Context and process IP Essay Example | Topics and Well Written Essays - 750 words

Context and process IP - Essay Example Beaufort and Longest (2006) note that knowledge of the external environment enables better collection, analysis, and organization of data. This assists in the development of strategies, based on risk assessment and needs analysis carried out by the body developing the policy. Data in this case may be collected from stakeholders by holding ad-hoc meetings or through the media. The data collected will then act as the foundation from which policies are developed. The involvement of the external environment in the policymaking process leads to the development of impartial and just policies. Beaufort and Longest (2006) note that policy making involve many phases of consultation and thus require specific modes of communication. For this reason, the participation of external parties will ensure that policies developed do not favor one party while marginalizing others. Data will be collected in relation to different stakeholders and their interests especially those of the shareholders, creditors, sponsors, society and the organization itself. Once all the views and interests of the stakeholders have been established, the policymakers will then have to assume a position of compromise so that no group is discriminated (Cizek, 1999). The number of laws regulating business activities has grown over the past years. In this regard, the government regulates the private sectors by ensuring that the policies adopted are for the good of the society. In this case, it limits the private sectors from adopting policies that in its view may cause harm to other organizations, individuals, and groups during the course of conducting business. The regulation will lead to adoption of policies that allows for a free market competition. It also reduces instances of adopting policies that may give control to one business over others resulting in monopoly. This will ensure that every business, individuals, and the society at large benefits from the policies adopted (Cizek,

Realism and Idealism Essay Example | Topics and Well Written Essays - 500 words - 1

Realism and Idealism - Essay Example Ideally, art should come from within an individual but this does not happen and instead, art is taught in schools. Courbet asserts that art cannot be taught and that it should come from inside an individual and should be an expression of the artists towards the things that surround him. In the same way, a person from another generation cannot accurately form an art of either the previous or he next generation. It is impossible to do so since an artist can only draw accurately what they experience. From this reading, it is clear that everyone knows their place in the society. The poor are aware that there are places they can only admire from afar but not get into. Even children are conscious of the poverty and the lanes that they should maintain. The children stare with amazement at how beautiful the building is yet the narrator had already exclaimed that it was unfinished. Further, the other guest is uncomfortable at the sight of the poor family and asks the companion to request the manager to send them away. The world has had a class struggle from time immemorial. There are those who own factors of production and those that work for the rich to earn a living. The bourgeoises are the rich in the society who continue accumulating wealth at the expense of the poor. The society has become such a money-minded community that even the prestigious professions such as medicine and engineering are focused on making money rather than helping the people. The proletariats, on the other hand, are the workers who work for the bourgeoises for a living. Once in a while they attempt to join hands so that they can have fair dealings with the bourgeoises. The strength of their unions and their demands is highly dependent on whether they will remain unified in the long run. For the proletariats to have a fair share in the society, they need to keep on fighting for their rights. A doll’s house is about a woman who leaves her husband and children to

A Birthday :: essays research papers

	Christina Rossetti’s poem "A Birthday" and Kate Chopin’s short story "The Story of an Hour" present conflicting attitudes toward love. In particular the speaker in Rossetti’s poem is anticipating and overjoyed by the arrival of her new found love, whereas the character in Chopin’s story, after the initial shock of her new found freedom , was overjoyed by the loss of her love. In the poem and short story several literary elements and techniques were used to convey these different attitudes toward love. 	A simile is comparison with one thing described as if it were another, using the words "like" or "as". In the poem similes are used to portray the joy of the speaker. Example of the joy of the speaker are found in the liens "My heart is like a singing bird", and "My heart is like a rainbow shell". In the story a simile is used in expressing the initial shock of the character. The words describing the characters shock are "a sob came up into her throat and shook her, as a child who has cried itself to sleep continues to sob in it’s dreams". 	Symbolism is the use of an object which represents itself and something beyond itself. A tree is a symbol used in both selections to convey there attitude towards love. In the poem the line "My heart is like an apple tree whose boughs are bent with thickset fruit" shows the happiness of the speaker and the fullness of her heart do to her new love. In the line "She could see in the open square before her house the tops of trees that were all quivering with the new spring life" The symbol of the tree is used to convey a different attitude towards love. It shows the excitement of the character for her rebirth and freedom obtained by the loss of her love. 	A character is a fugue who takes part in the action of a literary work. In the two selections the authors use two very different characters in conveying there different attitudes on love. In the poem the character is a young woman who by finding her love dreams of being like a queen at a banquet in a lavishly decorated room. This can be seen in the line "Raise me a dais of silk and down; Hang it with vair and purple dyes". In the story the character is an young woman who is looking forward to her future with out her love.

