., diabetes/obesity (Hep C #1, alc. cirrhosis #2)

irreversible dz processes -> chronic lliver failure (CLF) ->ESLD. erratic trajectory with increasingly frequent, severe exacerbations of symptoms. sudden death r/t complications.

ascites, hepatic encephalopathy, anorexia/cachexia, portal hypertension, poor immunity, n/v, lyte imbalance, pruritis, malaise, esoophageal varices, pain, muscle/extremities wasting d/t malnutrition

assessment: symptoms (pain, n/v, altered bowel, rectal bleeding, dysphagia, abd. distention, pruritis), jaundice of sclera and skin, rash, petichiae, open areas from scratching, nonhealing wounds, temporal wasting & sunken eyes d/t malnutrition; abd inspection/ausc/percussion/palpation (boardlike w/ generalized peritonitis; rebound tenderness with local inflamm)

Model of End-Stage Liver Dz (MELD) - INR, bilirubin, creatinine levels. (score 10-19 = 92% 6-month mortality)

Child-Turcotte-Pugh (CTP) - total bilirubin, albumin, INR, degrees of encephalopathy & ascites (Class A = 95% 12-month mortality)

ascites indicates 50% 2-year mortality (6-month median survival rate when refractory)

liver failure -> renal failure (hepatorenal syndrome); HRS type 1 -> 4-week survival rate; type 2 -> 6-month survival rate

DISCUSS PALLIATION EARLY

HOSPICE CRITERIA:

symptoms (ascites, hepatic encephalopathy, HRS, varices) are refractory to intervention

PT > 5 seconds over control OR INR > 1.5

serum albumin <2.5 gm/dL, plus one or more:

ascites, refractory or pt noncompliant

spont. bacterial peritonitis

HRS, elevated creatinine and BUN, oliguria (<400 mL/d), urine Na concentation <10mEq/L, chirrhosis and ascites

hepatic encephalopathy, refractory or pt noncompliant

recurrent variceal bleeding despite thx

SUPPORTING documentation: progressive malnutrition, muscle wasting, continued active alcoholism (>80g ETOH/d), hepatocellular carcinoma, Hep B (HBsAg) positive

dementia/neurocognitive disorders

NCDS - decline from previous function, distinct from congenital

risk factors - age (60yo, 85yo), genetic predisposition, female, poor diet/obesity/diabetes, depression, education level, multiple comorbidities

memory changes, poor recognition, word searching, decr. executive function, poor attention span, behavior/mood changes, altered perception, decreased function re: ADLs

APA diagnostic criteria (dementia): significant decline from previous level in multiple domains (complex attention, executive function, learning and memory, language, perceptual/motor, social cognition) based on concern from knowledgeable informant or clinician or documented by testing/assessment + interferes with ADL independence + not just delirium + not better explained by another mental disorder

Alzheimer’s - slow progression (6-8 years) with exacerbations of underlying illnesses; short term memory loss, decreased attn, word searching

vascular - stepwise decline; onset gen. corresponding to TIA/CVA/cerebral infarct; variability of symptoms: aphasia, motor deficits, impaired executive function/recall/problem solving

Lewy body - progressive symptoms: neurocognitive changes, movement disorders, hallucinations, parkinsonian movements, falls, delusions, sleep disturbance

frontotemporal - (umbrella - nerve cell damage) variable progression; aphasia, obstinacy, apathy, motor disturbances, disinhibition, decr. facial recognition, emotional distancing

PT/OT/ST to maintain function & speech/swallow ALAP; advance care planning, GOC, long-term management (LTC facility?) EARLY

cholinesterase inhibitors (donepazil) to impr. cholinergic transmission in early stages; NMDA receptor agonists (memantine) later stages (impr. memory, enhance reasoning, maintain physical function - can be used together

late stage - interdisciplinary team - serious motor impairment ->safety issues, dysphagia/incontinence/immobility -> skin integrity infection -> agitation, delirium/depression/lethargy, pain, SOB, limb contractures

terminal phase - per advance directive and GOC, d/c interventions if questionable benefit

CRITERIA FOR HOSPICE ADMISSION

FAST** Stage 7 or beyond PLUS one or more of

aspiration pna

septicemia

pyelonephritis

multiple S3/S4 pressure injuries

recurrent fever

other significant condition suggesting limited prognosis

hx shows inability to maintain sufficient fluid/calorie intake in past 6 months (10% weight loss, albumin <2.5gm/dL)

endocrine disorders (most common)

thyroid dz

hypo (high TSH) - weight gain, jaundice, hoarsenes, decreased sbp/increased dbp, pericardial effusion, bradycardia, edema, fatigue, myalgia/arthralgia, blurred vision, impaired hearing, increased perspiration, fever/sore throat, depression/emotional lability, cold intolerance, paresthesia, constipation; myxedema crisis/coma - LEVOTHYROXINE 1-2 mg/kg/d.

hyper (low TSH, high T4/T3) - Grave’s disease comorbid 60-80%. nervousness, irritability, tremor, muscle weakness, bruit over thyroid, hyperactivity, heat intolerance, hair loss, palmer erythema; thyroid toxicosis/thyroid storm (antithyroid meds, inorganic iodine, bile acid sequestrants, beta-blockers, glucocorticoids) - antithyroid meds (methimazole, propylthiouracil), beta-blockers for andrenergic symptoms. radioactive idodine thx/thyroidectomy.

diabetes

DM2 risk factors: age, htn, hypercholesterolemia, weight/obesity, smoking, inactivity, hyperglycemia;

increased risk of stroke, cardiac events; retinopathy, neuropathy

maintain AIC <5.7% or fasting plasma glucose <100 mg/dL

prioritize comfort/quality of life (when to d/c BG monitoring; EDUCATION of pt, family re: d/c)

immunologic disorders (w/ hiv admission criteria)

PAIN MANAGEMENT

assessment

chronic pain/chronic pain syndromes

low back pain - recurrent, refractory, impaired mobility, debilitation

myofascial pain syndrome (MPS) r/t muscle, fascia, tendon injury - myositis, fibrositis, myofibrositis, myalgia,

neuropathic

peripheral - diabetic neuropathy, nutritional deficiency, HIV, carcinoma - activity, allodynia

central - spinal cord trauma, tumors, vascular lesions, MS, Parkinson’s, postherpetic neuralgia, phantom limb, reflex sympathetic dystropy (CRPS)

CRPS - neuropathic, allodynia (diaphoresis, vascular changes, asthenia, disuse (PT, nerve blocks)

chronic postoperative pain (CRPS) - phantom limb, chronic donor site, postthoracotomy pain syndrome, joint arthroplasty (acute + chronic -> multimodal trx)

reticular - compression of neck/spine nerve roots (sciatica, injury, herniated disk, foraminal stenosis, inflammation) - sharp, stabbing, radiating

cancer - neuropathy, parasthesia, r/t tumor growth, trx, comorbidities - frequent assessment for rapid changes, short- + long-acting

PQRST

palliative & precipitating factors (what makes it better or worse)

quality (what does it feel like)

radiation (is it in one area or does it travel) (somatic gen. well-localized, visceral gen. poorly localized, neuropathic gen. radiates)

severity (can you rate it for me)

timing (better or worse at certain times, when did it start, how long does it last)

nonverbal: FLACC, Wong-Baker FACES, Faces Pian Scale Revised (FPS-R) (children 1-7), PAINAD

impacts

physical - quality, severity + related symptoms (nausea, sleep disturbance, depression, anxiety, immobility,

psychological - anxiety, depression, hopelessness; quality of life, incl. planning activities around pain/meds (Patient Health Questionnaire (PHQ-9, depression); GAD (GAD-10) screenings)

social - isolation, social consequences of reporting pain

spiritual - FICA Spiritual History (spiritual distress)

SUD - gen. more severe pain experience, poss. require higher med dose

40% comorbid mental/emotional/behavioral disorder

serious illness as trigger for substance abuse

AUDIT-C, Opioid Risk Tool

interventions

nociceptive pain (somatic or visceral) (sharp and localized)

visceral (gnawing, ache) - multimodal mgmt; metasteses, pancreatic tumors/pancreatitis, biliary or SBO/colon obstruction

neuropathic - multimodal mgmt, incl. nonopioids, gabapentinoids, antidepressants, SNRIs, anticonvulsants, Na-channel blocking antiarrhytmics. (opiods as second/third-line; methadone; high doses for effective trx)

WHO pain ladder

Step 1 - nonopioids with or without adjuvants

Step 2 - opioids with or without adjuvants, nonopioids

Step 3 - opioids for mod-severe pain (long-acting + short-acting) + adjuvants

non-opioids

acetaminophen (PO, PR, IV)

NSAIDS (selective vs. nonselective COX-2 inhibitors)

opiods

SEs

constipation (gastric motility) - bowel regimen (laxative + stool softener)

n/v (gastric motility, CTZ & opioid receptor stimulation)

entiemetics to antagonize specific receptors:

haloperidol - D(2)

promethazine - H(1)

naloxone - DOR

ondansetron, tropisetron, dolasetron, granisetron - 5-HT(3)

scopalamine - ACh

aprepitant - NK-1

dronabinol - DCB(1)

pruritis (partic. MORPHINE) (histimine release; effects on mu-opioid, dopamine, serotonin receptors) - rotation, reduction, antihistimines (xerostoma, confusion, blurred vision in geriatric pt - TOPICALS instead)

sedation (difficulty clearing incl. geriatric, renal dysfunction) ->

respiratory depression (opioid naive, sleep apnea, geriatric, drug-drug interactions, obesity, cardiac/respiratory disorders, functional/psych status, comorbidities) - naloxone, education

opioid-induced neurotoxicity (accumulated opioid metabolites)

partic MORPHINE then HYDROMORPHONE (kidney excretion, i.e., risks in geriatric and renal dysfunction)

fentanyl, sufentanil

do not use meperidine in palliative/hospice d/t seizure risk

myoclonus - first, most common sign

reverse mechanism, therefore -> reduce/rotate

clonazepam, midazolam, benzos, baclofen, dantrolene

overdose - often drug-drug interaction (opoids + benzos)

confusion/delirium, n/v, pinpoint, lethargy, cyanosis, respiratory distress/failure

naloxone (IN, SL, IV, IM)

CONVERSIONS

oral to parenteral - 3:1

long-acting dose - (actual TDD incl. PRNs / 2) Q12H

oral rescue dose (breakthrough pain) - 10-20% TDD Q1-2H PRN

parenteral rescue dose - 50-100% hourly rate Q15 min PRN

drug-to-drug*

adjuvants (NSAIDs, COX-2 inhibitors, muscle relaxants, psychotropics, antidepressants, antiepileptics, anxiolytics, sedatives, amphetamines, antiarrhythmics, Ca-channel blockers, ketamine, lidocaine, capsaicin, tramadol, etc.)

non-pharmacologial

evaluation

SYMPTOM MANAGEMENT

neuro

cardiovascular

terminal cardiac diagnosis -> deteriorating status; multiorgan system failure

coagulation problems inabilty to clot or regulate clot formation d/t tumor invasion, trx SE, thrombocytpenia, nutritional deficiency, anticoag use, coag abnormalities -> bleeding disorders/internal bleeding SSx epistaxis, hemoptysis, hematemesis, melena, hematochezia, hematuria, vaginal bleeding, sings of incr ICP

bleeding/hemorrhage - if nonacute, stop bleeding (packing, compression dressing, topical hemostatic, position to decr bloodflow, astringints) and alleviate pt’s anxiety. educte pt and family for risks for bleeding (partic in liver dz). Catastrophic hemorrhage - stem further bleed IF CONSISTENT WITH GOC. Radiation thx, palliative TACE, endoscopy, vitamin K, vasopressin, antifibrinolytics, otreotide (for varices), platelet transfusion, FFP. possibly palliative sedation. Dark-colored towels to reduce visual impact for pt and caregivers.

thrombi/dvt - risk d/t immobility, orthopedic trauma, circulatory problems - use TED hose/SCDs prophylatically. DVT SSx: edema, pain, localized warmth, venous distention, localized tenderness to palpation. Dx via venogram (”gold standard” but invasive), venous doppler to detect blood flow (evaluate/compare both extremities). Trx: hepairin, low molecular weight heparin (LMWH), unfractioned heparin, fondaparinux. NO enoxoparin (Lovenox) (a LMWH) in acute renal failure.

pulmonary embolism - d/t thrombus formation, often DVT migrattion to pulmonary artery. Risks: genetic predisp., recent surgery, hx DVT/PE, immobility, hospitalization, cx, age, HF, stroke, acute respiratory failure, IBD. may be initially asymptomatic/vague symptoms. Unexplained chest pain in 97% of confirmed PE. other SSx: anxiety, diaphoresis, cought, syncope, hemoptysis, hypoxemia, hypotension, pleuritic rub. -> pressure increase in R ventricle -> tacycardia, crackles, fever, prounounced S2 (with closure of pulmonic and aortic valves), S3 (d/t fluid overload), possible S4 gallop (d/t thickned ventricular walls 2ndry to HTN or aortic stenosis).

lab testing is not definitive. rule out differential dx w/ d-dimer, ESR, leukocyte level, dehydrogenase, BNP, troponin. rule out differential dx with chest XR. spiral CT with contrast can more accurately confirm - if non-contrast d/t allergy, renal impairment then ventilaion/perfusion (V/Q) scanning. Gold standard dx - confirmation via pulmonary angiogram (expensive and invasive)

trx: stabilize. invasive measures only if consistent with GOC (mechanical vent, intubation) - improve ventilation. BIPAP noninvasive may also improve.

