One Flew over the Cuckoos Nest Essay Example for Free

One Flew over the goofballs Nest EssayThe six psychological overturees are biological, learning or behavioral, cognitive, sociocultural, psychodynamic, and humanistic. Each approach is unique in its own way and used by psychiatrists to diagnose the problem. A biological approach is applied when the there is a known medical condition. The medical condition normally connects to mental health, and the solution comes from therapy. This particular approach looks at the whole body. The learning or behavioral approach is all near analyzing the persons the behavior and modifying their behavior biased on their response to the environment. This approach works from positive and negatives items in their environment, and is sometimes aged by brings these elements in and out of their life to fix the problem. The events in the environment can be rewards or punishments that will influence the patients behavior. The cognitive perspective is about understand a patients thinking and understandi ng. How we process, store, and retrieve information influences our behavior. It is said that all problems are located in the brain, and using this perspective you can find a medical issue that is affecting how the brain is working.The sociocultural approach is when the mental health has something to do with the environment that deals with growth. The culture in which the patient is a ample factor. In a psychodynamic approach an individualistics problem is inside the unconscious mind. This can be from a dramatic event that happened earlier in their life. Sometimes the cure can be from the patient themselves accepting the fact, or acknowledging that they have a problem. The final approach is a humanistic approach. This is about individual or self directed choices that influence behavior.This approach deals with the physical health of a patient to eventually cure their mental health. There is a headspring known philosophy that a healthy mind equals a healthy body. In this approach, a psychologist will control the patients diet and exercise to regain their mental health. The hospital used many methods on the mentally ill patients. They had group counseling scheduled e genuinely day where Mrs. rachet interrogated the patients and made them feel uncomfortable. The hospital also had electric shock therapy and lobotomy as other treatment methods.Also, the hospital gave the patients medicine, this is a biological approach, even though it was given to these people unwillingly. Mrs. Ratchet also allowed McMurphy to receive a vote in high society to watch the ball game and she bended the rules or was too strict in order to win her position. This is a behavioral approach because McMurphy watched the baseball probably in his normal environment at home. She teased him with the thought of reflection the game as a reward, then took it away. McMurphy had behavioral or learning approach.He would congratulate people when they did things he thought were good and he would yell at them when he thought they did something bad. For example, when McMurphy taught Chief how to shoot a basketball, he cheered after every point he made. The other patients looked up to and really admired McMurphy, which put him in a very powerful position. He had a strong effect on the other patients and they really admired him. Chief Bromdens recovery began when McMurphy came to the hospital and started talking to him and reservation him do tasks.McMurphy worked on chief to see if he was smart enough to complete simple tasks. The first step was him raising his pass above his head at the basketball court, which was the first movement he had done in his whole time being there. Before chief wouldnt handle directions from others very well. His next step was raising his hand to vote on watching the baseball game, which McMurphy also encouraged greatly. Later, McMurphy rounded up the patients to run into some basketball. McMurphy passed the ball to Chief and he shot it, which was followed by him beginning to follow orders and run up and down the court.The final step was when McMurphy gave him the gum forrader Electroshock Therapy and the Chief spoke fo r the first time at the clinic. After this, chief revealed his intelligence to McMurphy. Ken Kesey was always very interested, and was very talented with the subject of psychology. In 1959 he volunteer to take part in a study named Project mkultra, this was a CIA funded project dealing with psychedelic drugs. Some of the drugs included were LSD, psilocybin, mescaline, cocaine, AMT, and DMT.This and his work at the state veterans hospital, which gave him access to LSD, inspired him to write One Flew Over the Cuckoos Nest. At the state veterans hospital, Kesey spent a chance of time talking to the patients. sometimes under the influence of the hallucinogenic drugs with which he had volunteered to experiment. Kesey did not believe that these patients were insane. Kesey believed that society had pushed them ou t because they did not fit in the the culture, and that they well(p) wanted a place to keep all the mentally ill.I think that Kesey was trying to convey to people at mentally ill hospitals were hard-boiled in a bad manner. He tried to visual aspect people that the mentally ill were probably sheltered away from everybody just because they were different. The hospital pictured in the film didnt seem to help the patients out or want them to recover and go home. They seemed to have no rights. These patients adjusted to this lifestyle and didnt want to leave, that is a problem when the assumed goal was to improve these peoples problems.The rewards from good behavior seemed nonexistent and He also wanted to show how cruel the punishments were in the hospital. Psychedelic 60s Ken Kesey the Merry Pranksters. Psychedelic 60s Ken Kesey the Merry Pranksters. University of Virginia / Charlottesville, Virginia, 16 Dec. 2009. Web. 19 Sept. 2012. . I really enjoyed One flew over the Cuckoos Nest. I thought the movie was genius. There were parts of humor, and it kept you interested and wondering so many things. I enjoyed that there were many main(prenominal) plots and side plots, like the hospital verses the patients, or the patients versus their own recovery.McMurphy was a very mysterious character, because he was crazy, and nobody could figure out if there was anything wrong with him. I though that putting him in that section of the hospital was a mistake, because he is so manipulative and high functioning that he abused all the hospitals loop-holes. At the same time he was very good for the patients. I also enjoyed the character and all their different problems and personality differences. I enjoyed watching how Billy and the Chief progressed mentally throughout the film.I also love the thought of people breaking structure, and that is what McMurphy definitely succeeded in. This movie very closely think to psychology, because it directly dealt with people who were mentally ill. Also psychology was involved when McMurphy used his genius mind to go against the hospital in various ways. Thinking of these schemes uses a large amount of psychology. Even for the viewers, the movie left you deep in thought, with predicting and questioning what is going to happen next. This movie made you think deeply making this a very psychological movie.