Country Life vs. City Life

The stimulation of crowds and traffic generate energy that challenges the human spirit. Perhaps this is why the city dwellers seem angry, stressed and unfriendly people. Although, the quietness of the country has appealed to the minds of lots of people. The countryman or woman is usually represented as calm, relaxed and friendly. Health, education, transportation are three major concerns that many consider. In a city, pollution surrounds you wherever you step whether on the streets of a busy financial district or on the lawn of a large park. Pollution could possibly cause health problems later in life.In the country, pollution is scarce. Fresh air, rolling green hills, a few pieces of litter here and there but pretty much everything is clean, you can see the stars. Living in the country is a wonderful experience for a young family to grow on and see what life is really made of. Life in the city is challenging. Yes, there are large number of activities. Shopping is convenient and the presence of public transportation reduces the demand for private transportation and the accompanying expenses. For example, lots of cities have transits to take elderly, disabled or those who don’t drive to were they need to go.City life provides all the advantages of being only minutes away from the grocery store, banks, and gas stations. But the city life carries a heavy price. Housing and food are expensive when you live in a small town, the hometown grocery stores usually have prices higher than your regular grocery store such as HEB and Wal-mart. Services, such as transportation, are expensive. Worst of all, the most expensive component of life in the city is the toll it takes on your body through stress. Stress is present with every waking moment in the city. The crowds, traffic, tight work schedules never let up.The air is not healthy. The poisons of thousands of vehicles overwhelm what little green life remains to clean the air. Crime is high in most cities. The odds of becoming a victim are high even for simple trips to the local grocery or ATM. Opportunities to relax are few and short. Stress builds. Quality of life declines.. People who live in the city looks forward to a day out of the city. Movement patters have been from the city to the suburbs and later to the country. Escape becomes the order of the day. Each move to the outer boundaries of the urban environment makes life a little more peaceful.The move to the country is the greatest move of all. Peaceful is the most concise description of the country. The night is quiet. Soft insect noises and the plaintive call of an owl rule the stillness. No heavy traffic, no sirens, no rush of the â€Å"madding crowd. † Life is simple and calming. Food is grown locally, instead of remotely. Everyone knows your name, and has been to your house. I love to come home and see my horses and cows in my front pasture grazing, my dogs running to my car to welcome me home. My experience from living in the country for twenty one years is great.I was and still am being taught that living in the country, you can learn a lot of different things that some city folks don’t have the advantages of doing because of living in the city. Like raising your own livestock such as cattle, pigs, chicken, and so on to help your cost of spending by going to the grocery store. For example, I love fresh eggs, my chickens lay fresh eggs every morning, I haven’t bought eggs at a grocery store in years. Just like our cows, every year we butcher about three calves, they go through the meat processor which gives my family and I plenty of hamburger meat, steaks and so on for the year.So in conclusion I rarely by meat either. There are some disadvantages of living in the country like not being just minutes away from a store, I live about twelve minutes from town so it is a hassle when I need one little thing from the grocery store and have to drive ten miles to go get it. Another one I dislik e is having family and friends who live in the city, sometimes we seem them once a week or even less. Other than that I have no other dislikes about the country life.

Pros And Cons Of Imperialism - 853 Words

There are many elements to take into consideration when weighing the pros and cons of imperialism. After taking an objective look at the facts, I am of the opinion that no, the U.S. did not have the right to build an empire in the Caribbean and Pacific. Building in these areas caused many conflicts such as the Spanish-American War and the Panama Canal. In the building of the Panama Canal, the overall benefits were outweighed by problems such as diseases, and the cost was exceedingly high. The idea of freedom was also a frequent topic that occurred throughout the building of the empire. These problems that occurred through the rise to world power all convey that the United States did not have the right to build an empire in the Caribbean†¦show more content†¦First, the United States had bought a lease in Panama from France for 40 million dollars. The United States also had bought a 99-year lease on a part of land in Panama for 10 million dollars, plus 250,000 dollars as an an nual rent. The total cost to build the canal was 375 million dollars (pancanal.com).The workers who built the canal got sick and died from diseases which were malaria and yellow fever. From these diseases, 5,609 American workers died (thesilverpeopleheritage.wordpress.com). Another downside to building the Panama Canal and to the American Empire was that it was not only costly towards the United States finances, it was also extremely costly towards the environment. It cost ten dollars to kill one mosquito (economist.com). Plus, oil-polluted watercourses and insecticides killed other animals besides mosquitos. The United States spent a lot of time, money, and effort trying to build the canal. The United States values freedom and so we should let other countries have their freedom too. Keeping other countries as territories is against our values of democracy and freedom. Some of the territories we kept were Puerto Rico, Guam, and the Philippines. The Spanish American War started in the Philippines, and it served as a base for some of the Spanish Fleet. Eventually, when it declared independence, the United States didn’t know what to do with it. The United States allowed independence toShow MoreRelatedPros And Cons Of Imperialism1017 Words   |  5 Pagesthe 19th to the 20th century, imperialism swept across the globe. Imperialism was a process in which countries extended their influence