pharm (IV resuscitation, vascular stabilization) - vasopressors (norepinephrine, dopamine, epinephrine), anticoags (LMWH, unfractioned heparin, fondaparinux, warfarin, rivaroxaban). in initial phase, intiate parenteral heparin, LMWH, rivaroxaban, fondaparinux - > transitioned to oral or other agent. IF NOT CONSISTENT WITH GOC: alleviate dyspnea and anxiety, incl. sedation if sever distress and symptomatic. Family education, d/t suddenness, poor prognosis

DIC - thrombi -> infarction in multiple vessels/organs -> organ damage + internal bleeding d/t platelet depletion; risks: sepsis, inflamm dz, cx, liver dz, trauma, aneurysms, vascular disorder. ssx initially subtle; bruising purpura, petechiae, hematemesis, hematuria, hematochezia, hemothorax. trx: replace blood and blood products, correct metabolic shifts. anticoags (may need cautery, cryoablation to control bleeding), synthetic protease inhibitors (block serine proteases, incl. thrombin), antifibrinolytics, IF ORGAN FAIULRE, natural protease inhibitors, but avoid antifibrinolytics

angina d/t increased cardiac O2 demand d/t activity, cardiac vessel onbstruction, MI. stable vs. unstable. ssx: sudden chest pain, tightness, heaviness, squeezing, pain radiating to jaw/arms/back, SOB, fatigue, nausea (2-3 symptoms together - atypical angina). trx: rule out MI or occlusion, treat symptomatically - discontinue precipitating activities, nitroglyc SL/PO/TD/IV/lingual spray. Possible invasive (angioplasty, stent, CABG) if benefits outweigh risks

edema

lower extremities d/t ES organ failure (partic (R) heart/liver/kidney), med SE, superior vena cava syndrome (SVCS), vascular insufficiency, hypoalbuminemia, fluid overload. pitting vs. non-pitting. incr weight -> discomfort, decr mobility. trx: elevation, compression. diuretics may NOT be useful, particularly if refractory. interventions implemented slowly to prevent incr. cardiac symptoms.

lymphedema d/t obstruction/removal of lymph nodes (r/t cx surgeries, other trx) -> lymph accumulation -> fibrosis, sclerosis -> permanent edema. pre-fibrosis, trx with elevation, compression. diuretics generally NOT useful. SKIN CARE. manual lymphatic drainage by trained massage or PT (promoting mobility, ROM, QOL)

syncope temp. loss of consciousness d/t low blood flow to brain (hypotension, r/t (ES) cardiac dz/afib, dehydration, fluid shifts, postural changes (orthostatic)). SAFETY - educate pt and family on changing position slowly, assistance for transfers, sit/lie down at warning SSx: nausea, diaphoresis, lightheaded. Recurrent -> anxiety, somatization, panic -> fluoxetine. Testing (EKG, lab studies for lyte imbalance/dehydration, tilt table to test) for cause if GOC consistent. Pacemaker may relieve fatigue, dyspnea, syncope.

SVCS obstruction of SVS/nearby lymph nodes/vessels (usually d/tprimary tumor or mets from lung cx/breast cx/lymphoma) -> SSx obstructed drainage from hed/neck/UEs (facial swelling, JVD, distention of chest veins, UE edema, ruddy complexion; over 2-week period - cough, dyspnea, hoarseness, blurred vision, syncope, HA, confusion, obtundation). Confirm dx via chest XR, CT, MRA. trx via chemo/radiation, steriods, diuretic, thrombolytics, stent/bypass. RAISE HOB 45-90 degrees to promote drainage. prognosis (age over 50, extent of malignancy, hx smoking, steroid use) fair to poor, <6mo to 2yr -> team discussion GOC re: interventions

respiratory

constipation (abd distention, nasea/indigestion, <3BM/wk, difficult to pass/straining, feeling of incomplete emptying)

d/t slowed gi mobility, increased intestinal water absorption, obstruction, meds (incl. antidiarrheals, opioids), immobility, low fiber, dehydration

ausculate, palpate, skin turgor, hx (diet, mobiliyt, usual patter, associated issues, typical consistency)

high fiber diet, 2-3L fluids/day, exercise as tolerated, laxatives (increase if opiod increases)

bulk forming (absorb water, increase mass, stimulate peristalsis - psyllium (Metamucil), 5-7g daily start OR methylcellulose (Citrucel) 4-7g daily startt; 12-72H to onset. Use prophylactically, DO NOT use with ileus or impaction; req. 300-500ml fluid each dose (prevent impact.)

lubricant (also prevents reabsorption of water) - glycerin suppository 1PR qd OR mineral oil 30-60mL PO qd; 6-8H to onset (suppository 15-30 min)

opioid antagonists (block opioid receptors in bowel) methylnaltrexone (Relistor) for chroninc NON-cx pain 450mg PO qAM or 12mg SQ qAM (dose weight-based for adv. illness), OR naloxegol (Movantik) 12.5-15mg PO qd; 30-60min onset; d/c all maintenance laxatives prior to use, ensure close proximity to br

osmotic (pull water in and increase peristalsis) - lactulose (10g/15mL) @ 15-30mL qd to MAX 60mL/d in devided doses (24-48H onset), OR polyethylene glycol (Miralax) (48-96H onset) 17-34 g/d (dissolve 1cap in 8oz liquid /day up to 8 doses per day; poss bloating, flatulence

surfectant/detergent (draw water into colon) - docusate sodium (Colace) (whatever - this is useless) 100mg qd-BID (1-3 d onset) OR mineral oil 14-15mL qd (onset PO 6-8H, PR 2-15min); BITTER liquid, mix with juice or milk

bowel stimulants (stimulate submucosal nerve plexus -> incr. peristalsis) bisacodyl (Dulcolax PO) - 5mg qd start up to 30mg qd (6-10H onset), Dulcolax suppository (10mg PR qd) (,1H onset), OR senna (senokot) 15mg qd start to max 70-100mg qd (6-12H onset) - AVOID with ileus, obstruction, monitor for lyte/fluid imbalance, may develop tolerance. SE cramping, n/v with senna.

fecal impaction - bisacodyl or glycerin suppository, 2% lidocaine gel with disimpaction (avoid if possible perf or bleeding)

diarrhea (passed too quickly for water absorption) - abd pain, cramp, lethargy/weakness, n/v, distention, anorexia, incr thirst - dehydration, nutrient/lyte imbalance

d/c laxatives, assess for impaction, ID any ssx infx, replace fluids/lytes, provide skin care for incontinence. antidiarrheals cautiously with fever

opiods/opiod derivatives (ex. diphenoxylate/atropine (Lomotil)) 1-2 tabs PO BID-QID PRN

nonopiod (ex loperamide (Immodium)) 4mg PO 1x at ssx onset, then 2mg after each loose stool. (GERI SE - anticholinergic effects - prefer Lomotil)

antacids, adsorbents (bismuth salicylate - also antiinflamm and antibx) for n/d/indigestion; 2 262mg tabs QH PRN up to 16 tabs/24H

bulk-forming/fiber agents (absorb excess water) - ex. psyllium 1-2 tsp mixed with liquid up to TID

incontinence (muscle weakness/atrophy, neuro dz, severe diarr) - ID and remove (if poss) the cause; track associated ssx (weight loss, fever, R bleeding, steatorrhea)

env changes - BSC, clear path and proper lighting, remove physical restraints

skin care, with barrier cream/ointment

ascites (portal hypertension, hypoalbuminemia; malignancy, HF -> abd fluid collection) - indicate ES dz

discomfort, altered body image, decr mobility, dyspnea (diaphr. pressure), umbilical hernia, cellulitis, bacterial peritonitis

restrict NA 2g/d, fluid restriction, spironolactone (50-400mg qd), furosemide (20-130mg qd), paracentesis (if >4L, IV albumin), TIPS (potential hepatic encephalopathy)

repeated paracentesis -> indwelling abd cath

maintain trx consistent with GOC

hiccups (benign minutes to 2 d, persistent 2 d to 1mo, intractable longer than 1mo) -> indigestion, bloating, pain, abd distention, insomnia, fatigue. Quality of life

nonpharm - hold breath, breath into paper bag, compress diaphr., ice in mouth, induce cough/sneeze, pressure on nose, swallow sugar, eat lemon wedge with bitters, eat soft bread, touch palate with cotton swab, ocular compression, carotid massage, CBT (???), repositin, faseting, NG tube, acupuncture, induce emesis, disrupt phrenic nerve action (ablation last resort d/t pulmonary function risk)

pharm - simethicone 15-30mL PO q4H for distention; baclofen 5-10mg PO q6-12H up to 15-37mg qd OR midazolam 5-10mg PO q4H for muscle spasms; gabapentin 300-600mg PO TID for anticonvulsant; amitryptyline 10-50 mg PO OR sertraline 50-150mg PO QIS for CNS effects; haloperidol 2-10mg PO/IV/SQ q4-12H to block dopamine and alpha-andrenergic receptors

n/v (increased salivation, loss of appetite, diaphoresis) ASSESS N/V SEPARATELY

cerebral cortex (fear, anxiety, stress, memories, sensory stimulation)

pressure receptors (increased ICP)

chemoreceptor trigger zone (central neural pathway) (opioids, serotonin, dopamine, histamine, acetylcholine, antibx, NSAIDS, electrolyte disturbance, inhln agents)

glossopharyngeal/trigeminal (stimulate GP nerve - surgery, tumor growth, etc.)

vestibular (middle ear surgery, motion, vertigo)

GI (infx, cytotoxic meds, GI irritants, constipation, obstr., decr. motility)

-> stim vom center in medulla oblongata ->emesis

ANTICHOLINERGICS (hycoscine (scop) 1.5mg patch, 0.5-3 patch TD Q72H OR 0.6-1mg SQ/IV Q6-8H - spec. if d/t motion or obstruction. geri - anticholinergic SEs) (atropine opthm 1%, 1-2 drops SL Q8H PRN) (hyoscyamine 0.4-0.6mg SQ Q4H PRN)

ANTIHISTIMINES (diphenhydramine 25-50 PO/SC/IV Q6H PRN (blocks H1 receptors in vom center, CTZ, vestibular nuclei). GERI - risk for extrapyramidal SEs) (cyclizine 50mg PO Q4-6H PRN to max 200mg/day - rec. for incr. ICP, motion sickness pharyngeal stimulation, mechanical BO)

BENZOS (lorazepam 0.5-2mg PO/SQ/IV Q8-12H - use with another agent unless caused by anxiety)

CANNABINOIDS (dronabinol 5-10mg PO Q3-6H, nabilone 1-2mg PO BID - CHEMO, if other trx ineffective)

CORTICOSTEROIDS (dexamethasone 4mg PO Q6H WITH FOOD - prophylactically during chemo/radiation; may help reduce BO)

DOPAMINE RECEPTOR AGONISTS 0-20mg PO/SQ/IV Q6H OR 25mg PR (partic for opoiod-induced nausea) - blocks dopamine in CTZ. sedating effect - may be beneficial for imminent patients)

OCTREOTID (100-400mcg SQ Q8H) - BO

PROKINETICS (metoclopromide 10-20mg PO/SQ/IV Q4-6H up to 40mg - CHEMO n/v) - for gastric stasis, admin prior to meals; reduce dose geri, renal dz. NOT in BO, perf, or immediately postoperative

SELECTIVE 5-HT3 RECEPTOR AGONISTS (ondansetron 4-8mg PO/SQ/IV Q8H on Day 1 chemo; 16-24mg PO 1x OR 8-16mg IV 1x (max dose 16mg)) - specif. prophyl. chemo/radiation n/v (PREMED)

SUBSTANCE P AGONISTS (NKI receptor agonists) (aprepitant 125mg PO 1x Day 1 chemo, then 80mg PO Qmorning on Day 2-3. PREMED 1H prior on Day 1, with a corticosteroid (dex) and a 5-HT3 agonist (Zofran)) - used with ondansetron prophyl. chemo/radiation n/v

nonpharm: hydration, small meals/fulll liquid, withhold routine meds if poss, complementary thx (aromatherapy, meditation, relaxation), reposition, CBT, intervention for tumor growth (surgery, stent, NGT, decompression)