Reflection on self awareness and personal growth

Reflection on self awareness and personal growthThe purpose of this essay is for the trainee focusing to critically reflect upon, and evaluate, a recorded counselor posing which took place on Thursday 2nd April 2009. Within this essay, the trainee guidance will evaluate their workout of advanced counselling skills and assess the value and practicefulness of these skills. In severalizeicular, the trainee Counsellor will critically evaluate their own way of beingness by intimately examining their application of the six conditions which are intrinsic to therapeutic change and will focus onthe three attitudes or conditions that a person-centred therapist needs to submit for the node are congruence, empathy, and unconditional positive check. These attitudes are non presented as a hierarchy. Indeed they are viewed best as a trinity inseparable, essential and mutually independent.An evaluation and reflection of the trainee Counsellors performance will be enhanced by use of the person-centred rating scales. Mearns Thorne (2007) when writing approximately the rating scales posit thatDiscussing these ratings, and the a nonher(prenominal) possible responses the trainee counsellor might have made, could help to expand the trainees repertoire of ways of communicating her empathy.(Mearns Thorne, 2007, p.71)Another way in which the trainee Counsellor has evaluated the way they worked in this sitting is by closely examining the DVD with the observer who was present during the session and who asked the trainee Counsellor pertinent questions regarding the session. This procedure is known as Interpersonal Process retrieve (IPR) (Merry, 2006, p.146). Finally, the trainee Counsellor will refer to feedback notes from the observer order to critically evaluate their way of working with the leaf node.The invitee in this session is a 36 yr old married woman who has two children. This session is the trainee Counsellors second session with this invitee, although the trainee Counsellor is aware that the thickening has seen another therapist previously, nothing of these other sessions has been divulged by the client. In the first session prior to the client talking about her reasons for wanting to see a therapist, the trainee Counsellor and client worked collaboratively through the contract. This was done with sensibility as the trainee Counsellor was very aware that he was the first male Counsellor seen by the client and she had already disclosed her anxiety and nervousness about this fact. During the first session, the client talked about a number of different issues, but continually returned to focus on her feelings about a man who had been harassing her both physically and sexually. The client also expressed doubts about her own lack of self- depression and her compulsive organisational and controlling nature which she felt dominated her life. The trainee Counsellor considered how the client was moving along the Seven Stages Model (Merr y, 2006, p.59) and that the client was positioned approximatelywhere between stages 3 and 4, although possibly closer to stage 4 as during the first session the client exhibit some internal confusion about her feelings and there was a tendency for her to express things in terms of black white, she was however, also able to convey some profound and to a greater extent meaningful feelings. Merry (2006) describes stages 3 4 asClients who first seek therapy are often at this stage and need to be fully accepted as they present themselves before moving deeper into Stage 4. Stage 4 In this stage, clients begin to describe deeper feelings, usually those that happened in the past.(Merry, 2002, p60)At the beginning of the second session the trainee Counsellor checked, by working collaboratively with the client C1, C3, C5, about the contract in order to confirm with the client that she was happy with and understood everything discussed in the first session. The client confirmed CL6 that she was fine to continue. The trainee Counsellor then proceeded to set the boundaries C1, C7 for the counselling session. Boundaries are an extremely all important(p) element of the therapeutic mathematical process as they make the client aware of what the trainee Counsellor is offering them. The trainee Counsellor, by being open about the type of counselling they offer, by setting meter limitations and by reassuring the client, clearly sets the scene for a healthy, professional and mutually beneficial relationship. Mearns Thorne (2007) when discussing boundaries suggest thatIt is important both at this early stage and as counselling proceeds that the counsellor monitors continually what she is prepared to offer to the client, and what lies outside the boundaries of her commitment.(Mearns Thorne, 2007, p.53)The trainee Counsellor, when discussing the boundaries and when checking with the client about the previous session and the clients reasonableness displayed a deep aim of Unconditional Positive Regard (UPR) rating 4.0 C1, C7.At CL8 the client begins to talk about a man who is heavily impacting on her life at the aftermath. The trainee Counsellor C9 reflects the clients row back to her, but paraphrased and in a manner which questions the clients feelings. At CL10 the client is interrupted by a loud noise from an adjoining room and the trainee Counsellor, because of the psychological connection with the client and his aim of congruence rating 5.0 responds with a degree of immediacy C11 which is positively acknowl acutenessd by the client. At CL12 the client expresses anger and frustration at herself. The trainee Counsellor C13 is at this organise offering the client UPR rating 4.0 and a deep level of empathy rating 4.5 5.0 and acknowledges the clients anger by reflecting and challenging the clients feelings about being trapped C15 and angry. The client CL14 agrees with the reflection and at CL16 questions herself about what it is that she is actua lly angry and frustrated about. The trainee Counsellor remembers key details about the client which were disclosed in the first session and following the clients comments at CL16 makes some gentle and refined queries C19, C23, C25. These gainsays are accepted by the client, positively and with real emotion. The strength of the response identifies the level of relational reasonableness that the trainee Counsellor and client have formed. At this point C25, C27, C29 the Counsellors empathy rating 5.0, congruence rating 5.0 and UPR rating 5.0 are clearly apparent to the client and such a deep level of interdependency is present that previously unrecognised feelings which were just outside of the clients consciousness become visible and the client achieves a moment of comprehension and awareness CL30. Rogers (2004) describes this asthe permit of material come into awareness, without any attempt to own it as part of the self, or to relate it to other material held in consciousness.