Harriet is a 51-year-old married woman with a past history of alcohol and cocaine abuse. She has been attending AA and NA meetings regularly and does not report urges to drink or use drugs during the 4 years you have been her psychiatric mental health nurse practitioner. She needs carpal tunnel surgery and the typical regimen during recovery is oxycodone 15 mg per day.
What information would be most critical for the group leader to collect in the first visit?
What is the primary goal for the treatment of this patient’s family problem, based on the US clinical guidelines?
Discuss one curative factor the group would observe during the initial, middle and termination phases in group therapy?
Identify your city. Then refer this patient to three agencies near you that would support positive health outcomes for this patient. (These agencies must not have been used in past discussion posts). What was your rationale for choosing these three agencies?
At least 500 words. Minimum of 2 APA citations from last 5 years.
### Managing Harriet’s Care Post-Surgery
**Introduction**
Harriet is a 51-year-old married woman with a history of alcohol and cocaine abuse, now in recovery for four years, and under your care as a psychiatric mental health nurse practitioner. Harriet requires carpal tunnel surgery, for which the standard postoperative pain management includes oxycodone, a potentially addictive opioid. This situation poses unique challenges given Harriet’s history of substance abuse. This paper will discuss critical information to collect during the first group visit, the primary treatment goal for her family problem, curative factors in group therapy, and provide referrals to local support agencies.
**Critical Information for the Group Leader**
The most critical information for the group leader to collect during the first visit includes:
1. **Detailed Substance Use History:** Understanding the specifics of Harriet’s past alcohol and cocaine abuse, including triggers, patterns, and coping mechanisms.
2. **Current Sobriety Status:** Confirmation of Harriet’s current sobriety, participation in AA and NA meetings, and her strategies for maintaining sobriety.
3. **Surgical and Pain Management Plan:** Detailed knowledge of the surgical procedure and the proposed postoperative pain management plan, including the prescription of oxycodone.
4. **Mental Health Status:** Assessment of Harriet’s current mental health, including any signs of anxiety, depression, or other psychiatric conditions that may impact her recovery and sobriety.
5. **Support System:** Evaluation of Harriet’s support system, including family involvement, friends, and her engagement with AA and NA.
6. **Relapse Prevention Plan:** Discussion of a detailed relapse prevention plan during her recovery, including alternatives to opioid pain management and contingency plans if she experiences urges to use substances again.
**Primary Goal for Family Problem Treatment**
Based on the US clinical guidelines, the primary goal for the treatment of Harriet’s family problem is to **maintain her sobriety while effectively managing her postoperative pain**. This involves ensuring that her pain management plan does not jeopardize her recovery from substance abuse. The guidelines recommend a multimodal approach to pain management, including non-opioid analgesics, physical therapy, and psychosocial support to mitigate the risks associated with opioid use in patients with a history of substance abuse.
**Curative Factors in Group Therapy**
**Initial Phase: Instillation of Hope**
During the initial phase of group therapy, the curative factor of instillation of hope is observed. New group members, like Harriet, can be inspired by hearing about the successes and progress of other members, fostering a belief in their own potential for recovery and successful pain management without relapse.
**Middle Phase: Universality**
In the middle phase, the factor of universality becomes prominent. Group members, including Harriet, realize that they are not alone in their struggles. Sharing similar experiences with others helps to reduce feelings of isolation and stigma, encouraging open discussion and mutual support.
**Termination Phase: Cohesiveness**
During the termination phase, group cohesiveness is a critical curative factor. The sense of belonging and emotional bonding that has developed among group members provides a strong support network that can continue beyond the formal therapy sessions. This support is crucial for Harriet as she navigates her recovery period post-surgery.
**Local Agency Referrals**
**City:** San Francisco, CA
**1. Ohlhoff Recovery Programs**
– **Rationale:** Ohlhoff Recovery Programs provide comprehensive outpatient treatment for substance abuse. Their approach includes relapse prevention, individual and group therapy, which aligns well with Harriet’s need for ongoing support during her recovery from surgery.
**2. The Pain Management Center at UCSF**
– **Rationale:** The UCSF Pain Management Center offers multidisciplinary pain management strategies, focusing on non-opioid treatments and integrative medicine. This referral is crucial to develop a pain management plan for Harriet that minimizes the risk of relapse.
**3. San Francisco Mental Health Services**
– **Rationale:** San Francisco Mental Health Services provides extensive mental health support, including therapy, counseling, and crisis intervention. This agency can offer Harriet additional mental health support to manage stress and anxiety during her postoperative period.
**Conclusion**
In managing Harriet’s care, it is essential to gather comprehensive information regarding her substance use history, current mental health status, and support system. The primary treatment goal should focus on maintaining her sobriety while managing her postoperative pain. Group therapy provides curative factors such as instillation of hope, universality, and cohesiveness at different phases. Referrals to local agencies like Ohlhoff Recovery Programs, UCSF Pain Management Center, and San Francisco Mental Health Services will support Harriet in achieving positive health outcomes and sustaining her recovery journey.
**References**
1. American Psychiatric Association. (2018). Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. American Psychiatric Publishing.
2. Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624-1645.
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