Psychosocial Interventions With Psychosis Essay

Psychosocial Interventions With Psychosis - Essay Example A wide array of nervous system stressors can result in a psychotic reaction both at organic as well as functional level. However, the first line treatment for psychosis is generally associated with the administration of antipsychotic drugs and in some cases hospitalization, but there is increasing research evidence that suggests cognitive therapy; family therapy can be effective in the management of psychotic symptoms. This paper critically reviews on psychological intervention with patients affected by serious and prolonged mental disorders and the strengths and weaknesses associated with such types of therapeutic interventions. Psychosis is a mental state defining a group of mental disorders come into one singe head in psychiatry and it is characterized by certain common fundamental factors such as hallucinations or sensation of non-existent objects or phenomenon; delusions or possessing beliefs not based on reality; thought insertion, withdrawal, thought blocking, thought broadcasting lack of insight or being unable to understand the wrongs in the thinking or activity patterns. However, there are number of controversies associated with the psychiatric classification of psychosis, but usually the most common disorders come under the general title of psychoses are as follows: - Schizophrenia - Schizoaffective disorder - Maniac Depression (Bipolar Disorder) - Mania - Delusion (Paranoid) Disorder - Psychotic Depression Although these disorders differ in their symptoms but they consist of a common parameter that the individual suffering from any of the disease does not experience reality as most of the other people in general. Sample Case Study The patient is a female of 18 years doing graduation in a co-education college. She was brought to the clinic by her mother and sister for lack of sleep, verbal and physical aggressiveness, suspicion that the male faculty members in her college are writing love letters to her and making obscene gestures during the lecture and the fear of becoming a male. She had the habit of peeping into the bathroom when her mother takes bath. Sometimes she blamed her mother of appearing nude before her. Her elder sister and elder brother had innocuous relationship. She did not have any intimate relationship with the member of the same sex. The family disapproved of her friendship with boys of questionable character. Therapeutic Strategies Suggested The patient mentioned in the case study is suffering from paranoid schizophrenia. In the initial phase of the treatment, she was suggested to undergo neuroleptic pharmacotherapy especially antipsychotic drugs. The medication has been found to be effectual in treating the 'positive symptoms' of the disease, the treatment of 'negative symptoms' has not very yet found to be very successful. Later on she was suggested to undergo psychotherapeutic interventions like reality-oriented individual therapy so that she could be able to cope up with stressful thoughts and events encountered which eventually reduce the risk for relapse, cognitive-behavioural approach helps in monitoring and changing the negative patterns of thoughts and behaviours in ways to make her able to regulate irrational thoughts