(R ogers, 2004, p.78)There is a visible sky in the client at this point and the trainee Counsellor, because of the level of his empathy rating 4.5 is aware of the internal confusion and struggle that the client is undergoing. C29, C31At C33 by expressing his confusion to the client, the trainee Counsellor displayed a deep level of congruence rating 5.0 and this openness and genuine attitude assisted the client who crusaded on to explore her own feelings and reactions to what she had said at CL30, CL32. The trainee Counsellor C35, C37, C39 reflects some of the clients thoughts back to her. During this period of interaction, the trainee Counsellor takes the opportunity to make some gentle challenges which cause the client to question her thought process. At CL50 the client questions the trainee Counsellor, and it appears as if she is looking for some kind of affirmation that what she is saying makes sense. The trainee Counsellor C51 makes it clear to the client that what she has said makes perfect sense to him, and this could easily be construed as some form of collusion, however in this case it is more of a corroboration to demonstrate the trainee Counsellors empathic understanding rating 4.5 5.0 and as a form of rise to the client to continue. The interactions at CL50, C51 clearly display the trainee Counsellor and the client sharing the selfsame(prenominal) frame of reference, being in the same place at the same time. Worsley (2002) suggests thatThe greater the spontaneous-type content of the frame of reference, the more proper it is to call any therapist response process-orientated, because the therapist will be engaging empathically with the whole organism who is the client, and not just the reflexive, conscious elements.(Worsley, 2002, p.40)The trainee Counsellor, at interactions C53, C81, C92 makes use of challenges which could be construed as directive questions, however, with the use of IPR and a deeper analysis of the recorded session, it is apparen t that the trainee Counsellor was not directing the client, but was using thought-provoking words to stimulate the clients process. The trainee Counsellor used his UPR rating 5.0 and empathy rating 4.5 5.0 to identify with the clients goals whilst at the same time valuing and respecting the client at the deepest level and at the same time being his own person, being congruent rating 4.0 5.0 and honest with his own feelings so that the client is aware that she is valued and prized and that the trainee Counsellor is not hiding anything of himself from her.At interactions C81, C98 the trainee Counsellor takes the opportunity to query the clients incongruence and the clients responses CL82, CL83, CL85, CL99 clearly suggest that she was not being truly honest with herself. Rogers hypothesises that if the clientbecomes more self-aware, more self-acceptant, less(prenominal) defensive and more open, he finds that he is at last free to change and grow in the directions natural to the human organism.(Rogers, 2004, p.64)There is a point in the counselling session CL109 where the trainee Counsellor senses a shift and a visible change in the client. The client starts to question her own behaviour and self, and in doing so realises how important some of the issues discussed in the session are to her. Rogers (1980) suggests thatTo perceive a new aspect of oneself is the first step toward changing the concept of oneself. The new element is, in an understanding atmosphere, owned and assimilated into a now altered self-concept.(Rogers, 1980, p.155)The trainee Counsellor, through several interactions C112 to C134 briefly sums up the session so far, recapping the salient points of the session. This is done collaboratively with the client, continually checking that the client is in agreement with what the trainee Counsellor is reviewing. By working in this manner, the trainee Counsellor is adhering to the ethical principles recommended by the BACP and is ensuring that he is work ing in an anti-oppressive way. Within this review of the counselling session, the trainee Counsellor considered different parts of the clients self. Mearns Thorne (2007) refer to these different parts as configurations of self and suggest thata configuration is a real self-within-a-self that can fill a wide array of elements a set of thoughts, feelings and behaviours that together represent an important dimension of the persons existence.(Mearns Thorne, 2007, p.34)An analysis of the clients various dimensions gave the trainee Counsellor the opportunity C124, C126, C134, C136 to sensitively challenge those different parts which in turn triggered a reflective process in the client. The relational depth between the trainee Counsellor and client at this point was extremely good with both client and trainee Counsellor aware of their own feelings and expressing the genuine and authentic person to each other. Nothing was hidden and there was a real connectedness between both people in the counselling session. If both the trainee Counsellor and the client can be genuine in the relationship, the more helpful it will be. (Rogers, 2004, p.33)The trainee Counsellor is a student member of the British Association for Counselling Psychotherapy (BACP), and as such is fully aware of the richness of adhering to the elements within the BACPs Ethical Framework for Good Practice in Counselling Psychotherapy (BACP, 2007) which discuss the provision of maintaining a good standard of practice and wangle (BACP, 2007, p.5). The trainee Counsellor fully believes thatRegularly monitoring and reviewing ones work is essential to maintaining good practice. It is important to be open to, and conscientious in considering, feedback from colleagues, appraisals and assessments.(BACP, 2007, p.5)IPR of the session reinforced the trainee Counsellors authentic observations and feelings about the client as the session drew to a close. It was apparent that from interactions CL150 CL156 that the client was in a deep state of process. The trainee Counsellors level of empathy rating 5.0 and the relationship which had developed between client and trainee Counsellor was such that at interaction C157 the trainee Counsellor made the decision to end the counselling session a couple of proceedings early. This was checked with the client to ensure that she was happy to do this, and the expression on her face confirmed that the trainee Counsellors choice was the correct one. The client had, at this point, moved on and was clearly trying to figure out what was going on in her head. Rogers (2004) outlines a clients process by suggesting thatClients seem to move toward more openly being a process, a fluidity, a changing. They are not disturbed to find that they are not the same from day to day, that they do not always encumber the same feelings toward a given experience or person, that they are not always consistent.(Rogers, 2004, p.171)The clients progress in this session was, f or the trainee Counsellor, quite a revelation. The trainee Counsellor by focusing, using a felt sense (Mearns Thorne, 2007, p.79) C29 touches on the clients unknown feelings and attends with deep empathy rating 4.5 5.0 congruence rating 4.5 and UPR rating 4.5 5.0 to the client. It was the trainee Counsellors first real experience of witnessing a clients self-realisation CL30 to something that was at the edge of their awareness but which they had previously ignored or dismissed. A change came over the client CL30 and their honesty and openness became much more expressive. At this moment the relationship between the trainee Counsellor and client became much closer.Feedback from this session was received from a third party observer, who took notes to assist the trainee Counsellor in their evaluation of this session. The comments suggested that the trainee Counsellors congruence, empathy and use of UPR were obvious and perceived by the observer to be at a deep level. The observer sug gested that on occasion, in her opinion, the client / trainee Counsellor relationship seemed approximately friendly. From a learning and professional perspective and having reviewed the recording several times, the trainee Counsellor can see how some of the session might have been go through from an empirical point of view, but within the counselling relationship the two participants were experiencing each other and absorbed deeply in the counselling relationship. This is characterised by their ability to partake in a moment of levity CL36, C37, followed by the client moving flawlessly back