(malignent) bowel obstruction (d/t intraabdominal cx) (-> sepsis, perf, necrosis) (n/v undigested food, poss fecal matter in advanced MBO; hyperactive bowel sounds/borborygmi; pain/distention with large intestince) - prognosis 30-90 days

palliative mgmt for n/v, pain, colic, possible parenteral fluid fo comfort, NGT for distention. FREQ oral care, ice chips for dry mouth

palliative pharm: opioids, anticholinergics, corticosteroids (metoclopramide 10mg Q 6-8H nausea 1st line; octreotide 50-100mcg SQ/IV Q8-12H antisecretory, but high cost, SE (n/d, pain, constipation))

infx, cx, ES dz, iatrogenic

bladder spasms - stabbing/cramping, colicky suprapubicpain d/t detrusor muscle acting agaisnt partial/fully blocked bladder outlet (by tumor, blood clot, stent, cath (too large, kinked, blocked)). urgency or leakage poss. smaller cath, balloon inflated to appropriate size, drink sufficient fluids, avoid caffeine/alcohol/other irritants, anticholinergics (with care in geri pt); botulinum toxin A injection into detrusor to decr. urgency sensation

incontinence - transient in delirium, UTI, immobility, sever constipation; med SE; diminished contraction of detrusor. review meds for SE incontinence, sedation (reduced sensitivity to fullness); timing (only at night, stress (sneeze, etc.), continual?. Skin care; review incontinence aids with caregiver for bedbound patient. SSX of UTI - > sample and UA. Poss indwelling cath (UTI risk))

retention - d/t UTI, mechanical obstruction (partic in BPH, colon/pelvice cx), neuro issues, meds (anticholinergics, antihisitmines, antidepressents, antihypertensives, anit-Parkinsons, antipsychotics, sympathomimetics, opoids (partic. with anticholinergics). REVIEW MEDS and d/c if possible. Indwelling cath if bladder firmness on palpation, bladder scan >300mL or PVR 200-300mL (including after straight cath)

msk

immobiility, pain, debility, mestatses, ESdz

impaired mobility + complications - incr. risk of skin breakdown, physical deconditioning, activity intolerance, pathological frx. assess skin condition and ulceration risk factors with reliable tool (Braden Scale***). combined with sensory loss, incontinence, poor nutrition -> incr risk of pressure ulcers. Risk of skin shear of friction abrasion when pt repositioned by others. PRIORITY PREVENTION - encourage active participatoin in repositioning using rails/trapeze bar; freq reposition for immobile pt; pillow, cushions, antipressure devices/mattresses. Nutritional assessment for deficiencies, weight loss, cachexia (direct correlation b/t pressure ulcer risk and nutritional deficiency (low protein, albumin); consider supplements if appropriate

deconditioning/activity intolerance - d/t prolonged immobility, med SE, anemia, dz progression -> fatigue, weakness, decr. stamina -> incr falls risk, decr ADLs and QOL. weakness, dyspnea with exertion, fatigue with activity. preserve stamina in nonambulatory pt through passive/active ROM as tolerated. prevent falls - proper lighting, assistance with transfers and ambulation, necessary objects (glasses, telephone, call bell) within reach

pathological fractures d/t dz (most common osteoporosis; bone mets). femur most common site, 75% of which at proximal end. Also tibia, humerus, ribs, spine. SSx - localized pain/swelling, numbness; if femur, affected leg uually shorter and externally rotated. -> surgical stabilization (w/ or w/out joint replacement) common; contraindicated if widespread meets or life expectancy <6mo. Determine risks and educated on proper positioning, safety. pain mgmt and joint stabilization. team should collab with pt/famlly for plan of care to promote QOL, consistent with GOC.

integumentary and mucous membrane

meds, dz progression, poor nutrition/hydration,

xerostomia (radiothx head/neck, Sjogren’s, depression/anxiety/stress, malnutrition) dry mouth + hyposalivation. assoc: thrush, poor dentition, dry mucous membranes -> ability to eat/talk/wear dentures, incr. risk halitosis/caries/thrush/taste change. remove reversible causes (incl. meds if poss.), proper hydration, freq oral hydration, sugar-free gum/candy

pharm: pilocarpine 5mg TID, cevimeline 30mg TID (SE: d/n/v, sweating); sialagogue - oral topical

pruritis chronic in renal/liver dz, hypo/hyperthyroidism, anemia, malginancies, HIV; med SE (partic. opioids) -> disrupt ADL/sleep patterns. assess using Woods lamp if poss; parasites, bacterial/fungal infx, lesions. trx any underlying cause; also topical ointments, barrier creams, soakes (calamine, menthol, oatmeal bath, antihist. cream, steroids, capsaicin). Geri use of systemic thx (antihist) with caution (anticholinergic SE)

wounds (pressure ulcers, tumor extrusions, nonhealing wounds) - pressure and anoxia -> tissue damage in as little as 20-40 minutes.

frequent reposition - if bedbound, every 2-4H on pressure-reducing surface away from ulcer site; premed 20-30 min if pain; flexibility if actively dying or comfortable in only one position

adequate nutrition/hydration incl PO, SQ, IV dydration if appropriate, nutritional supplements. Provide as appropriate with GOC and prognosis

wound care based on staging, GOC, prognosis. NPWT to remove excess drainage/necrotic tissue/infx if large. Debridement of necrotic tissue: mechnical (wound irrigation/hydrotherapy, enzymatic via topical agents with dressing change Qday); biosurgical (medical maggots); autolytic (moisture-retaining dressing changed Q3-5 days, causing self-destruction of necrotic tissue)

S1 nonblanchable erythema, localized, usually over bony prominence. skin intact, red/purple/blue

S2 partial thickness loss of epidermis, some dermis. shallow open ulcer/superficial erosion, pink-red wound bed, no slough

S3 full thickness loss of skin, necrosis of SQ tissue, SQ fat poss. visible, but tendon/muscle/bone NOT exposed. Poss. undermining/tunneling, slough, necrotic tissue

S4 full thickness loss of skin including epidermis, dermis, SQ tissue; poss. muscle/bone/tendon exposure, slough, undermining/tunneling

(suspect) deep tissue injury - localized discoloration (purple/maroon), non-blanching, epidermis intact, feels boggy

unstageable - full thickness tissue loss covered by eschar or extensive necrotic tissue (tan, yellow-green, brown) (must be cleared before true depth can be determined)

OTHER DATA: length/width/depth (mm), description of edges, presence/description/amount of undermining/necrotic tissue/exudate/granulation tissue and epithelialization, condition of surrounding tissue

increased infx risk - debridement and wound care. high-risk wounds: silver-release topical dressings, medical-grade honey dressings, thin film dressings, hydrocolloid for S2-3, faom for exudative S2 pressure ulcers, hydrogel for nonexudative/necrotic, calcium alginates to absorb exudate

control odors - QOL. metronidazole gel (0.77-1.0%) Qday x 1wk to reduce microbe growth. dessings with activated charcoal. if not expected to heal, povidone iodine.

manage pain with systemic analgeisic, low-dose morphine

psychosocial/emotional/spiritual

anger/hostility r/t illness, lack of control, dependency, family/caregiver response to illness - interdisciplinary team (partic. social workier, chaplain) to help pt/family proces and express in safe manner. provide reassurance feeling is common AND usually related to abother emotion (fear, depression, grief)

depression (persistent low mood, anhedonia >2wks + accompanied by at least four of: sleep disruption, weight loss/appetite change, psychomotor retardation/agitation, fatigue/energy loss, worthlessness/excessive guilt, decr. ability to think/concentrate, recurrent thoughts of death/suicidal ideation). uncertainty of dz trajectory, possibility of death. FREQ with anxiety, so assess for both. Therapeutic listening, team collaboration with pt to develop plan: relaxation techniques, meditation, CBT.

SSRI (citalopram 20-60mg/day, escitalopram 10-20mg/day, paroxetine 20-50mg/day, fluoxetine 20-60mg/day, fluvoxamine 50-100mg BID, sertraline 50-200mg/day) - may take sveral weeks for effect.

methylphenidate (Ritalin) if life expectency <2weeks

denial shields pt from consequences of illness until psychologically ready to cope - challenging may increase distress. Active listening, therapeutic silence, reflection, calm reassurance team is available for support as needed.

fear -> tachycardia, tachypnea, shaking, insomnia, diaphoresis, stomach upset, nightmares (response to real threat vs. anxiety response to perceived as well as real threat). Distraction, deep breathing, meditation, massage, CBT, focused support by team social worker/chaplain

grief -> intrusive thoughts, regrent, inability to think clearly, dulled/heightened emotions, nausea, fatigue, myalgia. Therapeutic listening, empathetic support, reassurance experience is normal. team social worker/chaplain factilitate life review, teach CBT techniques, provide spiritual support/guidance

loss of hope/meaning as hope for recovery fails. GOC convo with team to help pt focus shift from hope of recovery to comfort, preserved function, preserved dignity, other comforts. team facilitates life review, which may ID source of meaning.

guilt r/t regret for actions taken or failed to take. personal responsibility for illness, leaving family. -> existential suffering. Encourage pt to explore and express, also to work with team.

nearing death awareness (NDA) about 50% of terminal pts experience, usually coherent, comforting. Generally brings preace, may involved communicating with deceased loved ones, preparing for change, seeing the afterlife, knowing death is near. Culturally bound and varies by pt. Center on differentiating from negative delirium/hallucinations, validate perceptions.

sleep disturbances (insomnia, unusual patterns, daytime fatuge) - review and address dz progression, socioec factors, pain, meds, psych issues; promote restful sleep via sleep hygiene, allowing undisturbed rest, avoiding stimulants. nonpharm: relaxation techniques, massage, aromatherapy, music

suicidal ideation - warning signs: bebavior changes, withdrawing from friends/activities, giving away possessions, talking about suicide, incr. use of drugs/alcohol

Key assessment questions: Are you considering harming yourself? Do you have a plan to harm yourself? if either, considered at risk, take steps to ensure safety

intimacy/relationship issues incl. caregiver stress vs. dependency issues, loss of sexual relationship d/t illness. Discuss openly, normalize experience, reassure, encourage counseling

nutritional/metabolic

d/t dz progression, organ failure, med SE

anorexia/cachexia (anorexia/cachexia syndrome (ACS)) - cx, HF, COPD, HIV, renal dz - sign of advanced dz (POOR prognosis, even with intervention) - metabolic & neurohormonal changes, systemic inflamm, catabolism

oral nutritional suppl., ease diet restrictions, small/freq meals; enteral/parenteral supplementation NOT generally beneficial end-stage, before trial consider potential benefit, life expectencey, functional status (Karnofsky >50, medical issues manageable, caregiver available and pt able to have follow-up lab monitoriing

pharm - megestrol acetate, glucocorticoids, cannabinoids increase appetite/weight but uncertain effect on QoL. with depression, mirtazapine (Remeron) 15mg QHS, methylphenidate 2.5-10mg PO at 0800 and 1200

mid-arm circumference to assess malnutrition over time - weight loss and muscle wasting

dehydration r/t anorexia, med SE, n/v, BO, dysphagia, cognitive impairment (mucous membranes, skin turgor, bowel function - diarr; constip., impact.). may exacerbate delirium, confusion, agit,, myoclonus - NOT usually responsive to fluid replacement. SE artificial hydration - nausea, fluid overload, dyspnea, ascites, edema. is patient acutely ill/expected to recover some function or actively dying? PT AND FAMILY DISTRESS - educate.

oral or enteral fluid replacement; parenteral nutrtion through CVC or other long-term access. SQ fluids (hypodermoclysis) -absorption rate comparable to IV admin. (rarely use protoclysis, PR admin fluids to GI tract).

fatigue (subjective, some objective effects) r/t cx, HF, COPD, renal dz, HIV/AIDS, MS, etc.; poss. secondary to insomnia, distressing SSx, dz process, med SE, psych/spiritual distress

nonpharm - exercise as tolerated, pain and sx mgmt, counseling, medication, relaxation, music thx, sleep hygiene, avoid sleep disruption

pharm - benzo or antidepressent to enhance sleep. if not related to sleep quantity/quality, psychostimulants (methylphenidate, modafinil); corticosteroids; megestrol

hypercalcemia (serum Ca >14mg/dL -> urgent intervention) (metastatic cx as bone deteriorates and released Ca; hyperparathyroidism, lithium thx, Addison’s, Paget’s, vitminan A or aluminum toxicity) -> n/v, anorexia, wekness, constipation, thirst, AMS.

intervention for comfort even in advanced dz

bisphosphanates (pamidronate, zoledronate), calcitonin admin, IV hydration, bone reabsorption agents (gallium nitrate, plicamycin), dialysis

hypo/hyperglcemia d/t uncontrolled DM, sepsis, organ failure, cortisol imbalance, altered intake

monitoroing and mgmt may not be feasible in terminal illness d/t PO inability; ASSESS necessity of fingersticks, dietary control at EoL, EDUCATE pt and family on change to normal routine, REVIEW GoC

hypo <70mg/dL -> diaphoresis, dizziness, pallor, tachycardia, weakness, anxiety, tremors, nausea, hunger. <50mg/dl -> irritability, blurry/double vision, confusion, HA, slurred speech. <40mg/dL -> severe reactions incl. coma, seazure, death

15g carb, 15 minutes BG check, repeat PRN until >70mg/dL

glucagon 1mg IV/SQ (5i minutes to effect)

D50 IV/SQ (immediate)

corticosteriods for dual effect if dyspnea, pain, inflamm

hyper = fasting >116mg/dL OR postprandial >200mg/dL - overtreatment or non-compliance with treatment plan, DM, acute ilness, stroke, sepsis, MI, pancreatitis, meds (glucocorticoids, high-dose thiazides, dobutamine, atypical antipsychotics, cocaine) -> polyuria, polydipsia, polyphagia, glucosuria, weakness, fatigue, weight loss, blurred vision, poor wound healing, incr. infx risk, diabetic ketoacidosis (usually in DM1)

lifestyle modification

pharm: metformin up to 2250mg/day; sulfonylureas (glipizide, glyburide, glimepiride); metglitinides (matelinide, repaglinide); glucosidase inhibitors (acarbose, miglitol); thiazolidinediones (pioglitazone, rosiglitazone); dipeptidyl peptidase 4 (DPP-4) inhibitors (sitagliptin phosphate); amylin agonists (pramlintide); insulin

immune/lymphatic

d/t dz progression, organ failure, med SE

fever (T 101.3F/38.5C x1 OR 100.4F/38C x3 1H apart); d/t infx, immunological disorders, metabolic imbalance; antipyretics PO, PR + poss. antibx for symptom control. possible central fever (high T, skin cool) near death - antipyretics for comfort.