and dominance over the rest of the world. It was a policy of much controversy during its day. Some people believed that imperialism was beneficial to society while others believed that imperialism was the doom of a nation. It was a fight between the conqueror and the conquered. There were advantages and disadvantages of imperialism, but a majority of the westernRead MoreEssay about The Pros and Cons of Imperialism540 Words   |  3 Pagescultural life is called as imperialism. Imperialism is often separated into two sects. The first one is old imperialism, which was the period from the 1500s to the 1800s, where European nation started to colonize many areas such as the Americas, and parts of Southeast Asia. On the other hand, the new imperialism was the period between the years â€Å"1870-1914†, where Europe became more focused on expanding their land into Asia and Africa. Imperialism had many pros and cons. In addition, it also had manyRead MoreDbq Causes of Wwii1581 Words   |  7 PagesWWII During the period previous to World War II causes that led to World War II included German attempt of imperialism in Europe, pro-appeasement ideologies towards German military expansion, and ignoring con-appeasement ideologies towards German military expansion. Documents1, 3, and 4 support the idea that one of the causes that led to World War II included Germany’s attempt of imperialism. Document 1, an excerpt from Mein Kampf by Adolf Hitler, explains some of Hitler’s ideas of forming a regimeRead MoreImperialism of India by Britain Essay571 Words   |  3 PagesImperialism is the domination of one country of the political, economic, or cultural life of another country. Imperialism is more often than not fueled by two major schools of thought known as nationalism and Social Darwinism. Nationalism is a feeling of pride and devotion to one’s country. This can drive a person to think that their country is the most powerful, and in essence drives that person mad with power and a hunger to conquer, which not ironically is exactly what many countries did. SocialRead MoreEssay about Appraise the Pros and Cons of Cosmpolitanism1454 Words   |  6 Pages10024634 Appraise the Pros and Cons of Cosmopolitanism Cosmopolitanism is the term to illustrate a theoretical belief of how some think the world should be, where interstate boundaries are abolished and citizens become part of a global body. It is derived from the ancient Greek, kosmopolites, usually translated as ‘citizen of the world’. Cosmopolitanism takes different stand-points throughout the fields of sociology, politics and philosophy. Gerand Delanty splits the concept into four main categories:Read MoreEssay The Phenomenon of Cultural Globalization747 Words   |  3 Pagesdepictions or portrayals of cultures have ignited heated debates amongst the international communities surrounding the concepts of cultural globalization. Cultural imperialism also referred to, as Americanization, or westernization, is a homogenization that critics insist the mass media is to be blamed for. The cultural imperialism debate becomes highly important shortly after the decolonozation begins to produce dozens of new states in Africa, Asia, and the Pacific (Lechner and Boli: 287). Read MoreA Passage to India: Imperialism1677 Words   |  7 PagesDiscuss Forster’s portrayal of Imperialism in the novel a passage to India A passage to India by E.M.Forster is a novel which deals largely with the political, economic and social takeover of India by the British Crown. The novel deals widely with colonialism and more specifically, imperialism. Forster presents the theme in question through the lives and minds of the characters from both the Indians and the English people. There is no subjective undertone to the novel and we see clearly how eachRead MoreGlobalization Of The American Style Fast Food900 Words   |  4 Pagesinstance to view the transformation between the indigenous culture and external culture; then, turn the point to the variation of food culture in Taiwanese social context, with reference to Gramsci’s cultural hegemony and Said’s cultural imperialism to scrutinize that globalization will lead to the loss of cultural identify or not. First of all, I shall emphasize on the cultural blending, the McDonalds company expands their branches worldwide and changes the eating habits in certain areaRead MoreGlobalization : Globalization And Globalization Essay1009 Words   |  5 PagesGlobalization I - the upside (2013) Available at: https://www.khanacademy.org/partner-content/crash-course1/crash-course-world-history/nationalism-imperialism-globalization/v/crash-course-world-history-41 (Accessed: 31 October 2016). Collins, M. (2015) The pros and cons of globalization. Available at: http://www.forbes.com/sites/mikecollins/2015/05/06/the-pros-and-cons-of-globalization/#1fcb9c862170 (Accessed: 31 October 2016). Miles, D. (2016) Brexit and globalisation. Available at: http://voxeu.org/article/brexit-and-globalisationRead Moretask 31185 Words   |  5 PagesCompany fought other European countries also occupying India for control of the region. By 1715 the EIC and Brittan had beaten back the French in the Battle of Plassey. This secured their dominance in India and a trading monopoly (Luscombe, 2012). Imperialism is when one country takes control of another. This can be via influence, military force, or economic power (Stuchtey, 2011). The EIC used all three to control the people of India. They instructed farmers what crops to grow and taxed the food crops

Improving Medication Concordance in Mental Health - Free Essay Example