into her train of thought and process.From the trainee Counsellors perspective, several key points were noticed. Firstly, there were a couple of areas C19, C39 where the session could have gone in different directions. As a trainee, the choice of language, the correct use of handle-words and the on-the-spot decision making is difficult to practice as every client is unique and individual, and every client will bring a different range of issues to the session. Secondly, the trainee Counsellor considered their use of questions in the session. There is no doubt that there will be some criticism of the way in which the trainee Counsellor phrased some interactions to the client, but there is a firm belief that none of the questions were deliberately directive and the session flowed well, with the relationship between client and trainee Counsellor relaxed, natural and open. Finally, the trainee Counsellor was real and authentic and it is clear that the client experienced this realness in the relationship.A major learning experience taken from this session is that of experience. There were three significant moments in the session, the first at interaction CL30 where the client achieved self-realisation about the way she had been behaving, the second was at interactions C61, CL62 where the client acknowledges her participation in what she refers to as a game in which she choose s whether or not to play, and the third is at interaction CL91 where the client starts to question the relationship she has with her husband with regards to her issue of control. As a learning outcome, these moments were invaluable as they provided the trainee Counsellor with experiences not previously encountered.The trainee Counsellor, in evaluating this counselling session, has already discussed and evaluated three of the conditions from the six necessary for therapeutic change the trainee counsellors empathic understanding of the clients world congruence on the part of the trainee Counsellor and the trainee Counsellors UPR towards the client. The remaining three conditions, although not mentioned specifically have also been present during this session. The first, that two people are in psychological contact, is demonstrated throughout the session by the dialogue that the client and trainee Counsellor maintained, thus forming a meaningful relationship. The second condition is tha t the client is in an anxious or undefended state, in other words is in a state of incongruence and this condition is openly displayed by the client throughout the session and no more so that at interaction CL8 where the client admits to being stuck and confused. The third and final of the remaining six conditions isThe communication to the client of the counsellors empathic understanding and unconditional positive regard is to a minimal degree achieved.(Merry, 2006, p.49)The trainee Counsellor, in evaluating this session, has visibly exhibited his UPR rating 4.5 5.0 and empathic understanding rating 4.5 of the clients inner world C61, C86 and in doing so helped to facilitate a safe and shaping environment for the client.This was a significant session for the client as the trainee Counsellor believes there has been a major movement along the seven stages of process and that the client at times during the session made the transition into stage 5. There was obviously some vacillati on between stage four and five and the trainee Counsellor, although identifying the shift in the client CL30, CL109 made no attempt to move them onto stage five, but rather left the client to find their own path, knowing that she would move forward when it was right for her to do so.The trainee Counsellor was himself, the client was herself. There were no facades, no hidden agendas, just two people experiencing a deep understanding of each other. Rogers (2004), when talking about this kind of relationship, positsacceptance of each fluctuating aspect of this other person makes it for him a relationship of warmth and safety, and the safety of being liked and prized as a person seems a highly important element in a helping relationship.(Rogers, 2004, p.34)The relational depth achieved by the client and trainee Counsellor is clearly evident throughout many parts of the session. A particularly powerful moment is at interaction CL109 where the client questions her own set and the clients body language and the timbre of her voice expose her feelings. Mearns Thorne (2007) suggest thatAt times such as these, understanding between client and counsellor exists at many levels, as does acceptance. The outcome is a profound sense of sharing.(Mearns Thorne, 2007, p.191)

Compliance Between The Patient And Medication

Compliance Between The Patient And MedicationIntroductionMedication respectfulness is a significant issue in the business organization of people with genial health conditions, particularly if the intellectual health condition is of an enduring and severe nature. The reason for this is that at that place is an augmentd likelihood of symptoms returning without the various(prenominal) maintaining chemical bond to a prescribed music regime. Conditions such(prenominal) as schizophrenia, psychosis and bi polar disorder fall under the remit of severe and enduring psychic illness and it is report that medication non compliance is likely to have severe implications to an man-to-manists psychological health and tumefy existence (Le Page, 2010).Leahy (2006) estimates that up to 70% of recurrent depression perseverings and almost one half of schizophrenia patients are noncompliant with their prescribed medication and there is also a direct congeneric between medication noncompli ance and an increased take on for hospitalisation. This in turn has a whole range of implications in terms of the electrical shock this has on employment, relationships, income, and parental responsibility and of course the uphold on resources go awayd by health providers such as the NHS should also be ack instantaneouslyledged.This assignment will examine and reflect on the case of a 40 year old gentleman with a diagnosis of schizophrenia. The gentleman, who shall be referred to as Mr metal resolveer for the purpose of this assignment (names have been changed to ensure client confidentiality as per NMC guidelines) has been receiving neuroleptic agent reposition medication (Flupenthixol) to treat the symptoms of a schizophrenic condition, stock-still Mr smith has stated that he no longer was willing to give the administration of the depot dead reckoning because he felt better.The assignment will start by briefly exploring the concept of compliance and the consequences of Mr metalworker declining to take the prescribed medication and the potence impact this will have on his mental health. The second part of this assignment will reflect on how the practician responsible for the take of Mr Smith addressed the issue of facilitating the ongoing adhesiveness to prescribed medication by focusing on theoretical frameworks that supported and encouraged Mr Smith to review his termination and continue to accept his depot injection. Consideration will also be made to legal and ethical frameworks that should be adopted in clinical dress when addressing the issue of medication compliance.Defining Compliance in intellectual Health CareThe term compliance is delineate by the Cambridge dictionary (2010) as existence a process where people obey an order, rule or request and that exclusives become willing to do what others want, particularly if the other person is a judge of authority. A core definition of compliance provided by Harvey (2004-09) suggests that compliance is the undertaking of activities or establishing practices or policies in accordance with