Outpatients’ Perspective of Clinical Communication Skills

Outpatients’ Perspective of Clinical Communication Skills Research Paper Title: Outpatients’ Perspective of Clinical Communication Skills of Doctors in Private Practice in Goa Abstract Clinical communication entails a dialogue between doctor and patient, and has been clearly demonstrated to affect many aspects of patient care, including health outcomes. Ideally, doctors are expected to play a dual role – as a source of patient healing as well as a source of reassurance and encouragement (Baker et al, 2011). This study was aimed at assessing the basic clinical communication behaviours of doctors in outpatient private practice in Goa, based on the reports of their patients. Good clinical communication skills include facilitation of the patient’s expression of feelings and expectations related to his/her health care, conveyance of clear information to the patient, and provision of empathy and encouragement. The participants of the study were chosen using purposive sampling. Internationally standardized questionnaires HPQ (Four Habits Patient Questionnaire), consisting of 15 Likert-scale items, and CAHPS (Consumer Assessment of Healthcare Providers and S ystems) was employed to understand the patients’ perception of ‘their’ doctor’s communication. Results were analyzed using total scores obtained. Individual behaviours were also analyzed using frequencies and percentages indicating doctors’ competence in one or more habits over others. Introduction The health outcome of a patient is greatly affected by the manner in which doctors communicate with their patients (Baker et al, 2011). The key to diagnosis and treatment is exchanging information, and communication plays a vital role in building a trusting relationship between doctor and patient that encourages better information-giving and information-getting, both of which are particularly important to enable positive healthcare. Furthermore, communication and trust may influence patient satisfaction, compliance, and coping (Desjarlais-deKlerk and Wallace, 2013). Recognizing the onus on the doctor to ensure satisfied and healthy patients by way of the former’s ability to communicate with the latter, this study attempted to determine the communication abilities of doctors in Goa as reported by their outpatients. Objectives To determine the medical communication skills of outpatient doctors To ascertain the relationship between doctors’ gender and communication abilities To establish a connection between the proficiency in communication of doctors’ support staff and ratings of doctors Method Sample and Sampling Method The study included 90 respondents (67 females and 23 males) chosen by purposive sampling from across the state of Goa. The respondents ranged in age from 20 to 70 years, with an almost equal number being below (n=47) and above (n=43) 40 years. Sixty percent of the respondents possessed a graduate or higher degree and nearly half (49%) the respondents answered the questionnaire based on their personal experiences with a General Practitioner. The perceived age of the doctors, as reported by the respondents, ranged from 26 to 70 years, with 63.3% being reported to be in the age range of 40 to 60 years. Measurement Internationally standardized questionnaires (4 HPQ – Four Habits Patient Questionnaire) (Bard, 2011), consisting of 15 Likert-scale items, and CAHPS (Consumer Assessment of Healthcare Providers and Systems, 2012) were employed to understand the patients’ perception of ‘their’ doctor’s communication. Results and Discussion Communication abilities of doctors’ support staff Effective communication between doctor and patient is a central clinical function that cannot be delegated (Simpson et al, 1991). The competency of support staff such as nurses and receptionists often influences the quality of health care (Marcinowiczi, 2010) as they are the first point of contact between doctor and patient. Their behaviour can, therefore, influence a patients’ rating of his doctor. Using CAHPS, it was observed that only 40% of the respondents were â€Å"definitely happy† with the help received by their doctors’ receptionist (see Fig.1), although more than half (51%) were â€Å"definitely happy† with the courtesy and respect accorded to them (see Fig.1). Figure 1. Receptionists’ Behaviour with Patients Analyzing a total score of receptionists’ behaviour, only 45.5% of the respondents reported â€Å"definite happiness† with the former’s conduct, thus suggesting that support staff ought to improve their communication skills so as to meet patients’ expectations of the healthcare system. Getting care quickly The availability of immediate healthcare is an important determinant of quality in the primary care setting. Availability refers to the ease with which a person may receive care (Marcinowiczi, 2010), and can include factors such as speed of providing an appointment, time spent by the patient in the waiting room (>15 minutes past appointment time), and doctor’s willingness to provide telephonic answers. An analysis of these factors, using CAHPS, revealed that a majority of respondents were quite happy with the rapidity of obtaining an appointment (44%) and obtaining answers to their telephonic queries (46%) (see Fig. 2). However, a moderate percentage (33%) reported having to wait for more than 15 minutes past