myelosuppression (anemia, neutropenia, thrombocytopenia) - dt decr. bone marrow activity (cx trx, end-stage dz)

anemia (Hgb <8.0 g/dL) - heart dz, pulmonary dz, kidney dz, inflammatory processes r/t chronic dz (age/weight-> higher risk). RBC transfusion (threshold 9.0 g/d/L in advanced dz), erythropoiesis-stimulating agents (epoitin-alpha, darbepoetin) although NOT wiht advanced cx (stimulation of tumor growth)

neutropenia (ANC <1,000/mm3) - bone marrow suppression, cx trx, infx med SE, autoimmune disorder; risk for febrile neutropenia (T 100.4F/38.3C longer than 1H + ANC < 500/mm3 with expectation to decrease). ASSUME with fever while on chemo until proven otherwise. if confirmed: broad-spectrum antibx, possible hospitalization for IV thx.

thromobocytopenia (<20,000/mm3 OR clinically significant active bleeding) - cx, aplastic anemia, med SE, autoimmune disorder, chronic ETOH; purpura + petichiae. if hemorrhage - rad thx, endoscopy, vitamin K, vasopressin, octreotride (for varices), antifibrinolytics, platelets or FFP, palliative TACE. (dark towels to reduce visual impact for pt and caregivers)

lymphedema - lymph accumulation -> fibrosis or sclerosis -> permanent edema. skin care, elevation and compression if no fibrosis yet, manual drainage (PT, MT). (diuretics not usually effective)

mental status changes

altered LOC (CNS dysfunction, med SEs, metabolic imbalance, infx, anxiety, psych issues)

confusion - Confusion Assessment Method (CAM) to detect delirium

delirium - inpt geriatric, postop, advanced illness (infx (UTI), renal failure, hepatic failure, CNS disorders, vascular disorders, pain) - acute onset, fluctuating symptoms, perceptual changes, sleep-wake cycle altered, delusions, hallucinations, paranoia, hyperactivity/lethargy; haloperidol (1mg), risperidone (1mg)

terminal delirium/terminal agitation - symptoms not reversible in >50% of patients - haloperidol 2-4mg PO/SC/IV Q30minutes up to 20mg/24hr, olanzapine 2.5-5mg SL HS-BID plus PRN Q4hr

patient/family care/education/advocacy

goals of care

psychosocial/spiritual/cultural

grief & loss

caregiver ed/support/advocacy

practice issues

coordination and collaboration

scope and standards of practice

* opioid drug-to-drug conversions (equianalgesic - PO and TD)

morphine 30mg

hydocodone 30mg

codeine 200mg

tramadol 100mg

oxycodone 20mg

oxymorphone, methadone 10mg

fentanyl TD 12.5mcg/H ##

hydromorphone 7.5mg

levorphanol 4mg

calculate current 24H dose (TDD including PRNs)

convert using equianalgesic

calculate new dose

reduce by 50% to account for cross-tolerance (can be titrated PRN) (DO NOT REDUCE FOR TD FENTANYL)

## morphine to fentanyl patch - each 2 mg PO morphine approximately equivalent to 1 mcg/hr fentanyl patch (e.g., morphine 100 mg/day → 50 mcg/hr patch applied q3days) (approx 2mg : 1mcg/H) Note: using this formula, 25 mcg/hr of transdermal fentanyl is roughly equivalent to 50 mg oral morphine/24 hours. This dose may be excessive when used in the opioid naïve or the elderly.

MORE CONSERVATIVELY: FDA prescribing information for transdermal fentanyl: 135-224 mg of morphine per 24 hours = 50 mcg/hr patch. Note: this range of morphine is very broad which may result in significant under-dosing.

IV morphine : IV hydromorphone = 5:1

IV morphine : fentanyl patch = 4mg/hr : 100 McG patch (approx.)

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mentalmindsetmatters · 30 days

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Navigating Life with Adult ADHD: Signs, Coping Strategies, and Support

ADHD isn't just a childhood condition — it often sticks around, affecting millions of adults' lives long after their formative years. In a world that demands focus and consistency, how do you recognize the signs of ADHD in yourself or a loved one? And, more crucially, how do you handle it?

In this candid discussion, we peel back the layers of ADHD in the adult world. We will define the symptoms, unpack the different ways ADHD can manifest, and empower you with strategies to manage your ADHD and thrive. Whether you're searching for answers or seeking to support someone who is, this comprehensive guide will accompany you on the vital steps of this unique life path.

Understanding Adult ADHD

Adult ADHD is a neurodevelopmental disorder that affects the ability to maintain attention, control impulses, and regulate energy levels. It's more than the occasional difficulty in concentrating — it's a pattern of ongoing problems that have significant implications for life, relationships, and the achievement of personal goals.

Prevalence in the Adult World

While ADHD is commonly associated with children, it persists among about 4% of the U.S. adult population. However, many adults with ADHD may go undiagnosed or misdiagnosed with other mental health conditions due to its varied and often subtle presentation in this demographic.

Spotting the Signs and Symptoms

The symptoms of ADHD can be divided into two categories — inattentiveness and hyperactivity-impulsivity. However, while these serve as a diagnostic guide, in the real world, ADHD often presents as a complex blend of symptoms that can differ widely between individuals.

Inattentiveness

Difficulty sustaining attention in tasks or play, making careless mistakes, poor listening skills, forgetfulness, and general disorganization are all typical signs of inattentive ADHD.

Hyperactivity and Impulsivity

For those with a hyperactive-impulsive presentation, the symptoms can be more overt, including fidgety behaviors, a constant need to be on the move, excessive talking, and abrupt actions without forethought.

The Intersection of the Two

Many adults experience a combination of both inattentiveness and hyperactivity-impulsivity, leading to a life where multitasking is a must but completing tasks can be a constant struggle.

Seeking a Diagnosis and Treatment

The path to managing adult ADHD starts with proper diagnosis. Seeking professional help is crucial, as diagnosing ADHD can be complicated, requiring a comprehensive evaluation by a qualified mental health professional.

Diagnostic Process

The diagnosis process may include psychological tests, a review of past medical and family history, as well as a thorough assessment of current symptoms and their impact on daily life.

Treatment Options

Once diagnosed, treatment typically involves a blend of medication and therapy. Medications such as stimulants or non-stimulants can improve symptoms, often in combination with cognitive-behavioral therapy (CBT) to address the emotional and social components of ADHD.

Strategies for Coping with ADHD

Beyond clinical treatment, there are numerous practical strategies that individuals with ADHD and their support networks can employ to manage their condition more effectively.

Time Management and Organizational Techniques

Employing techniques like breaking tasks into smaller, more manageable steps, using calendars, and setting routine alarms can all help to create a more structured day.

Setting Boundaries and Prioritizing

Learning to say no and choosing battles wisely can conserve precious mental energy for what truly matters.

Mindfulness and Stress Reduction

Incorporating mindfulness practices and regular exercise can assist in lowering stress levels and improving focus.

Emotional and Social Impact of Adult ADHD

ADHD doesn't just affect productivity; it can also have a profound impact on mental health and relationships.

Emotional Rollercoaster

Individuals with ADHD are more likely to experience depression and anxiety, often linked to the self-esteem battles they can face due to their symptoms.

Navigating Relationships

ADHD can place significant strains on personal and professional relationships, but with increased awareness and the right tools, strong, healthy connections are entirely possible.

Insights from the Community

The experience of living with ADHD is personal and varied, but finding a sense of community and identifying with shared experiences can be immensely comforting. Real-life stories and expert opinions provide a breadth of understanding that goes beyond clinical definitions.

Expert Perspectives

Hearing from professionals experienced in diagnosing and treating adult ADHD can provide clarity and direction in managing the condition.

Personal Testimonies

These genuine accounts from individuals navigating their own ADHD can be a source of solace and practical advice for those seeking ways to overcome the challenges and celebrate the strengths of living with the disorder.

Conclusion

Living with adult ADHD can be challenging, but it's essential to remember that a diagnosis is not the end of the road — it's just the beginning of a potentially rewarding and fulfilling path punctuated by self-discovery and growth. Seeking support, employing coping strategies, and fostering an environment of understanding are the pillars to standing strong in the face of ADHD.

To the adults on their journeys and the loved ones searching for ways to provide support and empathy, know that each step, no matter how small, is progress. In the mosaic of life, ADHD is but one piece, among many, contributing to an infinitely unique and resilient human story.

#mental health #healthcare #mental illness #bipolar disorder #mental wellness #mental health support #bipolar depression

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uvconsultants · 3 months

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Best Corporate Training Companies in Dubai

One of the top corporate training firms in Dubai is UV Consultants, a shining example

In Dubai’s dynamic economic environment, where ambition and creativity collide, corporate training has emerged as an essential component for businesses aiming for success. UV Consultants is a standout corporate training company in Dubai due to its unique combination of innovation, experience, and dedication to organizational growth, making it stand out among the many options available.

UV Consultants: Established as a top supplier of corporate training programs in Dubai, UV Consultants has established a distinct market niche for itself. UV Consultants is now a dependable partner for businesses looking to empower their staff and achieve success, offering a wide selection of programs that are intended to improve different aspects of organizational dynamics.

Important Characteristics of UV Consultants Among Dubai's Corporate Training Companies:

Various Training Courses:

UV Consultants is aware that every organization has different needs. As a result, the range of training programs they provide is extensive and includes topics such as team building, customer service excellence, leadership development, and communication skills. Because of this diversity, businesses can customize their training programs to meet certain needs and objectives.

Tailored Solutions: UV Consultants specializes in offering personalized training solutions since they understand that no two situations are the same. The UV Consultants team works closely with clients, whether they are local businesses or international corporations, to understand their specific needs and create programs that align with their goals and organizational culture.

Knowledgeable Facilitators: UV Consultants is home to a group of knowledgeable facilitators with a wealth of corporate training expertise. These professionals ensure that participants not only understand theoretical topics but also acquire important real-world application skills by bringing a wealth of knowledge and practical insights to the training sessions.

Innovative Approaches: UV Consultants, a leading corporate training company in Dubai, uses innovative approaches to provide training that has a lasting impression. Their courses make use of the most recent advancements in adult education, organizational psychology, and leadership development to produce an exciting and captivating learning environment.

The Influence of UV Consultants on Dubai's Corporate Training:

Executives and aspiring leaders alike find that participating in UV Consultants' leadership development seminars is a life-changing event. In Dubai's cutthroat corporate climate, the training emphasizes developing visionary leadership, sound decision-making, and tactics for managing high-achieving teams.

Effective Communication Skills: These are critical in a city where a diverse workforce is well-known. Professionals who receive communication skills training from UV Consultants are more equipped to negotiate cultural differences, express concepts clearly, and forge enduring bonds of cooperation.

Building Successful Teams: UV Consultants understands the value of well-functioning teams in accomplishing company objectives. Their team-building programs go above and beyond conventional methods by combining creative activities and experiential learning to promote team cohesion, trust, and collaboration.

Customer Service Excellence: Providing outstanding customer service is a must given Dubai's status as a major international travel and business destination. The customer service excellence programs offered by UV Consultants enable frontline employees and service teams to deliver an exceptional customer experience, hence bolstering corporate success.

The Benefits of UV Consultants Among Dubai's Corporate Training Companies:

Methodical Approach:

UV Consultants approaches corporate training strategically. Their programs go beyond simply developing skills; they also match with company goals, guaranteeing that the training expenditures have a direct impact on improved productivity and business results.

Constant Improvement: UV Consultants is dedicated to keeping up with the changes in the business environment. To guarantee that participants obtain the most pertinent and recent knowledge, they continually update their training programs to include new trends.

Flexibility and Adaptability: UV Consultants stands out in the dynamic business environment of Dubai thanks to their flexibility and adaptability. UV Consultants has the flexibility to modify their plans to accommodate changing requirements, be it rapid shifts in the market or particular issues faced by an organization.

In conclusion, with Dubai's continued positioning as a major international commercial hub, corporate training plays an ever-more-important role in developing talent and promoting organizational success. Among the top corporate training firms in Dubai, UV Consultants stands out for its dedication to quality, creativity, and a tactical mindset that enables businesses to prosper in the city's always changing environment. Selecting UV Consultants as your corporate training partner in Dubai is an investment in leadership excellence, organizational success, and a workforce ready for steady advancement, in addition to skills.

#Best Corporate Training Companies in Dubai

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maxiepenguin · 3 months

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I’m doing a rant like post so … read on if you’d like to read a rant about studying business with an outdated textbook.

Here I am studying my business textbook and I’m reading about different types of teams (I’m getting my MBA in leadership). When suddenly my textbook calls Millennials “the new office moron” and attributes the fact that millennials don’t know how to use a land line to part of the reason or knew how to be professional in a meeting. This is referencing an article in business week FROM 2010 per the text.

I am a millennial and I know what has been said about millennials in a professional setting. But I’d like to point out a couple things.

First, the earliest this book was copyrighted was 2011 and the most recent was 2018. A lot of this information that this book is talking about can still be relevant because it’s organizational psychology/sociology stuff and while things can and will adjust as society does as different generations enter the workplace. But per the internet millennials are born from 1980-1996 based on my most recent search. In 2011 that would be ages 14-21 and in 2018 that would be 21-28. If we base it on the referenced article they would be ages 13-20 … so they’re saying young adults potentially just entering the work force don’t know how to be professional? And this is surprising? This needs to be put in a text book in a section about multigenerational differences in teams???

Also, I work for a pretty corporate company and we don’t even use landlines anymore. I have worked places where we do use landlines and it’s a phone. It’s not that difficult to figure out. (Don’t get me started on having to use 9-1 to dial out in the US though the # of times people accidentally called the police is a nightmare.

But it’s talking about generational differences. Are there chances for miscommunication yes. I had to explain to my mother who is Gen X what a Rick roll was. And she’s just like “I keep getting Rick Rolled and I just like that song.” Are there different levels of what is a good work-life balance? Yes. It just pisses me off that the author of this text was like “oh this is a good example of generational differences” and then published a text that references a Businessweek article from 14 YEARS AGO that makes a generalization about an entire generation and my professor is just like “oh yes this is it this is the text.”