the requirements or expectations of an external authority.Compliance has been defined as the extent to which a persons doings coincides with medical or health advice (Haynes, 1974) and although this is an outdated definition the term compliance persists in mental health divvy up today. In contemporary mental health care there are suggestions that the term compliance has negative con nonations and it infers that an individual who does not comply is not doing as they are told by the mental health captain (Gray, 2002). Language and communication is an important tool in mental health and it is important to place the individual with mental health problems first by using terminology that is widely acceptable to both service providers and service users (Manzi, 2008).Repper Perkins (1998) support this come in of view and sharpen that the use of words like compliance infers that patien ts are passive recipients of health care who should obey instructions from professionals. As modern mental health care is concerned with developing therapeutic unions to improve outcomes (Hakan and Jan-Ake, 2010) consequently it has been proposed that the term concordance (Gray, 2002) or the phrase medication adherence (Velligan et al., 2009) should replace the use of the word compliance in an attempt to remove the unequal and passive tone the word compliance has.For the purpose of this assignment the word compliance will be substituted by the term adherence as this implies a more collaborative approach between service providers and service users to approach the issue of medication and treatment.Consequences of Medication Non love in SchizophreniaSchizophrenia is a complex condition and diagnosis is made on the testify of an individuals reported experiences (symptoms) and observable behaviours (signs) which commonly whitethorn embroil delusional thinking hallucinations, thought interference ideas of reference, thought disorder social withdrawal anxiety and depression (Keen, 2003). Psychiatric treatment for individuals almost always involves do drugs therapy to stabilise psychotic symptoms and to reduce the individuals luck of relapse (Barker, 2003).thither are many an(prenominal) different pharmacological preparations available for the treatment of symptoms experienced by an individual diagnosed with schizophrenia and they may include preparations that are taken orally or delivered by intramuscular depot injection. Our Client Mr Smith had been having a depot injection called Flupenthixol to treat the symptoms he experienced following his diagnosis of schizophrenia as a matter it is reported that he had felt better and therefore did not want to have the depot any more.Mr Smith had made a decisiveness not to accept his depot medication any longer however it is well documented in the research and evidence base that this course of action and termination wil l have a significant impact on his health and global well being. Novick et al. (2010) indicates that non adherence with anti psychotic medications, such as Flupenthixol for patients with schizophrenia and psychosis, is significantly associated with an increased risk of relapse, hospitalization and suicide attempts. There is a significant body of evidence that highlights that the symptoms of schizophrenia return without pharmacological treatment and medication adherence and that there are potentially devastating consequences to the individual with a serious mental illness such as schizophrenia if this behaviour of non adherence is adopted (Velligan et al., 2010).Therapeutic Interventions to Promote AdherenceAs a mental health practitioner it would not be uncommon at some point to experience a clinical interaction with a patient who has made a decision not to continue with their prescribed medication, however the practitioner has the responsibility to understand the reasons behind the patients decision making process and to provide the patient with the biggest opportunity to make an informed and educated decision about declining treatment for a chronic and enduring mental health condition such as schizophrenia.It is important for the mental health practitioner to obtain an perceptiveness of the reasons behind Mr Smiths decision to discontinue his depot medication and to do this the modality of cognitive behavioural therapy can be implemented. Cognitive Behavioural Therapy (CBT) is a form of psychological therapy and aims to help understand the link between thoughts, emotions and behaviour. It teaches individuals skills to overcome problematic thoughts, emotions and behaviour and to find ways of overcoming negative thinking and challenging unhelpful and inaccurate thoughts or beliefs (Royal College of Psychiatrists, 2008). The most favourable outcome from CBT is for the individual to develop skills and techniques that enables them to approach situations in a mor e reasoned and balanced manner which supports problem solving and increases the facial expressionings of being in more control (Royal College of Psychiatrists, 2008).An important consideration in relation to implementing CBT and for that matter other therapeutic interventions is that there needs to be an established therapeutic relationship between the client and the mental health practitioner to increase the opportunity for mastery and for both parties to engage in working towards a common goal for simulation for Mr Smith and the mental health practitioner to work towards exploring the issues surrounding medication adherence. NICE (2010) recommends that managing the process of engagement requires professionals to have sensitivity to the perspective of the individual and to understand that the condition can have a large(p) effect on the persons judgment, their capacity to understand their situation and their capacity to consent to specific interventions. The process of engaging successfully with individuals with schizophrenia may at time require considerable persistence and flexibility from professionals and the establishment of trust is crucial. Both parties may have differing views on what the main problem is and how it should be addressed, however the professional can help with finding common ground and this common ground can establish trust and collaboration (NICE, 2010).To address the issue regarding Mr Smiths decision to no longer adhere to his treatment plan and accept his depot medication for the symptoms of schizophrenia the mental health professional will need to enter into conversations to impinge on fellow feeling of the patients perspective. One way of achieving this is for the mental health practitioner to adopt motivational interviewing so that the two parties can explore the decision (stopping of the depot injection) and claim behaviour change (acceptance of the depot) through the individual (Mr Smith) being able to identify, understan d and articulate the benefits (remaining mentally well and symptom free) and costs involved (physical, emotional, family, employment for example will all be impacted upon greatly if symptoms return).Rollnick et al. (2010) indicate that simply giving patients advice to change decisions or behaviour is often unrewarding and ineffective and by adopting motivational interviewing a guiding style helps to engage with patients, helps clarify strengths and aspirations, evoke their own motivations for change and promote autonomy of decision making. The four central principles of motivational interviewing are described by Treasure (2004) as being the use of reflective listening in an empathetic manner to convey understanding of the patients point of view tease out ways the behaviour or choice conflicts with the wish to be good or viewed as good respond with empathy and understanding rather that confrontation