Sample details Pages: 16 Words: 4690 Downloads: 3 Date added: 2017/09/21 Category Advertising Essay Type Argumentative essay Tags: Discussion Essay Did you like this example? Improving Medication Concordance in Mental Health- A Review of the Literature Where a man is against his will, that to him is a prison. Epictetus Abstract There has been much discussion on why concordance with antipsychotic medication and treatment appears to differ from other fields of medicine. Does the literature support this contention? This review aims to seek out best practice and apply the principle of informed choice in assessing concordance and using appropriate interventions to educate individuals with psychosis. Contents Abstract Introduction Compliance or concordance? Client centered therapy Administration of medicines and patient capacity Competent or non-competent? Schizophrenia in comparison with asthma and epilepsy Negotiating medication Antipsychotics- Hobson’s choice? Education the patient’s view Psychosocial treatment interventions Compliance therapy Conclusion and Recommendations References Introduction The aim of this literature revie w is to identify if possible, what simple, easily introduced refinement may be useful on an acute mental health ward, with the aim of better understanding the factors affecting concordance with both medication and treatment provisions. The review of the evidence was necessarily broad, for two reasons. Firstly, the premise that concordance is poorer with mentally ill patients (Hughes, et al. 997, Marland and Cash, 2005), compared with those suffering from physical illnesses (although acknowledging the considerable over-lap). This premise has been personally encountered whilst on practice placements. Secondly, whether any advantage might be gained from other areas of practice and applied to the chosen patient group. The literature search strategy was carried out by initially accessing the â€Å"Pub med† and â€Å"Ovid† databases, using the terms â€Å"concordance†, â€Å"compliance† and â€Å"adherence†. Attention was focused on research papers that dealt with both physical and mental conditions. Priority was given to any evaluation of techniques potentially useful in improving concordance, and research papers frequently referred to by other authors, or otherwise indicated as seminal. The review was limited to studies carried out in the UK, Ireland, and the USA. It was of course, necessary to limit the final discussion to a representative number, which aim to reflect some changing views, with emphasis on recent research. Gray, et al. (2002) note that non-compliance with antipsychotic medication is a major preventable cause of relapse in psychotic patients. The causes of non-compliance are seldom immediately clear, and the literature suggests a large number of factors interplay, and individual reasons for stopping medication can be arbitrary. Evidence-based medication management aimed at enhancing treatment concordance should include a collaborative, educational approach to working with patients, tailoring medication regim es to the patient. Gray, et al. advocate using therapeutic techniques such as compliance therapy, discussed in this review, in order to empower individuals, and preserve their right to choice. Compliance or concordance? Repper and Perkins (1998) highlighted the importance of terminology in mental health, and suggest that the use of words like compliance infer patients should be passive recipients of health-care, and should obey professionals. It has recently been proposed that â€Å"concordance† should replace the words â€Å"compliance† and â€Å"adherence†. Concordance emphasizes patient rights, and the importance of two-way decision making. More controversially, it also suggests patients have the right to make choices such as stopping medication, even if clinicians do not agree with the decision. This principle conflicts with traditional psychiatric practice, and potentially with the provision of treatment under the Mental Health Act 1983. Since this re view reflects the source literature, the three terms are retained, and may be read as synonyms, unless the context dictates otherwise. Client centered therapy Rogers (1975) Client centered therapy, described five factors affecting health behaviour; severity, susceptibility, response, self-efficacy and fear. Focusing on the latter two factors, self-efficacy has been defined as a person’s belief in his ability to accomplish a given task (Bandura, 1977, quoted by Hughes, 2004). How a person thinks an illness will affect him is determined by previous knowledge or experience, as well as fear, or threat appraisal. Belief that a change would improve coping strategies, and the person is empowered to undertake such a change, can improve considerably the ability of the patient to be more independent, and concordant with medication strategies. Administration of medicines and patient capacity The law imposes a duty of care on those that administer medication to others (Griffith, et al . 2003). Administration of medication is not without its complications. Minor prescribing errors, adverse drug reactions, interactions with food, or herbal products, overdoses (intentional or otherwise), and even possible genetic problems or death. These potential problems are reflected in the strict legal framework that regulates the prescribing and distribution of medication. There is however, still widespread concern in the UK over the administration of non-prescribed medicine and the practice of covert administration in the non-compliant (Wright, 2002). The law is clear that covert administration is only justifiable in cases of incapacity. Incapacity occurs where the patient is unable to comprehend and retain information material to the decision, or the patient is unable to weigh up the information as part of the process of an informed decision (Nys, et al. 2004). In the case of covert administration to an adult there would be a need to demonstrate that the patient is inca pable. The nurse should be able to justify the techniques of administration were in the patients best interests, and the crushing of tablets, for example, was safe. In practice this should be a multi-disciplinary team decision. The covert administration of medication observed on placement was one reason I have chosen to explore the literature, and examine any methods used that may be applied to adults who are non-concordant with anti-psychotic medication. Competent or non-competent? Levenson (2003), interviewed patients with Parkinson’s disease, and their views are quoted here for two reasons. Firstly health care professionals may tend to view patients with Parkinson’s disease in a similar manner to those with a mental illness, i. e. not competent to self-administer medication. Secondly the benefits of helping patients maximize control over their own medication are so apparent, and might well be applied to patients with other illnesses. The issue of balancing the benefits of medication against very significant unwanted effects was a major concern to interviewees. The patients had in common an understanding of the symptoms of the disease, and how their medication, particularly the timing, affected their symptoms. It was clear in one case; the doctor really listened to the needs of the patient, adjusting dosages and times accordingly. Another patient was able to use a dosset box with electronic timer as a memory aid. Some patients experienced difficulties retaining control of their medication when admitted