Oh! And it was still $200 to buy the damn textbook and I wished I rented this one. (My last class I bought it but it was published within the last 3 years and it has fascinated and current information I apparently was dumb and assumed maybe this would be the same).

#blab #rant post #college #uggghhhh

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centerformentalhealth0 · 5 months

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Unlocking the Potential: ADHD Treatments for Adults

Understanding ADHD in Adults

Unraveling the Complexity

ADHD is often perceived as a childhood condition, but it persists into adulthood for many. Recognizing the nuanced manifestations in grown-ups is paramount. From impulsivity and inattention to hyperactivity, adult ADHD poses distinctive challenges that require a tailored approach.

Holistic Approaches to ADHD Management

1. Cognitive Behavioral Therapy (CBT)

In the realm of psychological interventions, CBT emerges as a powerful tool for adults with ADHD. Addressing behavioral patterns and fostering coping mechanisms, CBT equips individuals to navigate the challenges of ADHD in various aspects of life.

2. Medication Management

While medications are not a one-size-fits-all solution, they play a pivotal role in ADHD management. Stimulants and non-stimulants, when prescribed and monitored appropriately, can significantly alleviate symptoms, enhancing cognitive functions and fostering better concentration.

3. Lifestyle Modifications

Incorporating healthy lifestyle changes is instrumental in mitigating ADHD symptoms. From regular exercise to balanced nutrition, small adjustments can yield substantial improvements in focus, attention, and overall well-being.

Cutting-Edge Therapies for Adult ADHD

1. Neurofeedback

Harnessing the power of technology, neurofeedback provides real-time information on brain activity. This non-invasive therapy helps individuals train their brains to regulate attention and impulses, offering promising results in ADHD management.

2. Mindfulness and Meditation

The practice of mindfulness and meditation has shown remarkable efficacy in enhancing self-awareness and emotional regulation. Integrating these techniques into daily routines can be transformative for adults with ADHD, promoting a calmer and more focused mindset.

Navigating Challenges at Work

1. Workplace Accommodations

For adults with ADHD, creating a conducive work environment is pivotal. Simple accommodations, such as structured schedules, clear communication, and designated quiet spaces, can make a substantial difference in professional settings.

2. Time Management Strategies

Mastering time management is a key component in the professional success of individuals with ADHD. Implementing strategies like breaking tasks into smaller, manageable steps and utilizing organizational tools fosters efficiency and productivity.

Empowering Relationships and Communication

1. Support Networks

Building a robust support network is crucial for adults with ADHD. Establishing open communication with friends, family, and colleagues creates an environment where individuals feel understood and supported in their journey.

2. Effective Communication Strategies

Enhancing communication skills is a valuable asset for adults with ADHD. From active listening to concise expression, honing these skills fosters better interpersonal relationships, both personally and professionally.

Conclusion: Navigating Life with ADHD

In the realm of adult ADHD treatments, a personalized and multifaceted approach is essential. At CMH we believe in empowering individuals with ADHD to not only manage their symptoms but to flourish in all aspects of life. By combining traditional and innovative therapies, fostering lifestyle changes, and creating supportive environments, adults with ADHD can embark on a journey of self-discovery and fulfillment.

#adhd treatments for adults

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heidemahmoud76 · 8 months

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Anti-racist And Anti-bias

Khalid’s position consists of co-ordinating numerous employability initiatives and making certain services are delivered effectively within local communities. Khalid’s function consists of working with a extensive range of partners from the basic public, third and personal sectors. She has over 10 years’ of instructing and lecturing expertise in business and adult training. Sakina has also designed and delivered programs to organisations corresponding to Hitachi and L’Oreal Cosmetics. This course will educate you how to take action when employees and students report incidents of hate and discrimination, and how to develop an inclusive work surroundings for people from completely different ethnic, religious and minority backgrounds. Zainab is liable for guaranteeing all the work we do is communicated to our stakeholders. Farah has expertise working with shoppers who face a broad spectrum of day-to-day challenges, such as nervousness, stress, persistent pain, self-esteem points, low temper, relationship struggles and more. She locations nice importance on creating a safe, non-judgmental and supportive therapeutic environment where purchasers can discover their challenges and work in path of achieving their goals. Hugh is the founder and Chair of the Filipino Sports for Wales (FS4W) which serves as a research and training centre for sport, bodily exercise and recreation in constructing peace, cohesion and understanding in diverse communities. Throughout the week the organisation runs numerous women-only classes and groups, art courses, English language courses, sports periods, every day advisory periods and advocacy forums, with lunch supplied freed from charge every weekday. During her time with Coleg Morgannwg, Sakina also participated in a number of highway exhibits in conjunction with the BBC, creating consciousness inside the community of the importance of Life Long Learning and accessibility of the same. A workshop designed to develop pupils’ understanding of being anti-racist as opposed to not being racist. The activities discover the usage of language and challenge pupils to share and focus on racist incidents they might have expertise or seen in the information. The session culminates with pupils creating an action plan which seeks to encourage individuals and the school, as a wider group, to pro-actively take steps to become anti-racist. The concepts of white supremacy, privilege and white fragility will be investigated because it pertains to race relations, range, equity and inclusion. Learn how to promote psychological well being and safety by way of the work you do and turn out to be an anti-racism ally who contributes to creating a constructive impact in your group. Our employability and enterprise programmes present training, mentoring and private development training to people from underrepresented and deprived communities. Selam approaches her training and training with embodied compassion by calling in each individual to their fullest humanity. Black women’s labour has been historically and is continuously exploited and extracted and this work requires a deep quantity of emotional, physical, psychological and spiritual labour. To avoid the perpetuation of this systemic harm, The Antiracism Course is non-refundable. You’ll have full entry to the course materials FOR ONE YEAR from the course begin date. A Live Teaching Session on the methods Black, Indigenous & racialized people can look at internalized racism, empowerment and therapeutic. At occasions, people of color may also break into more particular race-based caucuses, typically primarily based on experiences with a specific concern, for example police violence, immigration, or land rights. Groups that use caucuses of their organizational racial fairness work, especially in workplaces and coalitions, generally meet individually and create a course of to rejoin and work together collectively. Founded in 2016, the AADM’s mission is to advocate for racial and social justice by way of education and activism. We provide trainings and workshops to empower and to dismantle patterns of racism and injustice in our community, faculties, the workplace, and inside law enforcement. We ship skilled training, session, and assets to help people or organizations striving for racial justice and fairness. anti-racism in the workplace training The People's Institute for Survival and Beyond is a collective of organizers and educators the world over working towards social transformation. This June, the group will be internet hosting an IRL workshop in New Orleans on undoing racism, with one in Portland scheduled for July. The platform CK Your Privilege is a information that helps individuals to dismantle their association with techniques of domination. Providing a voice for people who in any other case would not have one sparked a passion to continue supporting BAME individuals and convey about real-world change. Laura has beforehand labored in a university, offering finance recommendation to students. She assessed the University Hardship Fund and supplied bespoke recommendation to students on their money administration.

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corecompetency-blog · 11 months

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Talent Development Glossary

360° feedback evaluations draw from the perspectives and recommendations of superiors, direct reports, colleagues, and internal and external stakeholders to assess an individual's performance across various behavioral areas.

ADDIE model is an instructional systems design framework consisting of five stages:

Analysis involves data collection to pinpoint specific needs, addressing the who, what, where, when, and why of the design process.

Design represents the planning stage.

Development entails selecting and creating training materials and content guided by learning objectives.

Implementation occurs as the course is delivered, either in person or digitally.

Evaluation is the continuous process of refining and enhancing instructional materials based on feedback gathered during and after implementation.

Adult learning theory encompasses the collective principles and theories governing how adults learn and acquire knowledge. Malcolm Knowles popularized this concept, providing the foundation for training and developing professionals to address workplace learning needs effectively.

Affective learningrefers to knowledge acquisition based on Benjamin Bloom's taxonomy, which identifies three learning domains: cognitive (knowledge), affective (attitude), and psychomotor (skills). This taxonomy, which classifies thinking and learning processes, offers a framework for devising instructional strategies, materials, and activities to enhance individual workplace learning and performance. Affective learning pertains to the learners' mindset or behavior.

Analysis is the process of examining the components of workplace learning and performance. It is used to determine the following:

Gap analysis identifies discrepancies between desired and actual knowledge, skills, and performance, as well as the underlying causes.

Job analysis pinpoints learners' workplace duties, responsibilities, and tasks performed daily, weekly, monthly, or yearly.

Needs analysis involves data collection and synthesis to determine how training can help an organization achieve its objectives.

Task analysis identifies specific steps required for the accurate execution of job functions.

Andragogy, derived from the Greek term for adult learning, refers to the methods and practices employed in teaching adults. Malcolm Knowles advanced this theory, outlining five essential principles of adult learning: Self-concept, experience, learning readiness, orientation to learning, and motivation to learn.

Areas of expertise (AOEs) represent the particular technical and professional skills and knowledge mastery required for success in learning and development.

Appreciative inquiry (AI) theory is an organizational change strategy that analyzes positive and successful operations rather than negative or failing ones. The AI 4-D cycle—discovery, dream, design, and destiny–encompasses problem identification, cause analysis, solution exploration, and action plan development.

Artificial Intelligence (AI) is a machine's capacity to emulate human cognitive processes, such as perception, reasoning, learning, environmental interaction, problem-solving, and creativity.

Asynchronous learning occurs when trainers and learners engage in learning activities without being simultaneously present in time or location, as seen in asynchronous e-learning.

Authoring tools are software applications that enable content experts to develop learning material by interacting with a computer using everyday language. Core Competency's Learning Management System, or LMS, offers a robust set of authoring tools.

Balanced scorecard is a management system used to plan, measure, and monitor an organization's performance across four essential aspects: Financial, business processes, customer, and organizational capacity.

Behavioral career counseling employs a scientifically rigorous method for career decision-making that draws upon concepts from psychology.

Behaviorism is a learning theory centered on observable and quantifiable behavior, commonly associated with psychologist B.F. Skinner, asserts that animal and human behavior arise through conditioning, or the reinforcement of desired responses.

Benchmarking involves assessing quality by comparing business process metrics to standard measurements or industry best practices. It aims to compare and analyze similar items to understand how other organizations achieve performance levels and apply this knowledge for improvement.

Blended learning combines formal and informal learning elements such as classroom instruction, online learning, and on-the-job coaching within a single curriculum.

Bloom's taxonomy, created by Benjamin Bloom, is a hierarchical model that categorizes learning into three outcomes or domains: cognitive (knowledge), psychomotor (skills), and affective (attitude), collectively referred to as KSAs. The domain categories employ verbs to define behavior in a hierarchical relationship, growing progressively more complex and challenging to achieve. This taxonomy is valuable for crafting learning objectives.

Business insight entails understanding the critical factors impacting a business, including its current situation, industry or market influences, and growth drivers. It also encompasses comprehending how an organization fulfills its mission or purpose, generates and spends money, makes decisions, and the internal processes and structures that enable work completion.

Career advising provides guidance on how to make vocational and occupational decisions and recommends possible development opportunities.

Career development programs are planned interactions between a company and its employees that allow them to advance within the company.

Case study is a learning method that presents a real or hypothetical situation for analysis and problem-solving.

Certification enhances technical competencies through study, testing, and practical application while pursuing a recognized designation.

Change agent is an individual or group responsible for initiating or executing organizational change, understanding organizational and personal change dynamics, and striving to create different conditions within an organization.

Change management facilitates organizational change by employing structured approaches to transition individuals, teams, and organizations from an existing to a desired future state.

Chief Learning Officer (CLO) oversees organizational learning within a corporation. This role emerged in the late 1980s to align corporate learning strategies and people development with business objectives, elevating organizational learning as a crucial factor in an organization's success.

Chief Talent Development Officer is the executive responsible for the organization's talent development program. Also referred to as the chief learning officer, this role reports directly to the CEO.

Cloud is a model of computing that provides a shared network for accessing computing resources. As a concept still in its early stages of development, cloud computing is driving a significant shift in information technology that will impact everyone in the modern world.

Coaches assist individuals and teams in reaching their maximum potential through goal-setting, leveraging strengths, seeking development, and achieving results.

Coaching, according to the International Coaching Federation, is partnering with people in a thought-provoking and creative process that inspires them to maximize their professional potential. It is different from counseling, mentoring, training, and advice-giving as it may be provided on the job by a supervisor providing constructive feedback and advice to help improve an employee's performance.

Cognition is acquiring knowledge and understanding through our senses, thoughts, and experiences. Since the 15th century, the term has been used to describe how we think and understand the world.

Collaboration is an interaction between two or more individuals working towards a common goal, with equal participation, communication, and involvement opportunities. In conflict resolution, collaboration involves both parties working together to develop a win-win solution.

Collaborative learning is an instructional method that involves working together, either online or in person, to discover, learn, solve problems, and share information. The facilitator can use this method to encourage audience participation and engagement.

Communication involves active listening, supporting dialogue, and expressing feelings, ideas, and thoughts clearly, concisely, and persuasively. When sharing information or sending a message effectively, these six essential attributes (6Cs) are recommended:

Clear: Choosing precise, descriptive, and audience-appropriate words

Correct: Selecting accurate words and using proper grammar, avoiding misused words

Complete: Articulating comprehensive messages, including all relevant details

Concise: Choosing short, specific sentences and phrases and avoiding rambling

Coherent: Maintaining consistency, using simple sentence structures, and presenting information in an easy-to-follow order

Courteous: Employing respectful, friendly, positive, gender-neutral, and sensitive language and avoiding accusatory or blaming language

Community of Practice (CoP) consists of individuals sharing experiences and having a common interest in an area of competence.