their appointment time (see Fig. 2). A long waiting time, which can be interpreted as a mode of non-verbal communication, can be quite irksome, and underlines the need for doctors to improve their time management skills. Figure 2. Clinic Experiences of Patients Respondents’ rating of their doctor A health system can deliver truly patient-centered care only when patient ratings are elicited, integrated, and honoured. A 10-point scale (from CAHPS) used to measure the respondents’ rating of their doctor revealed that a majority (52.2%) rated their doctor as â€Å"Average† (see Fig. 3). This indicates outpatients’ perception that there exists scope for improvement in their doctors’ ability to provide quality healthcare. Figure 3. Respondents’ rating of their doctor Correlation between various parameters and rating of doctor Assuming that the longer the period of doctor-patient acquaintance, the better the rating obtained by the doctor, a correlation between the two was done but yielded no significant result (r = 0.15, p Analysis revealed that a majority of the respondents (78.9%) visited a male doctor, and literature suggests that females score over males in communication skills. A correlation was thus attempted between the gender of the doctors and the respondents rating of them. However, no significant correlation was obtained between the two variables in this study (r = 0.11, p Research suggests that education of respondents also affects ratings, with more educated individuals giving lower ratings to doctors (Instructions for Analyzing Data from CAHPS ® Surveys; 2012). However, the converse was noted in this study as a significant positive correlation was obtained (r = 0.244, p=0.05), indicating that the higher the educational qualifications of the respondents, the more accepting they were of their doctor’s communication abilities. It is a known paradox in medical literature that ‘patients can be satisfied with care that is not high quality and can be dissatisfied with high-quality care’ (Makoul, 2001). Willingness to recommend doctor Seventy six percent of the respondents expressed their willingness to refer their doctor to others (see Fig. 4). This suggests that despite scoring their doctors â€Å"average† in parameters such as clinic experiences and rating, the respondents had satisfactory overall experiences with their doctor. Figure 4. Respondents’ willingness to recommend their doctor to others Analysis of 4 HPQ In 1996, Frankel and Stein structured the principles of good, clinical communication into a teaching model for didactic purposes: â€Å"The Four Habits model – an approach to effective clinical communication†. The habits are: invest in the beginning of the encounter to create rapport and set an agenda (Habit I), elicit the patient’s perspective (Habit II), demonstrate empathy to provide opportunity for patients to express emotional concerns (Habit III), and invest in the end to provide information and closure (Habit IV) (Bard, 2011). The 4 HPQ, consisting of 15 questions divided into sets of 4, was formulated based on these well-researched habits. Analysis revealed that the respondents rated their doctors well in Habits I, II, and III (see Table 1). However, the doctors were scored low on Habit IV, thus suggesting that they require to further hone their skills in summarizing the consultation by checking the patients understanding and negotiating a treatment or follow-up plan (see Table 1). Table 1. Scores obtained on each HABIT Minimum Maximum Mean + SD HABIT I 8 16 14.34 + 1.76 HABIT II 3 8 6.52 + 1.27 HABIT III 3 12 9.82 + 2.18 HABIT IV 12 24 19.99 + 3.52 Conclusion Good medical communication includes building a relationship, exploring the patient’s perspective, displaying empathy, checking for understanding, reaching agreements on problems and plans, and providing closure (Makoul, 1991). Increasing public dissatisfaction with the medical profession is, in good part, related to deficiencies in clinical communication (Simpson, 1991). This study found that outpatients rated their doctors satisfactorily despite indicating certain communication habits that required improvement. Respondents also indicated that communication skills of receptionists in doctors’ clinics could be improved so as to provide a better healthcare environment. Shifting focus from patient satisfaction to patient experiences will enable doctors to be better communicators, thereby helping to bring about a radical shift in total healthcare experiences. References Bard J. Hospital Doctors Communication Skills: A randomized controlled trial investigating the effect of a short course and the usefulness of a patient questionnaire. British Medical Journal. 2011. Desjarlais-deKlerk K and Wallace J. Instrumental and socio-emotional communications in doctor-patient interactions in urban and rural clinics. BMC Health Services Research 2013, 13:261 http://www.biomedcentral.com/1472-6963/13/261 Instructions for Analyzing Data from CAHPS ® Surveys: Using the CAHPS Analysis Program Version 4.1 Document No. 2015 Updated 4/2/12 Makoul M. 2001 Marcinowicz L, Rybaczuk M, et al. International Journal for Quality in Health Care web site (Internet). Poland: 2010; Volume 22, Number 4: pp. 294–301 (cited 2014 January 15) Simpson M, Buckman R, et al. Doctor-patient communication: the Toronto consensus statement. British Medical Journal. 1991; 303:1385-7. 1