and finally support the patient in confidence building to understand change is possib le.For Mr Smith and his decision to settle any tho depot injections of Flupenthixol it may be very easy for the mental health practitioner and Mr Smith to become embroiled in conflict as the practitioner has the evidence base and clinical knowledge to know that a relapse is somewhat inevitable and the impact on Mr Smiths global wellbeing and function would be significant however Mr Smith believes that he is now well and therefore no longer needs treatment. By using motivational interviewing techniques the mental health practitioner can actively listen to Mr Smiths reasoning behind the decision he has made in relation to medication adherence support Mr Smith to see the pros and cons of his decision assess his confidence and elicit a view on his feelings fears and aspirations exchange information support with decision making and goal setting.To take a crap an example of how motivational interviewing may be implemented the practitioner may ask questions such asI want to try and unde rstand Mr Smith about your decision not to have your depot anymore can you give me your perspective on why you want to stop taking it?So Mr Smith if you were to stop taking your depot, where do you think that would leave you in terms of remaining well?How important is taking this medication for you right now?Would you mind if I shared with you some information and evidence I have about how the depot injection helps people with schizophrenia remain well and symptom free?AndOkay, can I check with you your understanding of the risks of not accepting the depot anymore?This approach to supporting adherence to medication is reported to be beneficial and it is suggested that the body of evidence continues to grow in support of its effectiveness (Rollnick et al., 2010) and with the many applications in psychiatry it is particularly helpful for use in settings where there is resistance to change (Treasure, 2004). However there are some considerations that need to be identified that may impac t on the efficacy of motivational interviewing as a technique to support medication adherence. Firstly one issue to consider is that motivational interviewing is a skill that mental health practitioners need to develop and practice and although the principles are described as easy (Treasure, 2004) putting these principles into practice may not be that simple.There potentially could be many different variables as to why adopting motivational interviewing may not be effective in supporting medication adherence. Barriers that may impact on the success of motivational interviewing in supporting Mr Smith to maintain his medication adherence may include there not being a therapeutic alliance established between the mental health practitioner and Mr Smith. The reasons for this can be numerous, for example Mr Smith may only recently have been discharged from hospital and the mental health practitioner is his new community psychiatric nurse that he has only met a couple of times Mr Smith may favor male workers to female workers and vice versa or even Mr Smith may not feel comfortable having mental health practitioners come to his home and feel unable to engage or discuss issues of importance. Another reason that may impact on the efficacy of the motivational interviewing process to support Mr Smiths adherence to medication is that the mental health practitioner may be constrained by time and resources and therefore not able to deliver the therapeutic process accurately or in a timely.Another issue to consider is that Mr Smiths adherence to medication and decision not to continue to accept the depot may actually be based on the schizophrenic condition relapsing and the decision to withdraw from treatment is being made due to reduced insight and understanding. It is suggested that there are potentially a large range of risk factors that can be present and that are related to the patients individual behaviour and understanding of the impact of schizophrenia and psychosi s. These variables are classified as patient related and include poor insight, negative attitude towards medication, symptom severity, history of previous non adherence, substance wrong and cognitive impairment. Other variables may also include treatment, environmental and societal issues such as side effects and complexity of medication regimes family support, side effects, financial problems and lack of access to treatment (Citrome, 2010).Legal and Ethical ConsiderationsIt is important for mental health practitioners to understand that there are occasions where more assertive and restricting approaches such as treatment orders or inpatient hospital care are the only way for adherence to medication to be sustained (Chaplin, 2007). The Mental Capacity Act (2005) provides a framework for the making of decisions for people who lack capacity in England and Wales. Under the Capacity Act healthcare professionals are cognizant that they must work on the presumption that every adult pa tient has the capacity to make decisions about their care, and to decide whether to agree to, or refuse, an examination, and investigation or in this instance treatment. A patient is regarded as lacking capacity once it is clear that, having been given all appropriate help and support, they cannot understand, retain, use or weigh-up the information needed to make that decision, or communicate their wishes.Therefore in this instance Mr Smith must be presumed to have capacity to make the decision not to adhere to the treatment plan unless there is evidence that he is no longer able to provide reasoned information to support his decision due to the presence of severe mental illness. It would be at this juncture that the mental health practitioner would look to ensuring Mr Smiths best interests are explored and this may result in an assessment under the Mental Health Act (1983), however until this time the mental health practitioner may continue to use the therapeutic alliance and CBT a nd motivational interviewing techniques to support the adherence process.The success of a therapeutic alliance is often based on trust and to establish trust the mental health practitioner must respect the patients ethical right to autonomy. Autonomy for Mr Smith would be the right to decide and determine whether or not to accept or decline his depot injection even if the refusal meant that his mental health would deteriorate and the consequences to his global wellbeing become severely impaired. It would be unethical for the mental health practitioner to coerce, threaten or manipulate Mr Smith into having the depot injection particularly if he has the mental capacity to make the decision to decline further treatment. For the mental health practitioner to behave in this manner would not only be a breach of professional and ethical conduct it would also potentially jeopardize any therapeutic alliance that had been developed.Addressing RiskMr Smiths decision to become non adherent to p rescribed medication presents a requirement for detailed risk planning and assessment to ensure the well being of Mr Smith, his family and friends and those providing care to him is sustained. Mental health practitioners have a duty of care to assess risk using a formulated tool that has been adopted by their employer and mental health service. The calculation of risk must be based on the practitioners knowledge, skills and competency and value should be placed on the process of risk taking, following assessment and in the context of appropriate management, as it will increase the practitioners efficiency to help clients to achieve their potential. However, there should be awareness that there may