Competency-based learning uses a competency dictionary based on a thorough occupational analysis of the skills required for successful performance to focus on individual skills called competencies. With this approach, learning modules are divided into competencies, and learners are allowed to skip a module if they have mastery of the skills contained within it. It is most often applied to skills-based learning.

Compliance refers to actions mandated by law, agency, or policy outside an organization's purview, generally accompanied by a training program requirement.

Computer-based training (CBT) is a teaching and learning methodology that includes computers for instructional and pedagogical purposes. In addition to computer-based instruction, computer-aided instruction and computer-managed instruction fall under the umbrella term CBT.

Confidence interval defines the range of values expected to fall within it.

Conflict Management involves limiting the negative aspects and increasing the positive aspects of disagreements, disputes, and differing opinions and desires.

Constructivism is based on Jean Piaget's learning theory that individuals construct their understanding and knowledge of the world through observation and reflection.

Consulting helps solve business challenges and transition individuals, groups, or organizations from their present state to a desired state over a short period.

Content management system (CMS) enables users to easily create, organize, modify, and monitor digital content for an organization's website or digital assets.

Creative thinking involves examining problems or situations from a fresh perspective and suggesting unconventional solutions. Creative thinking can be stimulated through unstructured processes like brainstorming or structured approaches like lateral thinking.

Criterion-referenced assessments or tests measure learners against predetermined criteria or standards.

Critical Path Method (CPM), similar to a Program Evaluation Review Technique (PERT) chart, demonstrates the workflow during a project. This chart identifies the critical path—the sequence of tasks that collectively take the longest.

Critical thinking is an analytical approach that helps evaluate an issue to form a logical and well-considered judgment. It entails examining the evidence supporting an argument or conclusion rather than accepting all opinions and conclusions at face value. Critical thinking skills include analytical thinking, open-mindedness, problem-solving, and decision-making.

Crowdsourcing refers to the capacity of a large group to accomplish tasks traditionally completed by a smaller, specialized group. Its appeal lies in its ability to engage individuals best suited to solve problems, channel creativity, and perform intelligent tasks.

Culture describes the collective assessment of an organization based on values, norms, and assumptions that are generally enduring, relatively enduring, and often unconscious.

Cultural awareness and inclusion involve respecting diverse perspectives, backgrounds, customs, abilities, and behavioral norms and ensuring that all employees are respected and engaged by leveraging their capabilities, insights, and ideas.

Data and analytics are essential for organizational performance and should drive talent development.

Data collection entails gathering facts, figures, statistics, and other information for analysis and assessment. Some standard data collection methods include questionnaires, interviews, and meta-analyses.

DMAIC methodology is a five-step (Define, Measure, Analyze, Improve, and Control), data-driven improvement process used to reduce defects, enhance operations, and improve customer satisfaction. It is the primary tool used to guide Six Sigma projects.

DEI stands for Diversity, Equity, and Inclusion.

Delivery methods, such as instructor-led training, virtual training, mobile apps, and books, describe how information is transferred to learners.

Design thinking is a human-centered process that enables the definition of problems from multiple perspectives, brainstorming potential solutions, prototyping those solutions, and testing and iterating to optimize the best approach. It focuses on the intersection of business needs, user needs, and technology or environmental constraints.

Development involves acquiring knowledge, skills, or attitudes that prepare individuals for new directions or responsibilities. It also refers to ADDIE's third phase, during which trainers select and develop training materials and content according to learning objectives.

Discovery learning is a distinct method wherein participants encounter a problem during an activity, address it, identify valuable knowledge or skills obtained, reflect on the lessons learned, and strategize to apply their newfound knowledge. This process is also referred to as experiential learning. See also Experiential Learning Activity (ELA).

Distance learning is an instructional approach where instructors and learners can be separated by time, location, or both. In addition, this mode of learning can be synchronous or asynchronous.

Diversity refers to the variety of differences in society, including race, gender, political beliefs, sexual orientation, ethnicity, nationality, language, health status, age, and more. Additionally, diversity may involve variations in political viewpoints, learning preferences, personality types, and communication styles.

Donald Kirkpatrick, often regarded as the father of training evaluation, first proposed his four assessment levels—reaction, behavior, results, and business impact—in the 1950s.

Double-loop learning involves modifying underlying values and assumptions during decision-making processes. It is also known as reframing or altering the context.

Effect size is derived by dividing two groups by their standard deviation and calculating the difference between them. For instance, when comparing a treatment group that has received an experimental intervention to a control group that has not, the effect size measures the difference between the two groups.

Elaboration is a purposeful practice technique where learners rephrase the content in their own words and link it with existing memories, such as previously acquired skills or knowledge.

eLearning encompasses web-based learning, computer-based learning, virtual classrooms, and digital collaboration and is also called electronic learning.

eLearning professionals perform various roles in supporting the creation of structured courses or learning experiences delivered electronically, including online or computer-based learning, virtual classrooms, performance support materials, and digital collaboration and knowledge sharing.

Emotional intelligence is recognizing, understanding, and responding appropriately to one's and others' emotions. Based on Gardner's multiple intelligence theory, this eighth intelligence was brought to prominence by Daniel Goleman in his book Emotional Intelligence.

Empathy involves acknowledging the emotional needs of others and effectively supporting them in the manner they need. Understanding others' feelings, conditions, and concerns is crucial for successful interpersonal relationships.

Employee experience, sometimes called the employee journey, represents employees' perceptions of an organization. It is influenced by workspace, communication, work-life balance, interactions with their teams and supervisors, the technology and tools they utilize, and numerous other aspects of their jobs.

Employee training and development encompass activities that aid employees in acquiring new or enhancing existing knowledge or skills. Training is a formal process through which talent development professionals assist individuals in improving job performance. Development involves gaining knowledge, skills, or attitudes that prepare individuals for new directions or responsibilities.

Energizer is an activity designed to rejuvenate a group.

Enterprise Resource Planning (ERP) refers to business management software, usually a suite of integrated applications that organizations employ to collect, store, manage, and interpret data from all business activities and departments.

Equity fosters justice, fairness, impartiality, and equal access to opportunities, advancement, and engagement. Equity tackles structural inequalities and obstacles by ensuring fairness in procedures, processes, practices, and resource distribution. Unlike equality, which implies treating everyone as if their experiences and backgrounds are identical, equity considers differences in people's experiences and backgrounds when determining what constitutes fairness.

Evaluation is a multi-level, systematic approach to collecting information on the effectiveness and impact of training programs. The findings can be used to enhance the program, establish whether learning objectives have been met, and assess the training's value to the organization.

Executive coach creates a secure, structured, and trustworthy environment to support senior managers or leaders.

Experiential learning recommends participants engage in an activity, reflect on what they have learned, identify valuable knowledge or skills they have acquired, discuss what they have learned, and apply their learnings at work. It is also referred to as discovery learning.

Facilitation pertains to the trainer's role in learning, assisting learners in acquiring, retaining, and applying knowledge and skills. It's also called training delivery.

Feedback is guidance or information from one person to another about the effectiveness or success of an event, process, or action. For example, in coaching and talent development activities, learners receive feedback on their progress, which aids in learning retention and behavior modification.

Formal learning is a structured learning program that arises from activities within a controlled learning environment and includes instructor-led classroom sessions, instructor-led online training, certification programs, workshops, and college courses. A predetermined curriculum, agenda, and objectives occur within a specified timeframe.

Formative evaluation takes place throughout the design of any talent development solution. Its goal is to refine the draft initiative and increase the likelihood of achieving its objectives. For instance, in performance improvement, the assessment measures progress throughout the HPI model, such as meeting a client's expectations and identifying the root cause.

Future readiness means being curious and constantly seeking new information about the business world, what employees want, and how people develop their skills. It also means adjusting to new working methods as things change over time.

Gagné's Nine Events of Instruction were designed by instructional design pioneer Robert Gagné to support learning and enhance retention—from capturing attention and informing learners of the objective to assessing performance.

Gamification incorporates typical game-playing elements (point scoring, competition, rules of play) into the design of development initiatives. The method can be used either as a teaching or engagement method.

Gig economy is a labor environment characterized by temporary, independent, and short-term engagements.

Goal is a desired end state or condition toward which human effort is directed.

Group dynamics involve the interactions of individuals working or learning together, encompassing communication, goal-setting, decision-making, leadership provision, and conflict resolution.

Growth mindset concept was proposed by Carol Dweck, which asserts that individuals have complete control over their abilities and that they can learn, improve, and develop them more.

Hackathon, initially rooted in technology, is an event where a large, diverse group of professionals come together to create new software or hardware rapidly. However, this concept has expanded to other fields, with people gathering for a day or more to collaborate on projects or new approaches in small groups.

Hard data comprises objective quantitative frequency, percentage, proportion, or time measures.

HR/OD professional is an individual who may hold various roles focused on optimizing talent and organizational processes or systems to achieve business goals.

Human capital encompasses an organization's people's collective knowledge, skills, competencies, and values.

Icebreakers introduce participants to one another and the course material at the beginning of a training program. That makes it easier for them to become comfortable with it.

Inclusion is cultivating and maintaining an environment of respect, belonging, and inclusion for all, including traditionally underrepresented or marginalized people.

Independent consultants in the talent development profession assist teams and organizational leaders in assessing employee learning and performance gaps, recommending or devising solutions to address those gaps.

Individual development plan (IDP) is a strategy for improving work performance or advancing one's career. The content may be connected to performance data. However, development discussions typically occur separately from performance appraisal discussions.

ILT (Instructor-Led Training) generally refers to traditional classroom training, where an instructor teaches a course to a group of learners.

Informal learning takes place outside of structured programs, plans, or classes. This type of learning occurs organically through observation, trial and error, and interaction with others. It can include coaching, mentoring, stretch assignments, rotational assignments, reading books, blog posts, watching online videos, listening to podcasts, browsing the internet, and consuming other digital content.

Instructional design is a crucial component of effective learning efforts, creating learning experiences and materials that facilitate acquiring and applying knowledge and skills.

Instructional designers design and develop content, experiences, and other solutions that support new knowledge and skill acquisition using systematic methodologies based on adult learning principles. They also develop mechanisms for assessing and evaluating the impacts of learning on organizations and individuals.

Instructional system designers (ISDs) analyze, design, develop, implement, and evaluate instructional experiences to create learning experiences that enhance learning. They typically follow the premise that learners are most likely to learn more effectively if given a clear description of what they will be expected to accomplish due to the training.

Instruments are HR tools for collecting information, such as assessments, checklists, inventories, questionnaires, surveys, and tests.

Integration involves unifying hardware, software (and, in e-learning, content) components to function as a cohesive, interoperable system. This process may also encompass front-end planning and strategizing.

Intellectual property refers to ideas, inventions, formulas, literary works, presentations, or other knowledge assets owned and protected by an organization or individual, such as copyrights, patents, trademarks, and service marks.

Interleaving is an intentional practice technique that alternates topics within instruction, weaving them together and revisiting them before one topic is completed.

Intrapreneurial describes a situation where an employee operates internally but is expected to exhibit entrepreneurial characteristics.

Job aid offers guidance on when and how to execute tasks and steps, reducing the amount of recall needed and minimizing errors. Job aids can be checklists, video demonstrations, or audio instructions.

Knowledge Management (KM) is an organized approach to achieving organizational goals through creating, capturing, curating, sharing, and managing the organization's knowledge, ensuring the correct information and expertise reaches the appropriate individuals at the proper time.

Knowledge mapping is a process to identify and connect where knowledge and expertise are located, whose ownership they belong to, what they are worth, and how they are used within an organization. Examples of knowledge maps include network charts, expert directories, or matrices connecting knowledge to critical processes.

LCMS, or Learning Content Management System, is a tool that lets authors, developers, and instructional designers create, store, reuse, and organize digital learning materials from one central object repository. An LCMS focuses on content development, management, and publication, typically delivered via a Learning Management System (LMS).

Leadership development encompasses any activity that enhances an individual's leadership abilities or an organization's leadership capacity, including learning events, mentoring, coaching, self-study, job rotation, and special assignments to develop the required knowledge and skills to lead.

Learning and Development is a department within an organization responsible for fostering employee growth and enhancing their knowledge, skills, and capabilities to improve business performance. This function may be organized centrally, independently, or within human resources (HR), decentralized across various business units, or as a hybrid (sometimes called federated) structure.

Learning Experience Platform (LXP) extends beyond a traditional LMS to offer personalized social and online learning opportunities.

LMSis a tool that helps share online courses and training with learners. It also keeps track of how learners are doing and creates reports. However, unlike an LCMS, it doesn't help develop the course materials, only sharing and managing them.

Learning sciences is an interdisciplinary field rooted in research that seeks to advance the comprehension of learning, learning innovation, and instructional methodologies.

Learning technologist oversees and implements the technological infrastructure necessary to support an organization's talent development strategy.

Learning modality describes how information is processed through the five senses as we hear, see, smell, taste, and touch.

Learning objectives are precise, observable, measurable statements of behavior that a learner must exhibit for training to be deemed successful.

Lifelong learning is the continuous, self-driven pursuit of knowledge for personal or professional growth.

Machine learning involves algorithms guided by insights from existing data that utilize various technologies, such as neural nets, deep learning, and natural language processing.

Metric is a number generated through a standardized procedure and calculation method, while a measurement may result from different calculations or measuring techniques each time.

Microlearning optimizes learning and performance by delivering brief, focused pieces of content.