Reunification in Homers Odyssey :: Homer Odyssey Essays

Reunification in Homer's Odyssey In Homer's epic poem, the Odyssey, the main theme is the reunification of the family, as Odysseus struggles to return home and rejoin his wife and son. Throughout the Odyssey, we are shown examples of families: good ones that prosper and bad ones that do not. As Telemakhos struggles to become a man and Odysseus struggles homeward, the concept of healthy family life is stressed. At the end, when all conflicts are resolved and Odysseus is reunited with wife and son, the lesson that a united family can overcome any obstacles is shown and is one that today's families should heed. As the Odyssey begins, we see a family in disarray. Odysseus' whereabouts are unknown. Penelope has spent four years keeping the suitors at bay and spent 20 years crying for Odysseus. And Telemakhos has grown up confused and unsure of himself, without a real father figure. Simultaneously, as a result, we see a kingdom also in disarray. Ithaca has no king, hence no "father" figure. And the sons of the kingdom, hence the suitors, have no guidance and act in an egregious manner. They eat and drink all day, slowly depleting Odysseus' cattle and wine stock. They gamble and constantly harass Penelope and Telemakhos. As Telemakhos, who is ignorant of how real family life should be, travels in search of his father, he learns about family life. In Pylos, he meets Nestor, who asks his son, Peisistratus, to accompany him. This is important because it is the first time Telemakhos has a real friend. In Sparta, he meets King Menelaos and Helen, who are in the midst of the celebration of a double wedding. Here he is shown what a real family should be. Menelaos and Helen have had their troubles. But since they were reunited after the Trojan War, their lives together have been happy and their relationship is loving, honest, and healthy. By the same token, their kingdom thrives, because of this healthy family relationship. Menelaos' brother, Agamemnon, does not have a healthy family relationship. His family is held up to everyone as what a family should not be. It is ironic that the marriages of two brothers, Agamemnon and Menelaos, to two sisters, Helen and Clytemnestra, should be such exact opposite in their outcome. During his absence during the Trojan War, Agamemnon's wife, Clytemnestra, took a lover, Aigisthos. Upon Agamemnon's return, Clytemnestra kills him and his slave-mistress, Cassandra.

Coca-Cola. Quality Management.

1. Introduction. The Coca-Cola Company is the world's largest beverage company, refreshing consumers with more than 500 sparkling and still brands. The global nature of our business requires that the Coca-Cola system has the highest standards and processes to ensure consistent quality — from our concentrate production to our bottling and product delivery. To ensure such consistency and reliability, the Coca-Cola system is governed by the Coca-Cola Operating Requirements (KORE), a new management system which replaced The Coca-Cola Management System (TCCMS) in January 2010.KORE guarantees the highest standards in product safety and quality, occupational safety and health and environmental standards across the entire Coca-Cola system 2. Quality policies Protecting the Environment: We focus on water, packaging and climate. We are committed to conducting our business in ways that provide all personnel with a safe and healthy work environment. (people issues) We provide substantial training for our associates, using the training requirements defined in TCCSMS(The Coca-Cola Safety Management System) as a global baseline. people issues) Focus on needs of our consumers, customers and franchise partners (customer satisfaction) Get out into the market and listen, observe and learn (continual improvement) 3. List of processes a) acquisition b) Purchases of raw materials c) production d) advertising e) distribution f) quality testing Coca Cola CompanyProcedure no: P08 Advertising PURPOSE: This procedure defines the actions to be carried out for the advertising of Coca-Cola SCOPE: This procedure applies to the advertisingSUMMARY OF THE PROCESS StageMethod Search The advertising manager researches open markets to advertise the products to. AssessmentThe advertising manager studies the culture of those markets to assess the best marketing strategy in terms of: age, local customs, economic situation, and best way to reach the target market. ShapingThe advertising manager determines how Coca-Cola will advertise itself to adjust to the language and lifestyle of the people living in the county they are marketing to.DeterminationThe advertising manager determines what sources of media should be used to reach the largest number of the targeted market, whether it be newspapers, billboards, TV ads, commercials, etc. Strategy The adverting manager will design a strategy that will set them apart from their competitors such as Pepsi Information CollectingThe advertising manager will distribute a customer survey to see where the customer shops and how they chose what brand to purchase.CreationThe adverting manager, based on the customer survey, will create a sales strategy that follows the customers’ responses on the survey. TestingThe advertising manager will conduct trails to make sure there are no accidental flaws in the language and the way the message is received in a different culture Prepared by:Approved by: NAME: DEPARTMENT: SIGNED: DATE:NAME: DEPARTMENT: SIGNED: DATE:

Native American Culture Essay

Estrangement is the state of being withdrawn or isolated from the objective world, as through indifference or disaffection. Ill-advisedly, the protagonist from â€Å"The Lone Ranger and Tonto Fistfight in Heaven† is forever bound in this state of mind. His internal conflicts enthrall between fighting for his Native American ethnicity, and, finding his purpose to this world. This link between the two becomes a challenge due to his pessimistic, and protective attitude for his race. The narrator’s volatile actions imply his frustration towards the discrimination against his native Spokane reservation heritage. The protagonists’ Native American upbringing intertwined with White culture challenges his Red and White thinking. The protagonists’ family style upbringing has distilled values that are outlived in his Native American identity. Unfortunately, the protagonist is quite protective of his Native American descent. In fact, his view of people is quite pessimistic towards the Native American race. This rigidness to his ethnicity is foretold in two parts. As humans, we are first born with an identity that is kept close to us, such as Native American, African American, or Grecian. Although we are born with uniqueness; the values we instill to our race are brought about through parent’s effort in raising their children. For Sherman Alexie, he’d developed a cynical character who bares strong connections to his Native American race. The protagonist’s existence and demeanor is uncanny because he’d been destined for a life of prosperity through public schooling and a college education. Found here, â€Å"But I was special, a former college student, a smart kid. I was one of those Indians who was supposed to make it. I was a new kind of warrior. † This quote reveals his sense of insecurity concerning his life thus far and how he has not lived up to his expectations. â€Å"The Lone Ranger and Tonto Fistfight in Heaven† exposes a few scenes where the main character is fighting for ethical freedom outside of Spokane. The protagonist’s discriminative experiences begin at a convenience store in Seattle where he feels like a predator lurking amongst his preys. As stated, â€Å"He looked me over so he could describe me to the police later. † The protagonist was familiar with this wicked look; as he’d lost a close relationship to its devilish hands once before. His loss began like this, â€Å"When one person starts to look at another like a criminal, then the love is over. † As Native American, these adverse impressions occur randomly as seen through the Police incident. In this scene, the protagonist had been pulled over in a wealthy neighborhood by the police officer, â€Å"You’re making people nervous. You don’t fit the profile of the neighborhood. † This was a friendly way of saying; you are not wanted in this area, please leave. These occurrences are upsetting to the narrator as they have affected his view of Whites. As the protagonist becomes disgusted with life, he packs his belongings and heads home to Spokane in Washington State. While home, he realizes that connecting to his family and finding peace is not easy. His weak-minded thinking is foreseen here,† They’d been expecting me back the day I left for Seattle. There’s an old Indian poet who said that Indians can reside in the city, but they can never live there. † In fact, while living in Seattle, his dreams became nightmares of a vivid war scene between the Red’s and Whites. The Indians became slaughtered by the Whites and at one point, â€Å"Three mounted soldiers played polo with a dead Indian woman’s head. † This graphic image stays with him as he found accounts of this madness occurred in the old west and in parts of the world today. The protagonist’s dreams and Native American ethnicity have instilled protective beliefs to his ethnicity and real life demeanor towards others. Although he’s strong-willed concerning his background, insecurity remains present. One instance occurs where he starts a job in Spokane at the local high school exchange program. He answers phone calls and asks himself, â€Å"Sometimes I wonder if the people on the other end of the line know that I’m Indian and if their voices would change if they did know. † His insecurity exponentially evolves to every facet in his life and only exacerbates his pessimistic attitude. The cynical behavior by the protagonist has incurred due to several discriminatory experiences. One being, the protagonist’s cup is full; which allows him to believe this Red vs. White rivalry will never change. Because of his ignorance, he leaves no trust to anyone and is forced to run when he encounters discrimination. One situation that symbolizes the protagonist’s doubtful thoughts is encountered at his hometown basketball court. He comes home to find the new BIA chief’s White kid named Jimmy Seyler who can play ball. â€Å"And he could play. He played Indian ball, fast and loose, better than all the Indians there. † That night, Jimmy whooped on every Indian who played Basketball. I recognize this as a change of tone and direction in the protagonist’s life. At this point in time, he realizes that he must submit to his Red vs. White rivalry in order to move forward in his life. Just as Jimmy will advance and become an NBA star, the gap between the two races, White and Indian will only become larger. Indian’s will control the small reservation plains out West while the White culture advances to become a powerhouse figure in the United States of America. Hereafter this epiphany, the protagonist’s life begins to move forward as he starts a new job and connects with his ex-girlfriend once again. .