be conflicts between professional accountability and the autonomy of the client (UKCC, 1998).Risk issues that may be identified for Mr Smith are individual and related to the course and nature of his experience of Schizophrenia, this is why it is important for the practitioner to have es tablished a therapeutic alliance with him so that discussions can be held about risk issues and care planning can be done collaboratively to reduce the risk impact. goalMedication adherence in schizophrenia is a complex issue with the consequences of non adherence impacting significantly on the global function and mental well being of individuals who make the decision to not adhere to their medication treatment plan. Through the process of collaboration and the development of therapeutic alliances between mental health professionals and patients it is suggested that adherence can be improved and sustained and that interventions such as CBT and motivational interviewing makes psychoeducation a cornerstone of many adherence interventions (Zygmunt et al., 2002).Mental health practitioners should have an understanding that medication adherence is less likely to occur in patients with severe mental illness who are not engaged with mental health function and who are not exposed to a good therapeutic relationship. One of the most common themes that have been identified throughout this assignment and in the evidence base is that the therapeutic alliance between a patient and mental health professional should never be underestimated particularly when it comes to supporting medication adherence in the treatment of schizophrenia.

Patient Safety in a Hospital Research

Patient Safety in a Hospital ResearchAttitudes toward ensuant reporting. Attitudes and perceived barriers to misfortune reporting among tertiary take aim wellness professionals were researched by Malik, Alam, Mir, Abbas (2010) to address the limited incident reporting framework in Pakistan. A ergodic sample of 217 doctors and nurses in Shifa International Hospitals were given a modified version of the AHRQs questionnaire to determine various factors that influence health professionals reporting behaviors, with an important concenter of the orbit on barriers to incident reporting. Results of the study plant that only 20% of house officers are unstrained to report, and greater than 95% of consultants, registrars, medical officers, and nurses are willing to report incidents related to them. Administration sanction was identified as a common barrier among doctors (69%) and nurses (67%). Additionally, reporting to the head of the department was preferred by doctors (60%) and nur ses (80%). establish on the studys findings, the researchers suggest that implementation of future incident reporting systems should consider supportive work environments, prompt feedback, and immunity from administration (Malik, Alam, Mir, Abbas, 2010).intensive Care Unit Registered Nurses perceptions of patient safety climate and potential predictors for patient safety perception and incident reporting were explored in a cross-sectional study by Ballangrud, Hedelin, Hall-Lord (2012). In ten ICUs in six hospitals in Norway, 220 nurses (72%) responded to the questionnaire, The Hospital Survey on Patient Safety Culture. The questionnaire heedful seven unit level and three hospital level patient safety climate dimensions, along with two outcome items. Of the 12 dimensions, 7 achieved a RN proportion of dogmatic scores (over 55%), and 5 achieved a lower proportion. Among types of units and among hospitals, world-shaking differences in RNs perceptions of patient safety were found. Unit level variables were found to have had significant impact on the outcome dimensions, overall perception of safety and frequency of incident reporting, in which both had a 32% total variance. However, among the outcome variables, differences were found in supreme scores on overall perception of safety (69%) and frequency of incident reporting (18%). In all dimensions, the total average of domineering scores was 55%. This study concluded that patient safety climate was most positive among ICU RNs at the unit level, and areas for improvement include incident reporting, feedback and communication about errors, and organizational learning and continuous improvement (p. 352). This study identifies several terminus ad quems. In contrast to other Norwegian HSPOSC studies, which include various health care professionals, this studys sample only included RNs. Additionally, generalizability is limited since the hospitals in this study were small and within a limited area of Norway. o ther limitation to this study that may have impacted the results was the known implementation of reorganization across units that were to occur after data collection.Perceptions of patient safety culture. In China, healthcare workers attitudes and perceptions of patient safety culture were explored using a modified version of the Hospital Survey on Patient Safety Culture (HSPSC), which measured 10 patient safety culture dimensions. Out of the 1500 questionnaires that were distributed to primarily internal physicians and nurses among 32 hospitals in China, valid responses were received from 1160 health care workers. Statistical synopsis was done using SPSS 17.0 and Microsoft Excel 2007, including descriptive statistics, along with analysis of the surveys validity and reliability. Two separate investigators entered and verified data independently. For each item, results included a positive response rate range of 36% to 89%. On 5 dimensions (Teamwork Within Units, Organization Learni ng-Continuous Improvement, Communication Openness, Non-punitive Response and Teamwork Across Units), the positive response rate was higher when compared to AHRQ data (P In a research study among 42 mainland China hospitals, the HSOPSC questionnaire was used by Chen Li (2010) to get wind the 12 patient safety culture dimensions. A total of 788 physicians, nurses, and non-clinical staff completed the survey. Statistical analysis was done using SPSS 15.0 for Windows and Amos 7 software tools. positivistic perceptions were found toward patient safety culture among Taiwan hospital staff, in which percentage of positive response rates were highest among teamwork within units, and lowest in the staffing dimension. Taiwan and the US differed in the following three dimensions Feedback and communication about error, Communication openness, and Frequency of event reporting. Several strengths and weaknesses were identified in this study. When compared to the original AHRQ database, which inc luded stupendous samples in various health care organizations, this studys data had a lower internal consistency. The use of the HSOPSC questionnaire is both a strength and limitation in this study. Although the HSOPSCs strong psychometric properties and broad safety culture coverage are considered strengths, the use of this questionnaire in Taiwan is also a limitation of this study because of its use in a cultural setting different from where it was developed. However, it is important to note that the application of the HSOPSC in Taiwan was found to be a good fit according to most of the confirmatory factor analysis indices. Based on their findings, Chen Li (2010) point out that, the existence of discrepancies between the US data and the Taiwanese data suggest that cultural uniqueness should be taken into consideration whenever safety culture measurement tools are apply in different cultural settings (p. 1). Not only is future research recommended to expand the survey in Taiwan, but also to consider measurements that will decipher individual and group perceptions and interactions related to patient safety culture.