Mind mapping is an inventive, convergent technique that organizes thoughts and ideas in branching subcategories around a central topic.

Mobile learning leverages wireless devices like smartphones, tablets, or laptops, to train and develop employees.

Model represents an idea, object, process, or phenomenon.

Moduleis a set of learning units containing predefined learning objectives and content. Each module has goals, information, task content, practice activities, and tests to assess whether objectives are met.

Multisensory learning engages the learner and boosts retention by employing different senses. The brain stores information differently depending on whether it is received visually, audibly, or through other senses. Therefore, engaging multiple senses in learning involves more of the brain in information storage.

MBTI, or Myers-Briggs Type Indicator, predicts personality types based on extraversion or introversion, sensing or intuiting, thinking or feeling, and perceiving or judging preferences. An everyday use of this technique is for career development and team building.

Needs analysis identifies the gap between the current and desired state by gathering and synthesizing data and information.

Needs assessment is a method for pinpointing and quantifying the discrepancy between existing and desired conditions.

Neuroplasticity refers to the brain's capacity to restructure itself, both physically and functionally, in response to environmental, behavioral, learning, and emotional factors.

Objective is an aim or purpose that, when combined with other objectives, contributes to a goal.

Observation involves participants witnessing an event and sharing their comments, reactions, data, and insights. It's also a popular data collection methodology.

On-the-Job Training (OJT) is a training delivery method that provides training to employees as needed, making it one of the oldest forms of training.

Onboarding is how organizations provide new employees with the knowledge and skill sets necessary to succeed.

Organization development (OD) enhances an organization's effectiveness in achieving its business objectives. OD employs planned initiatives to develop an organization's systems, structures, and processes to improve overall effectiveness.

Pedagogy refers to the art or practice of teaching, typically involving children. It concentrates on educators' techniques to impart knowledge and highlights the teacher's role. Pedagogy contrasts andragogy, which pertains to adult teaching and emphasizes the self-directed and motivated learner. See also andragogy.

Performance management is the continuous communication process between supervisors and employees to establish expectations to achieve the organization's strategic objectives. This process includes clarifying expectations, setting goals, providing feedback and coaching, and reviewing outcomes.

Performance improvement is a comprehensive and systematic approach to achieving organizational goals by identifying and closing human performance gaps.

Performance support provides performers with sufficient information to accomplish their tasks when and where needed. In this system, support is integrated into a natural workflow and organized for a particular environment or role.

Professor/educator is responsible for instructing learners within an academic institution or a specific course. This role encompasses those in primary education, secondary education, higher education, and executive academic education.

Project management entails planning, organizing, directing, and controlling resources for a limited period to accomplish specific objectives and goals.

Rapid Instructional Design (RID) is a flexible alternative to the conventional ISD model, employing various strategies to produce instructional packages swiftly. RID techniques include incorporating existing materials, utilizing templates, and engaging subject matter experts efficiently.

Return on investment (ROI) refers to the material benefits or profits derived from an investment compared with its cost. You can use it to compare the monetary benefits of training programs with their expenses. ROI is typically displayed as a percentage or cost-benefit ratio.

Retrieval practice is a purposeful technique where learners enhance retention by recalling a skill or knowledge directly from memory rather than referring to a text or observing a demonstration.

Retrieval, sometimes referred to as recall, is the process by which the brain accesses information that has been encoded and stored.

Sales enablement assists a sales team in achieving its objectives by supplying the necessary tools and resources for success. It encompasses sales strategy, sales training, coaching, content creation, process improvement, sales career development, and sales compensation, among other areas.

Scope creep occurs when tasks or deliverables are added to a project outside the original requirements without any control procedure like change requests.

SCORM (Sharable Content Object Reference Model) outlines a method for constructing learning management systems and courses, enabling them to be shared with other compliant systems.

Self-directed learning (SDL) allows learners to determine the pace and timing of content delivery, which can occur through various media (print products or digital).

Simulation is an extensive category of experiences, encompassing games for entertainment and immersive learning simulations for formal learning programs. Simulations employ simulation elements to model and present situations, depicting actions and demonstrating how those actions affect relevant systems, producing feedback and results.

Six Sigma methodology represents a data-driven approach to improving business processes. This method enhances output quality by identifying and eliminating defects while keeping the mean deviation from the nearest specification limit at six standard deviations. Six Sigma primarily aims to reduce variation through process improvement and to implement a measurement-centered strategy.

Subject matter expert (SME) has extensive knowledge and expertise in a particular subject or topic.

Social learning naturally transpires when two or more individuals interact. As a result, organizations are increasingly utilizing social media tools to augment social learning and knowledge-sharing, leading to more informed and effective workplace collaborations.

Strategic planning is the procedure an organization employs to determine its future direction. Although no single process exists, it typically involves envisioning the future, defining goals and objectives, aligning structure and resources, and executing the plan.

Succession planning is a systematic method of identifying, assessing, and cultivating personnel with the potential to assume leadership or mission-critical positions upon a current occupant's resignation, termination, transfer, promotion, or death.

Synchronous training takes place when the facilitator and learner engage in training simultaneously. This term is most commonly used for virtual training, which can be synchronous or asynchronous.

Talent acquisition refers to the process of promptly filling vacancies.

Talent development encompasses efforts that encourage learning and employee development to propel organizational performance, productivity, and outcomes.

Talent development director/executive is an individual who guides and establishes the strategy for a talent development unit within an organization. This unit may span multiple functional areas with broad responsibility for nurturing talent in the workplace.

Talent development manager is an individual who supervises and manages the work of a group of people and processes dedicated to fostering learning and employee development to drive organizational performance, productivity, and outcomes. This person may operate as a standalone department in smaller organizations.

Talent strategy and management involve practices designed to shape an organization's culture, engagement, capability, and capacity by implementing and integrating talent acquisition, employee development, retention, and deployment processes, ensuring alignment with organizational objectives.

Taxonomy refers to a structured system that underpins the classification of knowledge. For instance, a KM taxonomy facilitates efficient retrieval and sharing of knowledge, information, and data throughout an organization. It is designed around work processes and knowledge requirements within an intuitive framework.

Team building transforms inefficient or dysfunctional groups into high-performing, productive teams through experiential learning activities. These activities may include data review, interpersonal exercises, problem exploration, addressing challenges, and devising action plans for change.

Technology application pertains to a practitioner's ability to identify opportunities to adapt and harness the appropriate technologies at the right time to fulfill organizational and people development objectives.

Theory X is a concept of human motivation developed by Douglas McGregor in the 1960s. It posits that employees are inherently lazy, averse to work, and will avoid it when possible. Adherence to Theory X results in a management philosophy characterized by close supervision and strict control of employees.

Theory Y, a concept of human motivation developed by Douglas McGregor, contrasts with Theory X by positing that most employees are self-driven, enjoy work, and are committed to achieving goals. Embracing Theory Y results in a management philosophy that trusts employees to take responsibility for their work without constant supervision.

Train the trainer refers to a program or initiative designed to teach training and facilitation skills to newcomers or subject matter experts (SMEs) tasked with training others.

Trainer/facilitator guides learning in traditional or virtual classrooms, one-on-one settings, or on the job within an organization to help individuals enhance their performance.

Training/talent development coordinator is an individual who organizes, administers, and implements learning programs, whether developed internally or outsourced, to foster employee performance, development, and growth.

Training delivery (and Facilitation) represents the methods talent development professionals employ to help individuals improve workplace performance by acquiring new skills and knowledge.

Training objective is a statement outlining the intended accomplishments during a training session.

Training transfer evaluation is a process that measures the success of a learner's ability to apply and implement acquired knowledge on the job.

Triple-loop learning is a model, alongside single- and double-loop learning, that assists learning and development professionals in understanding learning dynamics frequently referred to as "learning how to learn." Learners reflect not only on what they learned but also on how they learned it, their thought processes, and others' perspectives on the acquired knowledge. This reflection prompts them to transform their beliefs and values willingly.

Unconscious biases are unintended, deeply ingrained learned stereotypes that influence behavior.

Upskilling refers to training intended to expand existing skills with new or significantly enhanced knowledge, enabling individuals to continue succeeding in their current profession or field. Upskilling does not encompass standard, ongoing development.

VAK model is a representation of individual learning and information retention styles. For example, some people primarily learn through one type, while others rely on a combination of three: visual (requiring images, diagrams, or other visuals), auditory (needing to hear information), and kinesthetic (preferring hands-on learning).

Virtual classroom is an online learning environment where learners and facilitators interact.

Virtual reality (VR) is a computer-generated simulation that uses a head-mounted display to immerse learners in a fully rendered digital environment, allowing them to manipulate objects with handheld controls and voice commands. This powerful tool enables learners to practice skills in a realistic, engaging simulation of a real-life setting. Training learners in dangerous or difficult-to-replicate situations, such as emergencies or heavy equipment simulations, is often critical.

Wants-based approach is a customer-centric strategy that primarily concentrates on fulfilling client requirements.

WBT, or web-based training, delivers educational content through a web browser over the internet, intranets, or extranets.

Web-based training, or WBT, offers online resources like articles, discussion groups, and references in addition to the core learning material, combining the benefits of instructor-led training with those of computer-based training.

White paper is a concise report addressing a specific topic relevant to an organization.

Wiki comprises a collection of interconnected web pages that can be contributed to or edited by anyone with access. It is valuable for fostering collaboration and compiling data.

Workplace learning and performance (WLP) refers to the fields of training, performance enhancement, learning, development, and workplace education and is often informally referred to as training or training and development.

xAPI, or the Experience Application Programming Interface, is an e-learning software specification designed to document an individual's online and offline learning experiences. It is also known as the Tin Can API or the Experience API.

#Talent Development Glossary

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crisspe · 1 year

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Difference between andragogy and pedagogy

Andragogy can be defined as a science that deals with the historical, philosophical, sociological, psychological and organizational aspects of adult education. While Pedagogy is the "Science that deals with education and teaching, especially children and youth."

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greatappliedbehavioranalysis · 1 year

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About Applied Behavior Analysis

Applied behavior analysis is a scientific approach to behavior modification. Based on principles of operant conditioning, it aims to change socially significant behavior. It is commonly used with children and adults. The goal is to improve the quality of a person's life and reduce his or her risk for behavior problems.

While the methods used by the ABA practitioners may vary, they all follow a consistent pattern of observation and manipulation. This is a key element to the effectiveness of applied behavior analysis therapy. The focus on scientific observation has existed since the earliest days of behavior therapy. Early proponents of radical behaviorism such as B.F. Skinner used an experiment called the Skinner Box to test their theories. Check out this site: aparaautism.com to book these solutions.

Applied behavior analysis is a type of behavior therapy aimed at helping children develop social skills. The method uses positive and negative reinforcement to teach children to follow desired behaviors. Parents are also involved in the process. Children who receive ABA therapy are much more prepared for the social world as a result. The therapist will set goals and milestones for the child's behavior. These goals are discussed with the child's parents and are updated as the child progresses.

Applied behavior analysis therapy is an invaluable component of the autism treatment process. Early intensive behavioral intervention is recommended for younger children and is particularly effective when it involves issues related to social, communication, and functional skills. The method can help a child learn to develop these skills before he or she starts formal school. It has a wide range of applications.

Applied behavior analysis can help improve a child's social skills by improving communication. It can also help reduce challenging behaviors. In addition to using positive reinforcement, ABA therapy can help prevent a child from repeating the same behaviors. The main focus of the therapy is to teach a child to associate desired behavior with a desirable outcome.

The field of applied behavior analysis has been growing rapidly in recent years. It is now used in many areas of management, from corporate organizational management to psychological treatment. Licensed behavioral analysts can work in a variety of settings, including medical offices, counseling practices, schools, and group care facilities. Some even use the method in training employees in the field.

Applied behavior analysis can be an invaluable tool for children with autism. The therapy improves social skills, helps children learn new skills, and addresses problematic behaviors. The effectiveness of ABA therapy depends on the severity of the child's autism and how early it is started. If started at an early age, ABA therapy can improve a child's social skills and IQ significantly. You can click for more info here on ABA therapy.

When a child begins behavioral therapy, the therapist will first assess the child's needs. Then, he or she will evaluate his or her interactions with others and the way he or she communicates. If appropriate, therapists may also visit the patient's home or school and talk with his or her family to understand the developmental challenges that the child has.

Check out this related post to get more enlightened on the topic: https://en.wikipedia.org/wiki/Applied_behavior_analysis.

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thetalabs · 2 years

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Mental Health Tips For Working Professional

Mental Health for Working Professionals

As adults, we spend most of our post-twenties to the early sixties at our workspaces. This is a long period and facing work-related anxiety is quite common. However, when this anxiety turns into something disturbing, it is time we take cognizance before it turns into depression. Hazards to mental health may be connected to employment duties or schedules, unique aspects of the workplace, or chances for professional advancement, among other factors. Hence, mental health for adults as working professionals is equally important. When we talk of Indian workspaces, low wages, a toxic environment, and no timely promotion are some of the factors that lead to stress and anxiety among Indian professionals. Between all this, their mental health gets at stake and as a result, every year we see a lot of adult suicide cases due to depression and anxiety issues.

In addition to being a fundamental right, safe and healthy workplace environments are also more likely to reduce stress and disputes at work, boost employee retention, and increase performance and productivity. Conversely, a person's capacity to enjoy their work and perform their job well can be harmed by a lack of effective constructions and support at work, particularly for those who live with adverse mental health conditions. It can also undermine people's attendance at work and even prevent them from obtaining a job in the first place.