to hospital. They found the timing of the drug rounds did not suit them. This undermined their efforts to comply with the medication. This aspect of medication administration appears to lend weight to the instrumental passivity hypothesis (Baltes and Skinner 1983, quoted in Faulkner, 2002) The argument is that hospitals and nursing homes reinforce dependent behaviour by supporting and encouraging them. The primary ethical strategy Fau lkner advocates is for staff to focus on reinforcing independent behaviour. Forms of self-medication come into this category. Melanie Baker (2003) described a scenario involving a 47 year old man suffering from bipolar affective disorder. His case typifies the interplay between physical and psychiatric health, and the patient poorly concordant with medication. Among his numerous significant medical conditions were angina, and a myocardial infarction. He also had diabetes mellitus and developed diabetic neuropathy, which was treated with carbamazepine. His mental state was coincidentally improved with the introduction of carbamazepine, but after 18 months of stability, he took an overdose, resulting in the prescription withdrawn. Prior to the 18 month period stability, the patient had a long history of decline. Psychotropic medication and his unstable angina may relate to poor adherence with cardiac medications. He was more amenable to cardiac treatment when mentally well. The consultant and Multi-disciplinary team felt that when he was mentally stable, his physical health improved in parallel, possibly due to improved compliance with both medication and lifestyle advice. He appeared to view psychiatric care as stigmatizing, contributing to poor compliance. Treatment for diabetic neuropathy was perceived as less stigmatizing. The importance of tailoring medication to each individual is highlighted in this case, as the accidental overdose of Carbamazepine led to a serious long-term deterioration. Schizophrenia in comparison with asthma and epilepsy Marland and Cash (2005) have found that the belief that non-compliance is a direct result of disease processes in schizophrenia dominates the clinical perception of non-compliance for these patients. One explanation given, was likened to a negative feedback, where a patient who stays off medication, perhaps out of a delusional feeling (â€Å"my doctor is poisoning me†), for a time feels well, which ma y have the effect of strengthening the delusion. They also demonstrated that although patient attitudes to medication change over time, the process of change is rarely well documented on an individual basis. The study objective was to compare the medicine taking decisions in people with schizophrenia to those of people with asthma and epilepsy, also both enduring, episodic illnesses. They concluded that for people taking antipsychotics, relapse was socially disadvantaging and unwelcome, particularly if it resulted in readmission to hospital. They confirm that the association between stopping medication and hospital readmission is learned eventually by many people on anti-psychotics. Interestingly people from all three diagnostic groups seemed prepared to experiment with timing and amounts of medication when well presumably as the fear of illness subsides. Patients for whom the consequences of altering medicine regimes were delayed or relatively mild were more likely to experim ent than those who experimented with medication leading to rapid or severe symptoms. Hence there was a learned ability to balance symptoms and medication side effects to achieve an optimum quality of life, whilst living with a fear of relapse. Fear of dependence was also a strong motivator for some, and exceptionally leads to complete cessation of medicine taking for long periods, even leading to frequent or severe symptoms. They conclude by confirming interventions useful in promoting therapeutic interactions with medicine in physical illness should also be appropriate in schizophrenia. They found it important to ascertain the individual’s level of understanding and insight, of the illness, medication and side effects. Negotiating medication Carder, et al. (2003) were concerned with how adults with illnesses characterized by repeated flare-ups, or instability, resulting in temporary inability to manage tasks of daily living, negotiated their medication needs. They incl uded sufferers of multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosis, along with those with schizophrenia and bipolar disorder. They described how these individuals with chronic illnesses made on-going negotiations with health-care practitioners, balancing health and illness with a preservation of self-identity. Many of those interviewed described on-going efforts to find the right medication or combination of medications. In addition, a third of participants described the use of alternative medications, such as vitamins, Chinese herbal tablets, and naturopathic remedies. It was found the necessity of taking daily medication did not always square with the individuals self-identity (â€Å"I am not ill†), so adaptation was stressed. The psychotic individual can often be fixed in their thinking, however, or for some, their illness appeared to have ended. Others described an aversion to feeling dependent on drugs, or perceived themselves subject to t heir prescriber’s ‘experimentation’. Some researchers describe resistance to medication as an initial stage (Gray, et al. 2002), but these participants described an on-going and periodic resistance to taking medication. Some described withholding accurate accounts of their symptoms, fearing an increase in dosage or a change in medication. One woman, at first appeared concordant, but described the emotion as one of â€Å"surrender†, a process of â€Å"going with the flow†, rather than fighting the illness and feeling resigned to whatever medication was prescribed. In the conclusion (Carder, et al. 2003), it was acknowledged medication remains the paramount way to manage chronic illness. For those who are asymptomatic while on medication, the medication is the only indicator of illness, and non- concordant individuals are sometimes led to question the need for medication, the diagnosis, or the reliability of the health-care team. The emphasis of this study was how healthcare practitioners must guide people through negotiations, identifying different choices, how best to self-regulate, and the effect that symptoms, side effects, and medication have on the body and on self-identity. A useful exploratory study