Case Study: Josie Bellings

at
Categories
Tags

 

Josie Bellings, a 34-year-old nurse, presents to your office. Her boyfriend, Robs, is with her.

“Hi,” Josie sighs deeply. “Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.”

Robs breaks in. “She’s told me she sometimes washes her hands six times in a row. Maybe even seven or eight to be sure. She does this at home, too.”

Josie nods. “Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night.”

“Even if I’ve already locked up and she saw me do it,” puts in Robs.

“Well, I feel like I have to have some control over my world. And, um, Robs doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”

Robs adds, “Actually, I did know about that, Josie. I’m also concerned because Josie will get focused on something and then not be able to shut her mind down. She perseverates and I cannot distract her for anything.”

Josie reports that she has always had these symptoms but that they are worse recently. She reports feeling depressed, mainly because of the OCD symptoms that are causing her trouble. She denies any SI, HI, or A/V hallucinations.
Here is the question to be answered!!!!
Based on the information that you have, what diagnosis would you give Josie? Please include differential diagnoses. Please match her symptoms with the corresponding DSM-5 criteria.
Her diagnosis is Obsessive Compulsive with depression .
Why is all of this important? What’s so important about having depression and OCD together? Well, it turns out that having severe depression can interfere with the effects of the most effective treatment for OCD: cognitive behavioral therapy using exposure and response prevention. As you might know, exposure therapy involves gradually confronting the situations and thoughts that trigger your obsessions; and response prevention means working on refraining from the corresponding compulsive rituals.

Sample Solution

“Business organizations can achieve a sustainable competitive advantage by integrating total quality management and business process reengineering. TQM seeks continuous improvements in product/service quality over time, while BPR takes advantage of information and telecommunication technology to achieve dramatic changes in organizational processes that facilitate performance improvements. While the two management approaches both seek to enhance performance and quality, they are often perceived as complete opposites because of their dissimilar pace, time requirements and change initiatives” (Lee and Asllani 409).

Lee and Asllani however, argue that the two philosophies and approach to management control the course of the business “have many similarities and can be combined to form the ‘endless quality improvement’ management approach” (Lee and Asllani 409).

Similarities between reengineering and TQM out number differences, both; are initiated by senior management, focus on enhanced quality, seek the contribution of all employees, are team oriented, allows the blurring of pre-existing departmental boundaries, and both requires full management commitment. However there are some differences between these concepts. “Quality programs work within the frame work of a company’s existing processes and seek to enhance them by means of what the Japanese cal Kaizen, or continuous incremental improvement” (Hammer and Champy 52). The idea here is to do what you already do, however only do it better. With QTM the process is never truly completed, whereas with BPR the process can be quickly called completed. Also with QTM the process is evolutionary and utilizes a democratic management style, however with BPR more measura

This question has been answered.

Get Answer