Maslow’s Hierarchy of Needs

When we talk of Maslow’s Hierarchy of Needs, we see that physiological and psychological requirements motivate our due actions. The 5 needs are as follows, in ascending order:

Physiological

Safety

Love & Belonging

Self Esteem

Self Actualisation

When applied in today’s perspective, self-esteem and self-actualization stand at the top of the table. However, in the informal economy, where there is no legislative safety for health and safety, more than half of the world's labor is employed there. These people frequently labor in hazardous conditions, put in long hours, lack access to social or financial safeguards, and face prejudice, all of which can be detrimental to mental health.

Although psychosocial hazards exist in every industry, certain employees are more likely to be subjected to them than others due to their jobs or the environment in which they work. Workers in the health, humanitarian, or emergency sectors frequently have professions that pose a high risk of exposure to unfavorable situations, which can be detrimental to mental health. Risks associated with economic downturns or humanitarian or public health situations include job loss, economic insecurity, fewer work prospects, or an increase in unemployment.

People with serious mental illnesses are more likely to lack employment opportunities and, if they are employed, are more likely to encounter discrimination at work. A threat to mental health also exists when one is unemployed. Suicide attempt risk factors include unemployment, financial hardship, unstable employment, and recent job loss.

How Can We Prevent Mental Health Hazards At The Workplace

Managing psychosocial hazards at work is key to preventing mental health issues at work. Employers are advised to carry out organizational initiatives that target specific working conditions and settings by the government. Organizational interventions are those that evaluate workplace hazards to mental health and minimize, change, or eliminate such risks. Organizational interventions might take the form of flexible work schedules or the implementation of policies to deal with harassment and violence at work.

Working professionals should also ensure that they spend time with their families, and keep work at bay when at home. The fine balance between personal and professional life should always be maintained. However, when we talk of this fine balance, more than half of the working population of India works in hazardous conditions, for extremely low wages, and maintaining this balance becomes quite tough.

Fortunately, the government and welfare organizations are raising their concern regarding the mental health of workers. They’re creating awareness to safeguard and promote one’s mental health at work and developing programs to assist those who have mental health disorders in participating and succeeding in their jobs, and establishing a setting that is supportive of change.

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casepsychology · 2 years

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Child Psychologist Burlington: Areas Covered in Child Psychological Assessment

A psychological assessment involves a series of questionnaires, standardized tests, and interviews to identify weaknesses and strengths in various areas of a person’s life. For psychological assessment for a child to be successful, you have to consider every aspect of the child’s life, including their family, school, and the general community. During the assessment, a child psychologist Burlington will look at:

Intelligence

Intelligence tests seek to identify any intellectual disabilities or gifts, developmental delays, nonverbal reasoning skills, language and communication skills, speed, reception, absorption, and processing of new information.

Achievements

These are psychological and educational tests that help measure a child’s academic strength and identify learning disabilities such as dyslexia. They are often done in reading, writing, and mathematics. If a child has special needs, the assessment helps develop an individualized education plan matching the child's abilities.

Attention and Memory

A child psychologist Burlington will run a neuro psychological test to measure memory and attention spans and identify attention deficit hyperactivity disorder. The test also helps measure reasoning abilities and executive functions such as organizational and planning skills.

Social, Emotional, and Behavioral Development

This consists of personality and social-emotional evaluation tools that help examine a child for issues such as anxiety, depression, and other social shortcomings that might make them have problems at home and school. If there are any issues identified, the assessment will give guidance on behavioral management strategies to be applied at home and in school. The assessment also provides the child psychologist Burlington with a platform to create a treatment plan and identify whether or not the child requires medication.

Psychological and educational assessment programs have a wide range of testing parameters suitable for school-going children, youths, and adults. These assessment tests not only help improve the lives of the individual but also contribute to research and development on mental health.

#Child Psychologist Burlington

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umsb · 2 years

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Hello Pak,

For our session Thursday, August 8, Bukittinggi

Please find my bio below.

Lynn Sutankayo is a Faculty member of Norquest College in the city of Edmonton, which is located in the province of Alberta in Canada. She is an instructor in Settlement Studies, a 2 year diploma program offered in-person and in hybrid formats, which equips learners with the skills and competencies needed to work effectively with newcomers to Canada in the role of a settlement or intercultural services provider. Here, Lynn developed a course in Gender and Culture, and has written a Chapter on the same topic in a forthcoming publication titled Canadian Settlement in Action: History and Future, which is a free and open Online Educational Resource. At NorQuest College, Lynn also teaches in the areas of cross-cultural interviewing and counselling, self-care in the human services, and organizational development. Lynn also works as a grant writer and project developer for the John Humphrey Centre for Peace and Human Rights, a Canadian non-governmental organization that works locally and regionally to advance dignity, freedom, justice, and security through collaborative relationships and transformative education on peace and human rights. Lynn combines her academic and NGO work as a member of Righting Relations Canada, a pan-Canadian network that strives to build capacity amongst adult educators and community organizers, to provide space and resources for them to connect, reflect on, and organize for heart-led social change. Lynn holds a Bachelors Degree in Psychology and a Masters Degree in Theory, Culture and International Studies in Education from the University of Alberta. She previously worked at the University of Alberta for 10 years in various capacities, including the Global Education Program at University of Alberta International, and in partnership development, and work-in-learning at the University of Alberta Community Service-Learning Office. She lives in Edmonton, Alberta with her husband and two children. She is currently visiting Bukittinggi accompanied by her father and relatives who are Orang Minang, where they are staying together for a short holiday at their family home here in Bukittinggi.

Lynn

"...for the passionate sense of the potential, for the eye which, ever young and ardent, sees the possible..." - Soren Kierkegaard

#umsumbar #shofwankarims #imeskafam #muhammadiyah #minangkabau #LynnSutanKayo #IsmalSutanKayo

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shofwankarim · 2 years

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Hello Pak,

Please find my bio below.

Lynn

"...for the passionate sense of the potential, for the eye which, ever young and ardent, sees the possible..." - Soren Kierkegaard

#imeskafam #shofwankarims #habdulkarimrahanaibrahimfam #LynnSutanKayo

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psychologistyourmentalhealth · 2 years

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Which Psychologist to Approach for Your Mental Health Problem?

Do you know there are many types of psychologists? For a layperson, the word 'psychologists' may just mean a medical professional who deals with mental ailment but then the truth is all different. There are several types of psychologists the stream of medical science has. It is very important for one with mental ailment to know who to approach or else improper diagnose and wrong treatment may bring irreversible consequences. Let us learn what different types of psychologists are and what their job is.

Due to a lot of pressure for performance at job, tension of sales in business, force to bring good numbers in academic career, these days, the cases of patients with mental disturbance has increased. In addition, it is not just adolescents or adults who suffer from mental pressure but children too face great difficulties keeping their minds in normal state as they are expected to perform marvelously in sports and other academic activities.

Mental ailments, if left undiagnosed or untreated, may bring worst consequences. That is why, it is very important to identify the signs and symptoms of mental ailments and quickly approach concerned psychologists nearby your area. Nevertheless, which psychologist is to be seen, matters a lot. Different kinds of psychologists are available who masters in their own field. For instance, if a kid is suffering from aloofness and irritable behavior, school psychologist and child psychologist can be approached. They master in studying child's brain that has all different state of mind as compared to adults.

Industrial or organizational psychologists provide psychological principles and research techniques to a businessperson who is depressed because of loss in business. Following the strategies as suggested by organizational psychologist may help boosting the revenues. Nevertheless, psychologist working for this would basically motivate the businessman and help him getting positive attitude.

Clinical psychologists are the ones dealing with general mental problems of the patients. Phobias, fears, anxieties, depression etc. are common mental health ailments they are known to diagnose, treat and prevent. Generally, in society, meeting psychologist means contacting clinical psychologist. They have their unique technique to approach patients that may include questionnaire, interview or other trick to know patient's mentality. They may prescribe some tests that help them diagnosing the cause and treating the disease.

Likewise, there are other psychologists such as health psychologists, neuropsychologists, forensic psychologists, research psychologists, and counseling psychologists etc. One must understand which psychologist to approach and where. Finding psychologist nearby your residence is preferred as the specialist can reach quickly during mental attacks that come without notice. You can simply search psychologists nearer to you on search engine. For instance, if you live in Austin, Texas, you can Google psychologists in Austin, TX to get the list of professional psychologists.

Since now you know which psychologist you must contact for, it is easy to see the one who is appropriate and experienced in his own field. If you live in Austin, you can find professional Psychologist in Australia to overcome issues related to mental health quickly.

#psychologists #business

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appliedbehavioranalysisguide · 2 years

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The Benefits of Applied Behavior Analysis

The principles of applied behavior analysis (ABA) are the basis for many modern educational practices. The Good Behavior Game, developed by Dr. Wolf, has become a popular classroom management technique. Other techniques include raising hands before speaking and giving a gold star for a job well done. These methods have become part of daily life for children and adults alike. Find ere, https://aparaautism.com/aba-therapy-the-woodlands/ some of the main benefits of ABA therapy. Further reading: What is ABA therapy?

ABA is a treatment for autism and is widely accepted as a safe, effective method. Many state and federal agencies have endorsed it as a proven way to help autistic children function. Applied behavior analysis can help foster basic and complex skills in children with autism. Parents of autistic children should be aware that ABA therapy isn't a cure.

Applied behavior analysis is a form of therapy that focuses on using positive reinforcement to encourage behaviors that are socially significant. Positive reinforcement is not a new idea; most of us use it subconsciously all the time. The process of ABA is based on the challenges and strengths of the individual child. The results of ABA therapy can be measurable. It can help children with autism, substance abuse, and phobias. However, not everyone believes that this technique works.

Applied behavior analysis is an excellent way to help children with autism achieve better social, emotional, and academic outcomes. The theory behind ABA is based on the idea that we can influence behavior simply by changing its circumstances. Previously, psychologists had assumed that children with certain weaknesses were "fixed" in a particular way. Now, they've come a long way. It's time for parents to embrace the latest techniques and make the most out of ABA. You can continuously learn here about the benefits of applied behaviour analysis.

While the terminology of applied behavior analysis is somewhat different from that of other approaches, the fundamental principles are the same. All behavior analysts begin every case with a functional behavioral assessment. They then create a plan to correct the behavior. ABA therapy is the most effective way to address behavioral problems. If you are unsure of which method of applied behavior analysis is right for your child, contact a professional who specializes in this field. It will be easier to get the best treatment and make the most progress with the right therapy.

Applied behavior analysis is most effective when the focus is on improving a child's skills. Skill development goals are important to applied behavior analysis therapy because they allow the learner to improve a wide variety of skills. The skills being targeted in an ABA program are generally communication, play, social, or motor skills. Each person's specific needs will dictate the goals of the program, but the end result is the same: improved independence.

Applied behavior analysis is increasingly popular in management. A junior high football coach, for example, recently used behavioral analysis techniques to teach his players how to block better. The results were impressive: ninety percent of his players improved their blocking skills. Applied behavior analysis has many applications, from corporate organizational management to psychological treatment. A behavioral analyst can work in a medical office, counseling practice, school, or group care facility. So what is applied behavior analysis therapy? You can get more enlightened on this topic by reading here: https://en.wikipedia.org/wiki/Autism_spectrum.

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appliedbehavioranalysisblog · 2 years

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Disadvantages of Applied Behavior Analysis

Applied behavior analysis is a type of therapy that can be used to help children with a wide range of different challenges. Its effectiveness depends on several factors, including the expertise of parents, hours they are willing to dedicate to the program, supervision by a professional, and the involvement of the wider family. Although the process of learning and implementing ABA strategies is not a new one, there are many variations in practice, including behavioral exercises, positive reinforcement, and social skills training. For more information about ABA, visit our Behavior & Life Skills page. It also features detailed answers to common questions about the program and how to choose an ABA provider. Visit https://aparaautism.com/aba-therapy-carrollton/ to get a therapist.

One of the main features of ABA is the way in which it teaches children. It focuses on systematic manipulation of consequences in order to achieve desired behavior. This approach involves providing a child with several hints and cues, such as verbal, physical, or visual, to help them understand what they're supposed to do. ABA therapy has become increasingly popular with parents because it has a long history of success. But there are some important disadvantages of ABA as a therapy.

Applied behavior analysis therapy is effective at educating children about social norms. By encouraging children to adopt certain behaviors, it will make it easier for them to behave in different social situations. This therapy will teach children that positive and negative behaviors are equally acceptable and that the desired behavior is the result of positive reinforcement. As treatment progresses, children will be more likely to repeat the behavior they learn. Therefore, the process will be more effective if the parent is involved.

As with any form of therapy, the process of applied behavior analysis is different for each child. While some parents compare the process to animal training, the actual method and the goals are unique to each child's needs. Applied behavior analysis also works for adults with behavioral disorders and autism. They went to therapy for one to three years and spent about 25 to 40 hours a week in therapy. The program can be challenging to follow, but the outcome is worth the effort.

Applied behavior analysis has a wide range of applications, from corporate organizational management to psychological treatment. Whether it's behavioral training or managing a child's daily routine, this therapy helps improve a child's life. The career prospects are vast. A successful ABA career can lead to a long-term job in the field of psychology. With a degree in applied behavior analysis, you can work in a wide range of settings from counseling practices to schools and group care facilities. You can try aba therapy in Plano tx for proper healing.

Applied behavior analysis (ABA) is a scientifically validated approach to teaching behavior. It looks at the function of a child's behaviors and the environment they live in. Then, a child learns new, more appropriate ways to do the same thing. In this way, their behavior improves and they will require less special services. If you are wondering about how to start applying applied behavior analysis therapy for your child, read on!

To learn about aba therapies check this site: https://simple.wikipedia.org/wiki/Applied_behavior_analysis.

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