confirming the findings of Carder, et al. was carried out by Hostick and Newell, (2004). They wished to determine the reasons service users discontinue community mental health-care. Although the presenting problems of respondents could not generally be classified as serious mental illness, the findings were significant. The study began on the premise that users would stop attending for two main reasons, either they had improved, or they were dissatisfied with the service. Few users cited improvement as the reason for non-completion. Many users expressed dissatisfaction about the lack of service flexibility, but could also be linked to practical difficulties or accessibility. The theme therefore continues for the need for a flexible, patient centered approach. Antipsychotics- Hobson’s choice? Hughes, et al. 1997) begins by describing what has become the standard medication regime for schizophrenia sufferers in the community, that is, the depot injection, administered intramuscularly on a regular basis at home, or at a community mental health centre. Depot injections are a dosage form of the anti-psychotic, allowing the drug to be released slowly into the bloodstream over a period of 1-5 weeks. For patients treated in the community, where good compliance with oral treatment cannot be guaranteed, depot anti-psychotics potentially provide a practical solution. However while having a monthly or fortnightly injection may be for some, less problematic than following an oral medication regime, good compliance is not guaranteed. Healy (2002) noted that far from blaming the medication, there was a tendency among mental health personnel to see the compliance issue in terms of patient unreliabili ty or lack of insight. In effect however, the depot removes control from the user, and even the administering nurses, since it is immediately obvious to service managers when someone stops receiving their depot injection. In addition to the unwanted side effects of anti-psychotic medication, there are the potential problems of intra-muscular injections to consider, and whilst good practice should minimize these, subcutaneous fat in adults in the dorso-gluteal area (site of choice for many UK nurses) varies from 1cm to 9cm. If injected into this layer, absorption of the drug will be adversely affected, and the tissue may become irritated. This occurs in up to 15% of patients (Greenway, 2004), and the threat of injury also remains significant to the sciatic nerve, and superior gluteal artery, which lie only a few centimeters from the optimum site. The suggestion was made by Hughes, et al. (1997) that it may not be the presence of unwanted side effects themselves, but rather how these side effects are regarded by the patient, that is in determining compliance. The physical discomfort of side effects may be less important in influencing compliance than the meaning patients attach to these side effects, for example, a movement side effect (tremor) is taken as the beginning of multiple sclerosis, or Parkinson’s disease. In this way, compliance may be improved simply by allowing patients to voice fears and concerns about side ffects. Hughes, et al. (1997) draws attention to another explanation for poor compliance in the hypo-manic or psychotic individual. Some sufferers enjoy the sense of euphoria that can characterize hypo-manic episodes. Similar problems have been experienced with patients with a history of recreational drug use. One likened his psychotic experiences to â€Å"tripping†. Education the patient’s view Carder, et al. (2003) found that even without structured efforts on the part of clinicians to inform patients about medicati on, education played an important role in their decision making. Of note in the context of this review, was the response of persons diagnosed with depression, who, in common with those suffering psychoses, are poorly motivated. They found these persons go through an extensive interpretive process that includes understanding the condition and its causes, the reality of medication side effects, and negotiating with healthcare practitioners. The view of one perplexed woman with bipolar disorder reflected the experience of many. â€Å"Some of the psychiatrists would hand you five or six different medications at once. I mean, how do you know which one’s working, or what’s not working. It took a while before I found a psychiatrist who sat and listened â€Å". The suggestion is made of using motivational interviewing techniques to weigh up identified positive and negative aspects of psychotic symptoms. For this reason, some clinicians have concentrated on schizophreni cs with relatively higher levels of negative symptoms. Hughes, (2004) describes how recent self-management approaches have produced better outcomes in these patient groups. Self-management programmes aim to encourage, or coach, patients, by supporting and influencing health behaviour and increasing knowledge of specific aspects of care, for example, pain and symptom control, or medication side effects. Nurses are well placed to offer holistic support to patients becoming more independent, but issues surrounding power and control in the nurse-patient relationship must be acknowledged in this process. The health belief model has been used to help patients perceive the benefits of following the recommended treatment regimen. Four factors identified as influencing patients were; the benefits of the treatment, susceptibility to relapse, the severity of the symptoms, and the cost in effort and pain from side effects. It was recommended health care practitioners not neglect the †˜secondary’ benefits of the medication, i. e. feeling calmer, sleeping better, easier socializing, and improved concentration, when seeking the views of patients , it was correctly predicted the secondary benefits of the medication would be valued as often as the main benefit of improving positive and negative symptoms. 