The Positouch System :: essays research papers

The POSitouch SystemConvention and Group SalesSunday, April 06, 1997 POSitouch The POSitouch system was conceived in1982, by the Ted and Bill Fuller, owners of the Greggs Restaurant chain. Theywere looking at to increase the efficiency of there restaurants through the use ofcomputer technology. During there search they found systems but none meetingthere total claims. That is wherefore the Fullers created the company, (R.D.C)Restaurant Data Concepts. RDC keeps developing better and more efficientequipment to be used in the food serving industry.ADVANTAGESDISADVANTAGES 1.) Timelyinformation, and speeds operations. 1.) People will blend in dependent on technology. Sowhen it fails they will2.) Tighter labor controls. probably notbe trained or prepared to be with out it. 3.)No need to hire or pay a bookkeeper.2.) Takes time to train people to work efficiently onPOSitouch. 4.) Calculates food costs and menu mix.3.) POSitouch is expensive tothe handsome5.) Tighter controls over orde rs taken. businessowner. The smallest system Cuts down on free meals waiters give out. that they haveinstalled cost under $10,000. 6.) Canorder (via modem) and keep track ofinventory.7.) constituent(a) modem allows technical supportvia modem, and on line access to reportsavailable at anytime, even historical reports..8.) Sales trend analysis.9.) Credit Card authorization with picture capture.10.) Easy to customize, to meet the needs ofmany different types of operations.11.) Increased speed means, increased turnover.Overall, I feel that POSitouch is well worth the initial expense. It should belooked at as an investment, saving time, and money in all areas needing tightcontrols. This management tool has been shown to cut labor, and food costs inmany food service establishments, not to mention the speed of the system, whichcould easily increase turnover.

Why Educate? :: Essays Papers

Why Educate?As I ponder what my educational philosophy is, and what I hope it will become, I find it necessary to consider why we educate our children in the first place, and why we finance countless public school systems with local tax dollars and federal funds only to hear over and over that schools are failing, our teachers are inadequate, and our students unprepared for life. The majority of high school graduates can read. They can perform introductory arithmetic. They know some literature, history, and civics. They are more computer literate than ever before, yet the U.S. Department of informations National Commission on Excellence in Education concludes in A Nation at RiskIf an unfriendly power had attempted to impose on America the mediocre educational performance that exists today, we energy well have viewed it as an act of war. As it stands, we have allowed this to happen to ourselves. We have even squandered the gains in achievement made in the stir of the Sputnik challenge. Moreover, we have dismantled essential support systems which helped make those gains possible. We have, in effect, been committing an act of unthinking, unilateral educational disarmament (NCREL 2002). This educational disarmament is really a misery to produce students that are truly competitive in the world marketplace, a failure to make the same technological advances as other industrialized nations. Joel Spring, in The American School (1997), asserts that beginning with the founding of the common school in the nineteenth century, education has been seen as a way of ending poverty, providing equality of opportunity, and an change magnitude national wealth (6). It is the increasing national wealth that students are tested on now, and found lacking. According to Sebastian de Assis, author of Teachers of the World, Unite (2000), it was during the Industrial Revolution that mathematics, sciences, good and vocational education became pivotal to the sustenance of the new economic order in the United States (p. 24). Students have become just another part of the extensive machinery that is America. Either they contribute and make the country, and themselves, richer, or they are failures, who have, in turn, been failed by an educational system that did not teach them how to grow rich or help the nation grow rich.Like de Assis (2000), I find the commoditization of students to be more than a little disturbing.

Pecado de omision por Ana María Matute Essay -- Spanish Essays Pecado

El cuento Pecado de omisin fue escrito por Ana Mara Matute como parte del movimiento de realismo social espaol. Fue incluido en el libro Historias de la Artmila, el cual fue publicado en mil novecientos sesenta y uno.Este cuento tiene dos tipos de tema. Su tema significativo trata de la injusticia de la situacin de Lope y su tratamiento por don Emeterio su tema mottotico trata de las relaciones familiares y el tratamiento de los pobres y de los hurfanos. Los dos son temas implcitos, porque no hay moraleja explcita.La historia tiene lugar en Espaa, antes de o cerca del principio del siglo veinte. Un nio inteligente, quien se llama Lope, haba dejado hurfano y el primo de su padre, que era muy rico y el alcalde de su pueblo, tena que cuidarlo. Este primo, don Emeterio, empleaba al nio de trece aos como minister y le dej lejos del pueblo para criar las ovejas. Pasaban cinco aos, y Lope revolvi a la casa de don Emeterio para ver al mdico. All vio a un viejo compaero de escuela, u n Manuel Enrquez, un muchacho que siempre le iba detrs en sus estu...