5% of patient identified the main benefit, but 70% noted the secondary benefits (for example; â€Å"it allows me to make friends†) and these were found to be more strongly associated with medication compliance than the primary benefits. Zygmunt, et al. (2002) was not so favorable to the health belief model. They felt the rational assumptions and broad generalizations implicit in it were not helpful in predicting concordance. This may reflect a more recent shift towards motivational interviewing and its development into compliance therapy. Psychosocial treatment interventions Zygmunt, et al. (2002) carried out a study of psychosocial interventions ta ilored for psychoses. Adherence to medication and outpatient appointments has become crucial for positive outcome during maintenance treatment. No one specific intervention demonstrated significant advantages in improving adherence; however, the small sample size may have been a factor. It was felt that both patients and their families need a more active role and greater self-responsibility. They found the greatest benefit of the six interventions studied, most evident during the first six months of treatment. The most prominent conclusion reached however, was that psycho-education alone had no effect on patient compliance, but felt this finding did not negate the need for further education and implementation of structured treatment programmes Psycho-educational interventions focused primarily on dissemination of information about the illness, medication and treatment, group therapy was based on the evidence of peer support and shared problems. Family interventions derived from a belief in the family as a critical influence on the course of a member’s illness. Community programs typically . involved a complex variety of supportive and rehabilitation services delivered without a choice. Cognitive treatment targets patient’s attitudes and belief toward medication. An assumption is made that adherence is a coping behaviour, heavily determined by each person’s own interpretation of his illness and medication regime. Behavioural modification techniques assumed that behaviours are acquired through learning and conditioning, and can be modified through rewards and punishment, reinforcement, and the promotion of self-management. Behavioural strategies worthy of note include providing selected patients with detailed medication instructions, reminders, self-monitoring tools, cues and reinforcements. In another instance, the therapist used assertiveness training techniques to teach patients to negotiate with their prescribers more effectivel y. An important conclusion about this study was that of the many interventions in practice, most were viewed as too complex, and multifaceted, and hence difficult to identify exactly what contributed to individual successes or failures. Interventions addressing medication non-adherence specifically, were found to work better than those covering a wider range of problem areas. One recommendation noted from this study, was the monitoring of patients with a history of non-adherence involving any medication prescribed for physical, not simply psychotic illness, and the authors opted for a definition of non-adherence as a complete cessation of medication for at least one week, as opposed to dosage deviations. Compliance therapy Kemp, et al. 1996), sought to determine if compliance therapy could improve compliance with treatment and hence social adjustment, and if the effects persisted six months later. 25 patients received compliance therapy and showed significant improvement in their attitude to drug treatment in comparison to a similar control group. Individuals were assigned to the two groups on a random basis. The 4 -6 counseling sessions lasted between 10 and 60 minutes. The following issues were addressed, eliciting the patient’s stance towards treatment, exploring ambivalence to treatment, and a treatment maintenance plan. The patient is first encouraged to review their recent past, identify likely barriers to treatment adherence, and describe any negative outcomes experienced. Secondly, the patient is encouraged to systematically choose possible alternative strategies to their antipsychotic medication. There is an emphasis on â€Å"normalizing† the experiences, for example, â€Å"in extreme situations hallucinations can occur to anyone†, and if requested, provide more information about treatment options. Thirdly, the patient’s freedom to choose whether to maintain treatment is emphasized, and parallels drawn with conditi ons such as diabetes, where regular insulin injections may be required. The object is to lessen any perceived stigma. The patient is encouraged to look ahead, set goals, examine what they find personally important, and the emphasis is on how not taking medication could affect the outcome of their goals. Finally, the therapist acknowledges, and empathizes, with the costs associated with any course of action, including the desired outcome of concordance with treatment. The control group received a similar number of timed sessions, but the sessions had no discussion of treatment, and were less structured. By rating compliance using a scale of 1 to 7, with 1 being fully compliant, and with an added interest in the medication, the authors were able to demonstrate a 23% improvement over six months. There are problems associated with measuring patient compliance, common techniques such as urine tests may overestimate compliance when drugs have a long half-life. Blood serum tests, when a vailable, are invasive, and of limited value in assessing partial compliance. Pill counts are widely considered a useful indicator, but potential exists for inaccuracy or deception, with no guarantee the patient ingested the tablets. A similar problem exists for electronically tagged dosset boxes. The study noted the high human and social costs of relapse, or persisting symptoms, and felt any proved means of counteracting non-compliance had important managerial implications. Kemp, et al. (1998) carried out a further investigation of the original trial, extending the number of participants, and including an 18 month follow-up. An effort was made to measure not only compliance, but also insight, attitudes, and a functional assessment. There were comparatively few participants dropping out, 11 over 18 months, or less than 10%. Results indicated a definite advantage for those who received compliance therapy. Relatively poor results with first admission patients could have been rel ated to acuteness of illness onset, lack of previous experience with antipsychotic effectiveness, or perhaps denial. Overall, the work supported the premise that poor compliance was associated with more severe drug side-effects. A recent study in Dublin (O Donnell, et al. 003), using the same basic techniques, failed to replicate the previous findings, and found no advantage over non-specific therapy in terms of patient adherence. Then again, in common with the earlier studies, there were fewer than 100 participants; therefore the possibility of false negatives remained. They did confirm that patient attitudes change over time, and were a useful predictor of future compliance. Despite the name, compliance therapy fits with a concordance model, involving patients in each decision making phase, with no coercion, implied or explicit, to obey professional opinion. Conclusion and Recommendations All of the papers reviewed agreed that ignorance about medication was common. Frequently, antipsychotic treatment had not been fully explained to patients or their families, where appropriate. The individual needs to be fully informed about the effects of the prescribed medication, there is no justification for withholding knowledge about adverse effects or poor prognosis, this would be paternalistic and unethical. The aim of the treatment should be made as clear as humanly possible, and alternatives clearly presented. Such patient empowerment enables genuine participation, reduces fear, facilitates informed consent, and gives the closest opportunity for concordance. Although by definition, the primary responsibility lies with the consultant, as part of a multi-disciplinary team, nurses on ward level, in primary care, or in the community, are well placed to facilitate evidence-based treatment regimens. The most promising recent development has been â€Å"compliance therapy†. Three of the papers discussed sought to quantify its potential. O’ Donnell et al (2003) gave a conflicting view, but most authors mention it as promising. It is recommended here that further application of its principles, in a local setting, be attempted. As an aid to an admitting nurse, or during a care plan review, a simple evaluation tool be devised, a questionnaire, to address past concordance issues, an area we noted was often overlooked, with the principle of future self-management the goal. If possible, such a tool could be applied on a rehabilitation ward or acute setting. Other considerations that should be studied are: ethical issues, staff education, and through multidisciplinary evaluation. Finally, although in this review evidence has been highlighted from a patient perspective, of the considerable debilitating side effects of antipsychotic medication, it is not the aim to argue here that it has no role in helping to relieve the suffering of patients with psychotic symptoms. There does remain considerable scope for discussion of implementing informed choice for the mentally ill individual, and multidisciplinary cooperation in how to best inform them. References Baker, M. (2003) The coincidental treatment of a major mood disorder Progress in Neurology and Psychiatry, accessed from www. rogressnp. com Carder, P. C. Vuckovic, N. and Green, C. A. (2003) Negotiating Medications: Patient perceptions of long term medication use Journal of Clinical Pharmacy and Therapeutics 28, 409- 417 Faulkner, M. (2002) Instrumental passivity: A behavioural theory of dependence Nursing Older People 14(2) 20- 22 Gray, R. Wykes, T. and Gournay, K. (2002) From compliance to concordance: a review of the literature on interventions to enhance compliance with anti-psychotic medication Journal of Psychiatric and Mental Health 9, 277- 284 Greenway, K. 2004) Using the ventrogluteal site for intramuscular injections Nursing Standard 18 (25) 39- 42 Griffith, R. Griffiths, H. and Jordan, S. (2003) Administration of medicines part one: the law and nursin g Nursing Standard 18 (2) 47- 53 Healy, D. (2002) Psychiatric Drugs Explained (3rd Edition) London, Churchill Livingstone Hostick, T. and Newell, R. (2004) Concordance with community health appointments: service users’ reasons for discontinuation Journal of Clinical Nursing 13 (7) 895- 910 Hughes, I. Hill, B. and Budd, R. 1997) Compliance with anti-psychotic medication: from theory to practice Journal of Mental Health 6 (5) 473- 489 Hughes, S. A. (2004) Promoting self-management and patient independence Nursing Standard 19 (10) 47- 52 Kemp, R. Hayward, P. Applewhaite, G. Everitt, B. and David, A. (1996) Compliance therapy in psychotic patients: randomized controlled trial British Medical Journal 312, 345-349 Kemp, R. Kirov, G. Everitt, B. Hayward, P. and David, A. (1998) Randomised controlled trial of compliance therapy: 18 month follow-up British Journal of Psychiatry 172, 413- 419 Levenson, R. 2003) Compliance in medicine taking- seeking the views of patients London, Depart ment of Health, Medicines Partnership Marland, G. R. Cash, K. (2005) Medicine taking decisions: schizophrenia in comparison to asthma and epilepsy Journal of Psychiatric and Mental Health Nursing 12, 163- 172 Nys, H. Welie, S. Garanis-Papadatos, T. and Ploumpidis, D. (2004) Patient capacity in mental healthcare: legal overview Health Care Analysis 12 (4) 329- 337 O’Donnell, C. Donohoe, G. Sharkey, L. Owens, N. Migone, M. Harries, R. Kinsella, A. Larkin, C. and O’Callaghan, E. 2003) Compliance therapy: a randomized controlled trial in schizophrenia British Medical Journal 327, 834- 842 Repper, J. and Perkins, R. (1998) Different but normal: language, labels, and professional mental health practice Mental Health Care 2 90- 93 Rogers, R. (1975) A protection motivation theory of fear appeals and change Journal of Psychology 91, 93 Wright, D. (2002) Medication administration in nursing homes Nursing Standard 16 (42) 33- 38 Zygmunt, A. Olfson, M. Boye, R. C. and Mechanic, D . (2002) Interventions to improve medication adherence in schizophrenia American Journal of Psychiatry 159 (10) 1653- 1664 Don’t waste time! Our writers will create an original "Improving Medication Concordance in Mental Health" essay for you Create order

Post 9/11 Arab-American Discrimination - 680 Words

What are Arab Americans? An individual can be classified as â€Å"Arab† if the person speaks Arabic, practices Islam, and identifies with the traditions of Arabic-speaking peoples. (Aguirre and Turner 276)These individuals are usually subject to negative and differential treatment by others. It is essential to identify the differential treatment of Arab Americans by others in society. The mistreatment of Arabs in the United States can be contributed to many factors; however, there have been certain events that have occurred in the United States, which have increased and enraged these strong emotional feelings in many Americans. Discrimination and stereotypes of a culture or group mainly develops from a lack of understanding. We can become a†¦show more content†¦It is time to end the hating and labeling of all Arab Americans for what was done by a few individuals. One person’s race, religion, and activities do not mirror a population. 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